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NOVEMBER 20-21, 2020 ONLINE


Healthcare Communications in the Middle East

Schedule

November 21, 2020, 09:30 - 10:30

Provider – Patient relations - The Elephant in the room? – A thought paper

Dr. Sathyanarayanan Doraiswamy, Dr. Sohaila Cheema

Institute for Population Health, Weill Cornell Medicine, Qatar

sdo4003@qatar-med.cornell.edu.

A web search for provider-patient relationship yields an overwhelming number of results on the doctor-patient or physician-patient relationship. There is an inherent problem in this virtual assumption, which is also prevalent in the real world. While the physician is ‘the’ provider in the context of a private practice providing one-on-one service, ‘the’ provider in the context of a health facility / hospital is not an individual physician but a team of healthcare providers working as a team under the auspices of a (public/private) health system. In the shared decision-making model, the physician and the patient contribute as partners in the medical decision-making process to achieve patient-centered outcomes. This model is based on mutual trust between the physician and the patient, collaborative decision making and patient empowerment. This narrative, however, misses the elephant in the room ‘the health system’ which is the real ‘provider’ of service in today’s world and the physician, the mere front face of it.The health system in which the physician operates can be well- or poorly-resourced depending on the setting. Systems, like individuals need to survive without being burnt out or rusted out. Such emerging systems demand that the physician alter communication with patients to accommodate the interests of the health system in ensuring optimal use of available resources, which may not necessarily always be in the patient’s interest. Communication in the context of a clinical encounter is viewed as happening spontaneously at that moment, ideally driven by patient needs. However, the physician working within the constraints of a health system is indirectly ‘primed’ by the system on what it wants the physician to communicate. To survive within this health system, the physician must adhere to the reduced time allocation for patient visits imposed on him/her by the system, and at the same time protect the image, reputation and interests of the health system that he/she operates in. Patients are sensitive to such attempts and often direct their frustration towards physicians rather than the health system in which they are employed. This dyad of provider-patient and equating this with physician-patient poses the risk of viewing clinical encounters as a mere bilateral process involving only physicians and patients, forgetting the elephant in the room. Policy makers and health system managers in many contexts conveniently act as mediators between civil society groups, which demand greater accountability from physicians, and the physician community, which demands greater understanding from the civil society and patient groups pertaining to the complexity of medical science and its limitations. Health system stakeholders should take greater responsibility in ensuring that physicians have the freedom to work with the patient in a truly shared decision-making spirit without having to worry about constraints imposed by the health system. Where such constraints are unavoidable, the health system should take leadership in informing communities about them rather than expecting the physician to address this with the patient during the clinical encounter.