Trust

“ I am going overseas to see a doctor.”

“Make sure you shop around before deciding, OK?”

Huh? A new concept in health tourism? Not really.

Mr X had gallbladder disease and consulted Dr K. After appropriate tests, Dr K explained the management options and recommended surgery to remove the gallbladder. Mr X left and after 5 days returned to Dr K for surgery. In the intervening 5 days, Mr X had visited another surgeon who performed further tests and said there was nothing wrong with the gallbladder. While feeling relieved to be told his gallbladder was blameless, Mr X was still unsure and visited another doctor. The physician told Mr X he definitely had gallbladder disease and needed surgery. After surgery by Dr K, the pathology of the removed gallbladder confirmed that it was diseased. Dr K asked Mr X and family why they had seen two other doctors before coming back for surgery.  They told Dr K that “in our country you do not trust the first doctor you see, you always see a few doctors and verify that the majority of the doctors are telling you the same thing.”  Personally, I am saddened by this.

The doctor-patient relationship is based on trust. The patient must trust that his doctor is truthful in his diagnosis and management recommendations. In an environment where there are doubts about the impartiality of the information / recommendations given, this trust is broken. The patient and family are thus conditioned to distrust all doctors in and outside their country.

In both public and private settings, a doctor’s practice can be influenced by many factors. In a public institution, the desire to try out a new treatment modality may ‘induce’ the doctor to recommend this over the conventional approach. The pressure to recruit patients for a study can influence the way in which a doctor presents and discusses treatment options. In private practice, the doctor may be motivated to over-investigate or ‘expand’ the indications for treating a condition for personal gain.

In order for the public to have implicit trust in the health care system, the industry must be regulated to a high standard. The existence of stringent rules and regulations within a health institution will reassure the public. A transparent, strong and impartial professional body will give confidence to the public that the conduct and practice of the doctors are tightly controlled. Those who stray will be brought to account.

While the above will help to ensure ethical and good heath care and restore trust in the doctor-patient relationship, to me, the most reliable gatekeeper for achieving this is still the doctor himself. If the doctor practices with scruples and principles, the patient can rest assured that he will be properly looked after.