Attitude, Ethics and

Communication
(AETCOM)

Module 1.2 : What

does it mean to be a
patient?
 Disease and Illness: Differences between the
perspectives of a doctor and his patient
 Patients and doctors can differ in many ways in their perceptions and concepts of illness and
disease.
 These differences may arise due to:
1. Differences in education level
2. Variation in access to healthcare facilities due to differences in socio-economic status
3. Influence/interaction with peer groups
4. Over/less exposure to medical information on social/print/electronic media
5. Previous self-experiences
 What is empathy?

 Empathy is defined as, “the ability to understand and share the feelings
of another.”
 An empathic physician has the capacity to emotionally connect with
his/her patients and understand their anxieties and sufferings in a
better way.
 Why is it important for a doctor to
be empathic?

 Better adherence to medications

 Reduced lawsuits of medical negligence against doctors
 Fewer mistakes by the treating physicians
 Increased level of patient satisfaction
 More job satisfaction among doctors and lesser incidences of job related “burnout”
 Practising Clinical Empathy:
Some Do’s and Don’ts for doctors
 Make good eye contact with your patient
 Mirror your patient’s facial expressions
 Try to know the patient’s own feelings about his sickness.
 Try to get more clarity about vague symptoms.
 Try to avoid unnecessary harsh criticism of your patient’s habits/lifestyle such as smoking or
drinking. Express your views in a polite yet firm way.
 Patient’s expectations from doctors
 Transparency in dealings
 Active listening of complaints
 Trust
 Care and connection
 Respect
 Good communication
 Time
 Empathy
 Easy access
 Clarity of instructions
 Collaboration
The last decade has witnessed a paradigm shift
in patient perceptions about doctors
 Previously doctors were regarded as demigods by the society but in the modern era, they
are considered merely as “PROVIDERS of MEDICAL SERVICES”.

 This paradigm shift in the society’s viewpoint has created two contrasting scenarios
wherein
 On one hand there are patients that still hold doctors in high esteem.
 While in other cases, there are instances of aggression/v iolence/litigation against doctors by
patients or their kin.
 Reasons for change in perceptions about
medical profession
Some probable causes may be:
1. Inclusion of medical and healthcare services under
the ambit of the CONSUMER PROTECTION ACT by
Govt of India.
2. Increased awareness among patients due to
information access through print/electronic media
and internet.
3. Commercialisation of healthcare services.
4. Privatisation and high cost of medical education.
5. Instances of malpractice by some medical
 Probable causes for anger/aggression in patients
 There may be certain instances where a doctor may have to face the
wrath of the patients or their kin.
 Probable reasons for anger in patients:
1. Discomfort/depression related to prolonged or terminal illness
2. Previous bad experience with some other doctor
3. Prolonged waiting time in doctor’s clinic
4. Death of a relative during treatment by that doctor
5. High cost of treatment
6. Co-existing financial/health problem of some other family member
7. Type A personality of patient; always-on-the-edge type attitude.
8. Communication gap between doctor and patient
9. VIP or high profile patients or their relatives
10. Any other non-specific reason
Attitude, Ethics and
Communication
(AETCOM)

Module 1.3 :
Doctor patient
relationship
 The IMPLIED CONTRACT between a doctor and his
patient
 A doctor cannot be forced to treat any person, yet he DOES HAVE
certain responsibilities towards those that he wishes to treat.
 WHAT IS AN IMPLIED CONTRACT?
An implied contract is one that is NOT WRITTEN, but is still legally valid
 Obligations of the IMPLIED CONTRACT for a doctor
1. Continue to treat his/her patient whom he has accepted
2. Practice reasonable skill and care in the treatment
3. Maintain professional secrecy
4. Never undertake any procedure beyond his/her acquired skills

 Important note
The doctor is legally bound to fulfil the above obligations EVEN IF his services are
voluntary and free of charge.
 1. CONTINUE TO TREAT
 As soon as the doctor starts the history taking session, he/she accepts his/her
responsibility towards the patient.
 The doctor cannot abandon the treatment EXCEPT under the following
circumstances:
 The patient is free from his illness
 The patient has been given prior notice about discontinuation of treatment
 The patient has expressed his intention of changing his doctor
 The patient does not co-operate with the doctor’s advice or instructions
 The patient does not pay the doctor’s fees
 The patient consults another doctor secretly
 The doctor is convinced that the illness is a false one
 2. REASONABLE SKILL AND CARE

 The doctor MUST:

 Use properly sterilised and clean instruments and appliances
 Write his prescriptions legibly and with full instructions on dose and other advice
 Promptly refer the patient to another competent/specialist doctor in case of serious or difficult
cases
 Refrain from giving any new medical or surgical treatment without his patient consent
 3. PROFESSIONAL SECRECY

 A PROFESSIONAL SECRET is information about any aspect of the

patient’s illness that is revealed to a doctor on account of his/her
professional skill.
 In routine cases, a doctor is under an implied legal obligation
NOT TO REVEAL such confidential information to anyone.
 However there are special circumstances where a doctor is
JUSTFIED in disclosing professional secrets about his patients to
appropriate authorities.
 “PRIVILEGED” COMMUNICATION
 A doctor has the privilege of revealing his patient's confidential
information ONLY whenever there is a legal, social or a moral issue
concerning safety of patient or his family and general public.
 Such information SHOULD BE divulged only to appropriate authorities.
 Some examples:
 An epileptic/colour blind/hypertensive driver
 A patient having typhoid or any other communicable disease who works as
cook or a bartender
 Suicidal or violent tendencies in patients
 Any illness found during medical examination for insurance reports
 When an prospective employee is sent by an employer for medical
examination
 In matters pertaining to an ongoing case in civil/criminal courts
 Consent
 Two or more persons are understood to be “in consent” when they
AGREE WITH the SAME THING in the SAME SENSE at the SAME TIME.
 Obtaining patient consent is the FIRST and FOREMOST thing for a doctor
before starting treatment.
 Types of consent
 IMPLIED CONSENT
 It is “ïmplied” i.e. well understood, ev en though it is NEITHER WRITTEN NOR SPOKEN
 It is expressed by the general co-operativ e behaviour of the patient towards the
doctor
 Most common v ariety of consent in clinical practice.

 EXPRESS CONSENT
 It is “expressed distinctly and explicitly” either in WRITTEN or SPOKEN language
 It is employed for some special therapeutic or surgical procedures and medical
examinations.
 Cardinal rules w.r.t. consent
 The law presumes the doctor to be in a dominating position, hence the consent
should be obtained after providing all the necessary information e.g. the reasons for
obtaining consent, details of procedure, the risks involved, side effects of drugs, etc
(INFORMED CONSENT).
 Patient’s consent must always be ensured EXCEPT in cases of emergency e.g.
unconscious patient, roadside accident victim, etc.
 The consent MUST NOT BE OBTAINED under pressure, fraud or intimidation. It must be
FREE & VOLUNTARY.
 Consent from a parent or guardian is necessary where the patient is underage,
mentally sick, comatose, etc.
 Consent is valid only for a particular procedure or treatment.
 Professional misconduct on the part of doctors

 Also called INFAMOUS CONDUCT

 What is professional misconduct?
 Any conduct on the part of a medical practitioner during the practice of
his/her profession which is considered morally/ethically disgraceful or
disrespectful by his colleagues of good reputation and skill.
 Employment/Hiring of incompetent
 Advertisement of medical services
medical and paramedical staff in
by a doctor in print, electronic
clinic/hospital by doctor
media, radio, etc.
 Canvassing: Use of touts or commission  Adultery: Sexual harassment
agents for procuring patients of patients
 Assisting in illegal abortion/female  Supplying/selling addictive drugs
foeticide
 Making derogatory remarks  Dichotomy (fee-sharing): Giving or
about other doctors. receiving commissions for patient
referral from or to a doctor, chemist,
diagnostic lab, etc.
 Issuing false certificates: e.g. medical  Consuming alcohol during
fitness, births, deaths, illness, office hours.
vaccination, mental illness, etc.
  Refusal to treat based on religious
 Secretly Attending patients beliefs of doctor or patient.
who are under care of
another doctor.
 Receiving gifts or cash and  Running shop for selling
funding of conferences and medicines, surgical goods, etc.
foreign trips from
pharmaceutical companies.
 Writing prescriptions in code  Failure to discharge duty in
language that is understood by a times of emergency e.g.
particular chemist only. natural disasters, accidents,
epidemics, etc.
 Disregard of personal responsibilities towards his/her own patients:
1. Use of unsterile instruments and/or expired medicines.
2. Inadequate information about medicines and diet.
3. Giving wrong information to patient for monetary gains

e.g. pressuring a female to go for caesarean

section where normal vaginal delivery can be
done
reporting a benign condition as potentially
dangerous and doing unnecessary surgery.
4. Ordering unnecessary laboratory tests.
5. Suddenly terminating services towards a patient .
6. Experimentation of newer drugs, procedures on patients without their
consent.
 Disciplinary action in cases of professional
misconduct
 State medical councils take action in cases of professional
misconduct of doctors ONLY WHEN:
 Someone files a written complaint against a doctor.
 A doctor is convicted by a court of law in some case.

PROCEDURAL PROTOCOL
 Upon receipt of a complaint of professional misconduct, the
appropriate Medical Council will hold an inquiry.
 During the inquiry, the medical practitioner will be given an opportunity
to be heard in person or by pleader.
 A decision on the complaint has to be taken within 06 months from
filing the complaint.
 The MALINGERING patient
 A deliberate attempt by the patient to deceive the doctor by providing
false information about his condition.
 Instances of people resorting to malingering:
 Office goers who want to avail medical leave
 Personnel in armed forces/navy/air force who want to leave their job midway
 Businessmen/politicians who are accused of fraud/scam
 Factory workers who want to get compensation from their employer
 Prisoners/convicts to escape prison
 An assault victim to strengthen his case in trial court
 To obtain free food/stay in a hospital setting
 To obtain monetary gain through bogus insurance claims
 WHAT IF the professional misconduct is established
against a doctor?
 Depending upon the severity of the misconduct, any of the following action(s) can be taken
by the medical council:
 Duties of patients

1. He/she must TRUTHFULLY DIVULGE ALL INFORMATION that may be necessary for the proper diagnosis
and treatment of the disease.
2. He must CO-OPERATE WITH THE DOCTOR with regards to the recommended laboratory investigations for
proper treatment.
3. He/she must FOLLOW ALL INSTRUCTIONS w.r.t. diet, drugs, exercise and visit the doctor as per the follow
up schedule prescribed by the doctor.
4. He/she must PAY THE DOCTOR’S FEES unless it is clearly mentioned/stated that the services are free of
charge.
5. Should knowingly NOT INDULGE IN MEDICAL FRAUD.
6. REPORT UNETHICAL/ILLEGAL PRACTICES of the doctor to higher authorities, e.g. civil surgeon, medical
council, health ministry, etc.
7. REFRAIN FROM ANY KIND OF VIOLENT/AGGRESSIVE BEHAVIOUR towards the doctor or his staff.