DAMODARAM SANJIVAYYA NATIONAL LAW UNIVERSITY,

NYAYAPRASTHA, SABBAVARAM, VISAKHAPATNAM, ANDHRA PRADESH-

531035

PATIENT DOCTOR RELATION

HEALTH LAW

SUBMITTED TO: DR. VARA LAKSHMI P

SUBMITTED BY:

VANSHITA GUPTA

2017104

9th SEMESTER
 ABSTRACT

“A doctor–patient relationship (DPR) is considered to be the core element in the

ethical principles of medicine. DPR is usually developed when a physician tends to a
patient’s medical needs via check-up, diagnosis, and treatment in an agreeable manner. Due
to the relationship, the doctor owes a responsibility to the patient to proceed toward the
ailment or conclude the relationship successfully. In particular, it is essential that primary
care physicians develop a satisfactory DPR in order to deliver prime health care to patients.

The doctor–patient relationship has been and remains a keystone of care: the medium
in which data are gathered, diagnoses and plans are made, compliance is accomplished, and
healing, patient activation, and support are provided. To managed care organizations, its
importance rests also on market savvy: satisfaction with the doctor–patient relationship is a
critical factor in people's decisions to join and stay with a specific organization.

The rapid penetration of managed care into the health care market raises concern for
many patients, practitioners, and scholars about the effects that different financial and
organizational features might have on the doctor–patient relationship. Some such concerns
represent a blatant backlash on the part of providers against the perceived or feared
deleterious effects of the corporatization of health care practices. But objective and
theoretical bases for genuine concern remain. This article examines the foundations and
features of the doctor–patient relationship, and how it may be affected by managed care.”
 TABLE OF CONTENTS

1. ABSTRACT
2. INTRODUCTION AND HISTORICAL BACKGROUND
3. OBJECTIVES/AIMS OF THE STUDY
4. SCOPE OF THE STUDY
5. LITERATURE REVIEW
6. BODY OF THE STUDY
a. Fundamentals of Doctor Patient relations
b. Judicial interpretation
i. Dr. Sarosh Mehta vs. General Manager, Central Railways
ii. Directorate of Enforcement v. Ashok Kumar Jain
c. Ethical Perspective in Physician-Patient Relationship
7. CONCLUSION AND RECOMMENDATIONS
8. BIBLIOGRAPHY

INTRODUCTION AND HISTORICAL BACKGROUND

Clinical care is built on the foundation of the physician-patient relationship. Clinical

treatment can be greatly influenced by physician-patient relationships, both positively and
negatively. Ultimately, the physician-patient relationship's overarching goal is to improve
patient health outcomes and medical care. Improved patient outcomes are linked to stronger
physician-patient connections. Understanding the factors that influence the relationship
between physicians and patients is becoming increasingly important as the importance of this
relationship grows.

Doctors and patients interact; it necessitates respect, and if the doctor also
demonstrates compassion, it sets the stage for the formation of trust. Physicians must never
lose sight of the fact that their patients are unique human beings with issues that often extend
beyond their physical ailments. There are no "cases," "admissions," or "diseases" involved.
Patients don't fail therapies; treatments don't work for them. The majority of patients are
jittery and scared. Physicians should engender trust and reassurance, but they should never
appear arrogant or patronizing. The doctor–patient connection is therapeutic in and of itself; a
successful consultation with a trustworthy doctor will have positive consequences regardless
of the situation.

The doctor-patient connection is complex, dynamic, and bidirectional. When

contemplating a relationship based on mutual participation of two individuals, the term
"relationship" refers to an abstraction encompassing the actions of two interacting systems or
persons, rather than structure or function. The apparent, intrinsic aspect of this one-of-a-kind
doctor-patient relationship permits two people who had never met before to feel at ease with
varying degrees of intimacy. With time, this relationship may evolve to the point where the
patient is able to discuss extremely intimate and private matters in a secure and productive
atmosphere. A professional demeanour combined with friendliness and openness can go a
long way toward reducing anxiety and encouraging patients to open up about their medical
history. Compassion and empathy are vital qualities in a caring physician. The physician
must analyse the context in which an illness occurs, not only in terms of the patients, but also
in terms of their familial, societal, and cultural backgrounds. The ideal patient-physician
relationship is built on a deep understanding of the patient, mutual trust, and communication
skills.

OBJECTIVES/AIM OF THE STUDY

The main objective of this study is to analyze the formal and informal relation that the doctor
and a patient share, the scope of it, and discusses two classic cases which determine the ambit
of liability and responsibility the authorities have, in case they are met with a situation of
mishap.
SCOPE OF THE STUDY

For the sake of brevity, the researcher has limited the scope of the current study to
determining what DPR is, and discuss the two landmark decisions per the topic given.

LITERATURE REVIEW

Articles:

1. Susan Dorr Goold, MD, MHSA, MA1 and Mack Lipkin, Jr., MD, The Doctor–Patient
Relationship- Challenges, Opportunities, and Strategies, J Gen Intern Med. 1999 Jan;
14(Suppl 1): S26–S33.

2. Yolanda Smith, Doctor–Patient Relationship, News Medical Life Sciences.

Databases:

1. Manupatra
2. SCC OnLine

BASICS OF DOCTOR PATIENT RELATION

Several medical studies have discussed how to establish a relationship between a doctor
and a patient. The following are some of the most crucial characteristics for keeping a healthy
DPR:

1. Communication: To create DPR, good communication skills are required. Effective

communication between physician and patient has been shown to have multiple
effects on various aspects of health outcomes, including:
 • improved medical, functional, and emotional conditions of patients;
• better patient compliance with medical treatment;
• increased patient satisfaction with healthcare services; and
• lower risks of medical misconduct, according to studies.

“Because of the high level of illiteracy and lack of medical awareness among the
populace, even among the urban educated, this task must be carried out with even greater
caution in India. It is the doctor's responsibility to describe the treatment approach and
associated hazards to the patient in a language and manner that the patient understands.
Paying lip respect to the law does not exempt the doctor from his responsibilities in this area.
The fact that a patient visits a doctor develops a relationship in which the doctor is obligated
to disclose information. As in cases of carelessness, no universal standard can be established
because medical practise is highly case specific. Doctors are trusted to exercise this discretion
in the interest of the patient under the exception for therapeutic privilege.”

Because the threshold of what constitutes informed consent is so vague in the first place,
it becomes much more abstract in the face of such an exception. The mental state of the
patient at the time is vital in determining how much information should be given to them. As
a result, before reaching a conclusion, courts must look into the facts surrounding the
patient's care. What level of informed consent would there be if there was only one viable
course of treatment and the odds of survival were slim? In this instance, informed permission
may become even more important as the patient's risk increases.

3. Doctor empathy: Empathy is essential for a high-quality DPR. This allows the doctor
to better understand the symptoms and needs of individual patients. Physician
empathy, according to studies, improves the therapeutic outcome and the patient's
quality of life.
4. Trust: Patients can effectively share their health difficulties when they have faith in
their providers. The development of trust allows the patient to follow the doctor's
instructions, resulting in an improvement in health
5. Informed consent: This is based on the patient's autonomy's moral and legal
arguments (independence in decision making). In terms of trust, the physician must be
open and honest with the patient and his family in order to provide an accurate
assessment of the chances of a good and bad outcome, as well as the recommended
treatment.
 6. Boundaries between professions: This refers to any activity on the side of the doctor
that goes beyond the professional relationship's bounds, often known as boundary
violations. To respect professional boundaries between the doctor and the patient, for
example, the following behaviours should be avoided:
•observing the patient in unusual locations for the physician's convenience;
•burdening the patient with personal information.

JUDICIAL INTERPRETATION OF DOCTOR PATIENT RELATION

There are various cases where the theme of scope of doctor patient relation is
discussed but for the sake of brevity, the researcher has struck with two important judicial
decisions in this regard. The first case is an excellent example of judicial activism where
extensive directions which tantamount to law were given in order to establish the liability of
Railways in case of an accident. The second case deals with how official authorities cannot
be compartmentalized and the Court cannot impose modalities on such officers in disposing
their duty under the law.

The question in Dr. Sarosh Mehta v. General Manager, Central Railways1 was
whether Suburban Railways in Mumbai was responsible for providing health treatment to
passengers, especially given the high incidence of accidents. After the final five carriages of a
CST-bound Kasara local derailed between Titwala and Ambivli railway stations in Thane
district on March 20, Dhaval died in the disaster. According to Dhaval's relatives, the
adolescent survived the collision for an hour before succumbing to his injuries due to a lack
of urgent medical attention. The following are some highly essential directives:

The Railways shall notify an emergency telephone number and shall publicize the
same in all compartments, stations and other places. The calls made to the said number shall
be monitored by a special cell situated in the control room which shall be open for 24 hours.
The personnel of such cell shall immediately contact nearest Station Master/ s at the place of
the accident. Such cell shall maintain records of the calls received as well as follow up
reports.

1
Writ Petition No. 2405 of 2001, Bombay High Court.
(i) The railways must notify and publish an emergency telephone number in
all compartments, stations, and other locations. Calls to the specified
number will be monitored by a separate cell in the control room that will
be open 24 hours a day. The staff of such a cell must call the nearest
Station Master/s at the scene of the accident as soon as possible. This cell
will keep track of the calls it receives as well as follow-up reports.
(ii) Wherever parking is available, Railways and the State Government would
offer free parking for an ambulance outside all stations.
(iii) The Station Master or his agent should summon an ambulance or cab.
(iv) Funding for (a) Hammals/Porters and (b) Ambulance/Taxi for transferring
the victim from the accident scene to the hospital, as well as if the person
needs to be transferred to another hospital.
(v) Transferring the accident sufferer to the nearest hospital as soon as
possible (Private or Government).
(vi) Mr. J.P. Cama, experienced counsel for the petitioner, has supplied a list of
ambulance services and hospitals, which will be made available to all
Station Masters.
(vii) Minimum All Stations have two lightweight folding or foldable stretches
that must be cleaned after each use. Each station has a rechargeable torch,
disposable sterilised hand gloves, and a first-aid kit.
(viii) Walkie Talkies in all Central Railway trains until the Train Management
System is implemented.
(ix) The recommendations should be monitored by a committee comprised of
Divisional Medical Officers from each railway, the Dean of Municipal
Hospital, and the Additional Commissioner of Police. The Committee
should also include one doctor chosen by the Association of Medical
Consultants. The complaints will also be heard by the committee. The
Committee should produce a six-monthly report to each Railway's General
Manager. The Committee should convene every two months at the very
least. All affected parties would be free to make or lodge complaints with
the Committee for Preventive Measures, and the Committee would
investigate those concerns as quickly as feasible.
 “The court gave the following instructions for Station Masters and Government
Railway Police in terms of a plan of action.

(I) The number for the helpline should be displayed in all coaches and
stations.
(II) Upon receiving accident information, take the following actions:
1. If an accident occurs between the Stations, information about
the accident must be sent to the Control Room;
2. As soon as the accident site is located, the Control Room
should notify the concerned Station Master, who should make
an announcement for hammals/porters, GRP, and call
ambulance/taxi;
(III) as soon as the announcement is heard, hammals and GRP should
rush to the Station Manager's Office, take the stretcher from the
office, and go to the accident site by the quickest mode available,
i.e. by train or by walking,
(IV) to arrive at the accident site as soon as possible.
(V) After lifting the victim, the victim will be transported to the Station
by train or by passing train/ ambulance/taxi; in the meantime, the
ambulance/taxi will be kept available at the Station so that the
victim can be sent to the nearest hospital as soon as possible.
Simultaneously, a professional railway/GRP worker will take care
to stop the bleeding.
(VI) GRP/Station Master will make every attempt to notify the victim's
relatives about the accident as soon as feasible.
(VII) The entire accident data should be made available in the control
room.
(VIII) The accident data will be presented to the Coordinating Committee,
which will take the required steps to identify methods for
improving and better dealing with accidents.
(IX) Every accident sufferer should be moved as soon as possible.
(X) If the victim's name is known, it should be announced through the
public announcement system.”
Subsequently, on February 8, 2006, the High Court passed the following order:

“We perused the Affidavit of Dr. (Mrs.) Mohua Halder, Sr. Divisional Medical
Officer, Mumbai Central, Western Railway and the Affidavit of Mr. Arvind Malkhede,
Senior Divisional Commercial Manager of the Central Railway Administration in
Mumbai. None of these two Affidavits answers and provides for solution regarding
treatment to the accident victims in the nearest private hospitals. In the Affidavit filed
by Arvind Malkhede, it is stated that all injured persons in railway accidents are
given free treatment in Railway Hospitals, but so far as other hospitals are
concerned, Railway’s liability is restricted to free transportation of the injured
persons to the hospital. It is the obligation and the responsibility of the Railways to
take the accident victims to the nearest hospital. If the Railways or Government or
Municipal hospital is not close by, the accident victims need immediate medical aid
and attention at the nearby hospitals.

It appears from both the Affidavits that the injured persons as a result of untoward
incident or other mishaps are transported from the site of the accident to the nearest
State Government/ Municipality hospital at the cost of the Railways. However, it is a
fact that many of the Government/ Municipality hospitals are at quite a distance from
the Railway Stations and transporting the victim to nearest State
Government/Municipality hospital many a time is proved fatal. Obviously, it is the
obligation of the Railway authorities (Western Railway, as well as, Central Railway)
that accident victims are provided treatment in the cases of emergency in the nearest
private hospitals where the Government hospital/Municipality hospital is not within
the 5 kilometer radius of the site of the accident. Having given thoughtful
consideration to these aspects, we issue the following further direction:

The emergency treatment to the injured person/s, as a result of untoward incident or

other mishaps in Railway premises shall be provided at the cost of Railway
authorities in the private hospitals if nearest State Government/Municipality hospitals
is/are in within 5 kilometers of the Railway premises where such incident or mishap
had occurred.”
 The Court concluded in Directorate of Enforcement v. Ashok Kumar Jain2 that the
police have a statutory obligation to protect the lives of those in their custody by providing
medical care and treatment and taking into account their health status. However, such
individuals' rights cannot be utilised as a shield to obstruct police investigations.

In this case, papers were retrieved from the Respondent's possession that revealed a
flagrant breach of the Foreign Exchange Regulation Act (FERA). The Respondent sought
anticipatory bail to escape questioning on the grounds that he had a serious heart ailment, and
he presented medical evidence to back up his claim. “In case the Directorate considers
custodial interrogation of the Respondent necessary, it should approach the Director, AIIMS
to form a Board of cardiologists to examine the Respondent, and if the said Board forms an
opinion that custodial interrogation is not feasible, it will be open to the officials to
interrogate him under the care of doctors at AIIMS,” the high court wrote.

The Appellant objected to the requirement imposed by the Supreme Court. The
Supreme Court ruled that the high court made a mistake by setting requirements on the
Directorate for how the Respondent's interrogation should be regulated.

“Without a doubt, Enforcement Directorate investigators are obligated to keep in

mind that Respondent has presented a case of precarious health. They can't ignore it, and they
must protect his health while he is in their care. However, saying that interrogation should be
subject to the opinion of the AIIMS cardiologists and that officials from the Directorate
should approach the Director of AIIMS to form a Board of Cardiologists to examine the
Respondent, etc. would, in our opinion, significantly impair the efficient functioning of the
FERA investigating authorities. The authorities should be able to devise whatever safeguards
are required to protect the health of those who will be subjected to interrogation. They cannot
be bound by pre-determined procedures for conducting interrogations imposed by the court.”

In the case of Siva Salian v. MSHRC3, the complainant, advocate Siva Salian, was
denied access to his wife, who was admitted to KEM Hospital on January 1, 2001, with a
respiratory condition. Her condition was described as critical three days after her admittance.
She died at 6:20 a.m. on January 23. Two complaints were made by the complainant. First,

2
(1998) 2 SCC 105.
3
Case No. 109/01: Order dt.19/05/04.
the doctor-in-charge refused to let the complaint and his younger daughter, Dr. Supriya, meet
the patient, even though she was in a serious state, and second, the patient's husband and
daughters were not allowed to see her when she was in the ICU. They claimed that human
rights had been infringed upon. The importance of the doctor-patient interaction, as well as
the patient's family member or relatives, was considered by the panel. The physician-patient
relationship and the therapeutic options accessible to health care providers have been
revolutionised as a result of improvements in medical knowledge and substantial changes in
health care coverage. The doctor-patient connection is built on trust, but because health care
has grown less personal and more corporate, doctors frequently disregard patients', families',
and relatives' rights. As a result, the doctor and others are unable to respect and carry out the
patient's last wish.

The commission went on to say that while medical personnel's primary responsibility
was to the patient, when the patient is dying, the demands of his or her family took
precedence. Ignoring the grieving family's rights might result in a loss of value and dignity.
In this regard, the commission cited research material and stated that human beings have
inherent value that is independent of their state of health or proximity to death. If human
beings have the ability to choose and act, both patients and relatives should communicate
their perspectives from a humanistic standpoint. "The moment of truth" occurs in the
connection between a doctor and a dying patient. This isn't always the same as the
explanation time. As a result, during the ultimate crisis, when there is no way to avoid death,
the patient need the most communication, not only with the doctor but also with her relatives.
As a result, the panel concluded that such variables heightened the importance of attitudes
and how the doctor should have acted at the time.

Ethical Perspective in Physician-Patient Relationship

The issues in medical ethics often involve life and death. Serious health issues are raised over
rights of patient, informed consent, confidentiality, competence, advance directives,
negligence, and many others.

Ethics deals with the right choices of conduct considering all the circumstances. It deals with
the distinction between what is considered right or wrong at a given time in a given culture.
Medical ethics is concerned with the obligations of the doctors and the hospital to the patient
along with other health professionals and society.

The health profession has a set of ethics, applicable to different groups of health professionals
and health-care institutions. Ethics is not static, applicable for all times. What was considered
good ethics a hundred years ago may not be considered so today. The hospital administrator
has an obligation to have a clear understanding of its legal and ethical responsibilities.

The essential ingredients of a good doctor-patient relationship are communication, respect,

confidentiality, professional honesty and trust.

Effective communication has always been important in doctor-patient relationship. Patients

today are considered as health consumers and want to be active participants in decisions
about their health . Doctors, who educate patients, encourage patients to talk, laugh and use
humours tend to have less formal complaints than those who do not do these things.

For a better communication the physician should sit down and attend to patient with comfort,
establish eye contact, listen without interrupting, show attention with nonverbal signs such as
nodding and gestures, acknowledge and legitimize feelings, and explain and reassure during
examination. Good communication habits must have the following routines:

In a recent study, patient-doctor relationship was discussed in response to both “belief” and
“preference” questions. Their trust emerged as a key theme related to patient–doctor
relationships. Some participants felt trust existed because of respect for the doctor’s position,
whereas others described trust evolving over time with a particular doctor and relating to that
doctor’s honesty .

The positive relationship between a doctor and patient are productive to both - the doctor and
the patient. Benefits to doctors include higher doctor satisfaction, better use of time and fewer
complaints from the patients whereas benefits to patients include higher patient satisfaction,
better patient adherence and improved patient health. This is what most people consider to be
the essential task of medicine to help patients get healthier. Thus physicians have a duty to
safeguard the health of the people and minimize the ravages of disease. Their knowledge and
conscience must be directed to the welfare of the patients.
Law and Ethics

Law is an obligation on the part of society imposed by the competent authority, and
noncompliance may lead to punishment in the form of monetary (fine) or imprisonment or
both. There are two kinds of laws mainly, statutory law and judgment law.

“Ethics” is concerned with studying and/or building up a coherent set of “rules” or principles
by which people ought to live. It is the social value which binds the society by uniform
opinion/consideration and enables the society to decide what is wrong and what is right. It is
the science of morale concerning principle of human duty in the society.

recipients of the medical care. But, now there is need of the practice of mutual acceptable
physician-patient relationship model in clinical set up.There is considerable healing power in
good physician-patient association. The essential unit of medical practice is the moment
when a person who is ill seeks advice of a doctor whom he or she trusts. These meetings are
frequent and regular occurrence between doctors and their patients. The success depends not
only on the doctors’ clinical knowledge and technical skills, but also on the nature of the
social relationship that exists between doctor and patient.

During the last two decades, there has been a struggle over the patient's role in medical
decision making often characterized as conflict between autonomy and health, values of the
patient and the values of the physician. In a quest to restrain physician dominance, many have
advocated an idea of greater patient control. Others question this idea because it fails to
acknowledge the potentially unbalanced nature of this interaction where one party is sick and
searching for security, and when judgments need the interpretation on doctor’s skill and
clinical ability. This struggle shapes the expectations of physicians and patients as well as the
ethical and legal standards for the physician's duties, informed consent, and medical
malpractice. This scuffle forces us to ask, what should be the ideal physician-patient
relationship?

The relationship between a doctor and patient is the basis of successful clinical medicine.
This relationship is important for improving patient health . Although a doctor's professional
knowledge and skills for safe practice of medicine are important; the relationship with the
patient does affect the outcome measures.

Historically the physician-patient relationship involved patient dependence on the physicians’

professional authority. The patients’ belief that they would benefit from the actions, led to
patient's preferences being ignored. Such a concept of beneficence allowed this authoritarian
model to flourish with patients being passive

1. The Paternalistic / Parental/ Priestly Model

In this model, the physician acts as the patient’s guardian articulating and implementing what
is best for the patient. Physicians use their knowledge and skills to determine the patient’s
medical condition, stage in disease process and identify medical test and treatments
Parihar5to restore the patient’s health or ameliorate pain. Then the physician presents the
patient with selected information that encourages the patient to support the intervention the
physician considers best. Finally, it is believed that the patient would be grateful for decisions
made by the physician even if he or she would not agree to them at the time. Hence, the
physician can determine what is in the patient's best interest with limited patient participation.

2. The Informative/Scientific/Engineering/Consumer Model

The aim of this model is to provide the patient with all relevant information, for the patient to
select the medical interventions, and for physician to execute the selected interventions. The
patient is informed about disease state, the nature of possible diagnostic and therapeutic
interventions, the nature and probability of risks and benefits associated with the
interventions, and any uncertainties of knowledge. Here, Physicians have an important
responsibility of providing truthful information, be competent in their area of expertise and
consult others when they lack knowledge and skills.

3. The Interpretive Model

The objective is to enlighten the patient’s values and what patient actually wants, and help the
patient to select the available medical interventions. In this model the physician does not
dictate to the patient; it is the patient who decides which values and course of action best fit
who he or she is. The physician acts as a counselor and does not judge the patient’s values
instead he or she helps the patient to understand and use them in the medical situation. In
addition to supplying relevant information, helping elucidate values and suggesting what
medical interventions realize these values the physician has a responsibility of engaging the
patient in a joint process of understanding.

4. The Deliberative Model

In this model, Physician provides information on patient's clinical situation and helps
elucidate the types of values personified in the available options. The physician suggests why
certain health-related values are more worthy and should be aspired to. Here, physician and
patient take into consideration what kind of health-related values the patient could and
ultimately should pursue. In the deliberative model, the physician acts as a teacher or friend,
engaging the patient in dialogue on what course of action would be best. Not only does the
physician indicate what the patient could do, but, knows the patient and wishes what is best
and indicates that the patient must do-what decision regarding medical therapy would be
worthy

Ethical Codes:

For monitoring the concord of this relationship, ethical codes have been developed to guide
the members of the profession. The Hippocratic Oath was an initial expression of such a
code. In India the Medical Council of India (MCI) has also established a code of medical
ethics for doctors to regulate the misconduct of the ethics in this noble profession and MCI
has underlined that all the principles of ethical behaviour are applicable to all physicians
including those who may not be engaged directly in clinical practice in India. Even it has
been proposed by Medical Council in India that ethical issues should be included in
internship curriculum studies of medical undergraduate course . According to this, physicians
have some responsibilities or obligations to the patients as follow:

1. Duties of Physicians To Patients Obligations to the sick

 Though a physician is not bound to treat each and every person, one should be
mindful of the requirement of high character of mission and the responsibility for
performance in professional duties. One should never forget that health and lives of
those entrusted to his care depend on his skill and attention. A physician advising a
patient to seek service of another physician is acceptable; but in case of emergency he
must treat the patient. No physician could arbitrarily refuse to treat a patient, however
for good reason, when an ailment which is not within the range of experience of the
treating physician, he may refuse treatment and refer the patient to another physician.

2. Patience, Grace and Secrecy

Patience and gracefulness should characterize the physician. It is the responsibility of

the physician to keep patient’s information confidential unless there is a serious or
imminent danger in doing so. Under some circumstances, a physician may reveal it in
the interest of society to protect a healthy person against a communicable disease. In
such instance, the physician should act as he would wish another to act toward one of
his own family in like circumstances.

3. Prognosis

The physician should neither exaggerate nor minimize the gravity of a patient’s
condition. He or she should ensure that knowledge of the patient’s condition disclosed
to his relatives will be for the best interest of the patient.

A physician is free to choose whom he will serve except in an emergency. Once having
undertaken a case, the physician should not neglect the patient, nor should he withdraw from
the case without giving adequate notice to the patient and his family. Physician could not
commit an act of negligence that may deprive his patients from necessary medical care.
Provisionally or fully registered medical practitioner shall not wilfully commit an act of
negligence that may deprive his patient or patients from necessary medical care.

When a physician who has been engaged to attend an obstetric case is absent and another is
sent for and delivery accomplished, the acting physician is entitled to his professional fees,
but should secure the patient’s consent to resign on the arrival of the physician engaged.
Recently, MCI has also come out with a modified code of ethics for doctors, who have often
been suspected to be ignoring the ethics of the noble profession by promoting the
pharmaceutical industry’s interests. The modified code of ethics prohibits medical
practitioners and their family from accepting gifts, travel facilities, hospitality and monetary
grants from the healthcare industry either in their name or in the names of their family
members.

The modern societal values do not support or nurture relationships. In medicine, individual
achievements and technological solutions are being valued above community and wisdom.
Contemporary medicine today faces a great challenge of retaining its humanity. Now-a-days
we are producing more doctors but unfortunately with less values of humanity. This can be
achieved by education which can counter the imbalance and model the middle way.

Firstly, teaching the science of medicine separate from art of medicine and disease as
separate from the person must be resisted. The disease issues and patients’ illness must be
integrated in patient-centred clinical method. Secondly, the value of relationships must be
taught avoiding the perspective of breaking down caring into minute skills and behaviours.
Thirdly, emphasize that each patient is surrounded by a web of caring relationships that
matter to a patient's health, healing and wholeness. Fourth, engage patients as allies in
teaching by encouraging them to be experts in their meetings with students (that is, to
participate fully, ask questions, provide written notes about their concerns and expectations)..

Just like our concerns, medical students are overwhelmed, fearful and defensive. We should
teach in a way we would want to be taught, thus modelling the kind of relationship we
encourage our students to have with their patients. Just as the doctor does not abandon his or
her expert role when attending to the patient's voice, the teacher of medical students and
trainees must not give up their role as teacher but listen more to the student's voice, enter the
student's world, and open up more their inner world to model the care and the joy of being a
committed prescriber.

CONCLUSION

Traditional health systems, with patients as passive recipients of care, have proven
unsuccessful in stemming the most irresistible and exponential growth of the epidemic we
now face. There is considerable healing power in a good Physician-patient relationship. In the
field of healthcare, patient empowerment has been acknowledged as an alternative to
compliance in order to guide the provider–patient relationship. It will help patients’
confusion, fear and doubt slowly transform into clarity, relief and assurance. With the
positive role of physicians, patients will definitely be relieved of hopelessness, have higher
satisfaction, better adherence and improved health. There is no doubt that this small gesture
by physicians will be a precious gift to humanity.

Previously, patients were frequently thought to be too stupid to make decisions for
themselves. Doctors felt at ease making decisions on their patients' behalf. Doctors and their
patients thereafter grew politically, economically, and socially estranged. The gap between
doctor and patient grew wider, and the doctor-patient interaction became cold and distant.
However, today's doctor-patient relationship is focused on collaboration rather than
confrontation, and the doctor must “understand the patient as a unique human being.” As a
result, patient-centered care has taken the role of a one-sided, doctor-dominated relationship
in which the exercise of power affects both sides' decision-making processes. Instead of
simply eliciting symptoms and indications, the doctor's primary goal is to listen to the patient
in order to determine what the'real' problem is. The most appropriate and optimal course of
action for an individual patient will be determined through shared decision making between
the doctor and the patient. In this patient-centered model, the doctor is well-positioned to
bridge the gap between the world of medicine and his patients' personal experiences and
needs. The importance of a close personal contact between a physician and a patient cannot
be overstated, because in a vast majority of situations, both diagnosis and therapy are directly
dependent on it. One of the most important attributes of a clinician is an interest in humanity,
because the secret to patient care is to care for the patient.

Until recently, the relationship between a health practitioner and a patient was
primarily defined by medical ethical guidelines, but the focus has switched to legal
restrictions, and the issue has begun to attract greater worldwide attention. It is the incumbent
duty of the doctors as well as the authorities to comply with their duty and in no circumstance
refrain from doing their part.

The first priority of a committed physician is to consider the health and well-being of patient.
There is considerable restorative power in the physician-patient alliance. Working together,
we may have better results that can significantly improve the patient's quality of life and
health status. It will help patients’ confusion, fear and doubt slowly transform into clarity,
relief and assurance. With the positive role of physicians, patients will definitely be relieved
of hopelessness, have higher satisfaction, better adherence and improved health. There is no
doubt that this small gesture by physicians will be a precious gift to humanity.

There is still much more to understand in this relation. However one thing is certain, there is
no going back to the paternalistic model of the mid 20th century and together patients and
professionals will work together for the benefit of individuals and populations. So, there is
need of a fundamental shift in thinking around patient empowerment. For patient
empowerment to succeed, it must be firmly rooted in health systems that support and foster
its wider adoption and spread. However, it has yet to play its proper role as a fundamental
component to achieve mainstream status. To date there is still much more to understand in
relation to a partnership approach than that has been summarized in this review.