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Paradigm of attitude for a better health care

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Major  (Dr) Zulfiquer Ahmed Amin :

Astronomical advancement in medical science has offered an opportunity for best possible diagnostic, medical and care facilities for the patients. There is no dearth of electro-medical equipments to diagnose even the rarest medical conditions, no scarcity of specialist or even super specialist doctors to provide the best possible option of treatment and ample of proficient nursing staffs in the medical team to take care of any patient from the day of attending to the hospital or clinic to the last day of discharge. Added to it, supportive services aplenty are integrated to make hospital stay a home to the patient to feel safe and cared. Paradoxically, despite all these technical innovations, professional wisdom and avant-garde facilities, there are evidences of intense frustration and dissatisfaction among many patients towards the health care services.
Out of many raison d'être, asymmetrical distribution of health care resources across countries and seemingly palpable demand and supply gap in the cognitive expectations among the stakeholders are the root of this discontent. Expectation of the patients and the service providers have reciprocal relationship and needs to go hand in hand. On the contrary, in the existing environment, it goes reverse and mostly conflicting in nature. Having though all the participants of the theatre, the right intention to cure and to get cured, there remain issues unnoticed and unattended, that creates and fosters the differences. From this notion, the conjecture of doctor-patient relationship has come into being where both the service providers and the service takers presumably share equal responsibilities to contribute towards developing a service structure which is conducive for the both.
Often heard tell of patient moving abroad for treatment is returning home with a smile in face and questioning our health service quality and ability is not an experience unusual. One vital thing we forgo to concede that in abroad with the huge medical cost, we buy the quality and additional services of cognitive satisfaction. With each extra money we pour in, we get an additional service which can make a difference in our perceived mental contentment. Here the question is what the standard is, especially for a poor nation and the incremental value for each additional money added into the treatment process.
Here lies a paradox in our health care system. We have shortage of health care professionals but many of the doctors and nurses remain unemployed. It is a policy failure needs to be wisely addressed. If we fail to bring in to the system, the required quantity of health professionals and related services in relation to population density, quality care is likely to be a distant dream. Where the WHO given standard for doctor: population ration is 1: 1000, nurse: population ratio is 2:1000, population: hospital bed ratio is 500:1; with our present state of 1:47194, 1:8226, and 3231:1 respectively, quality of care and to meet the expectations of our patients are natural to fall short. Bangladesh commits only 4.7% (Proposed in 2012-13 budget) of its GDP in health sector, where the share of USA and UK is 18% and 9% respectively. Bangladesh has a per capita health care expenditure of $7.5, whereas USA and UK spend $2,535 and $3129 respectively.
Empirical evidences have shown that inspite of committing staggering resources in the health sector, expected outcome in terms of quality and satisfaction of the patients are pegged with doubt. Thus, though it is undeniable reality that binding resources are a must but not all for a success story.
Thus, issues on attitude have gained momentum in contemporary scientific literatures. It is about the attitude of the patients, their families, friends and the health care providers. Attitude is the outcome of expectation and is the driving force for action. In a course of conflicting expectations, how better an attitude can be nurtured is the struggle of the time.
In health profession, every member cultivates two basic goals, a desire to advance his professional aptitude for better delivery of care and a solvent life accrued as a by product. This is in perfect connotation with the principles of Abraham Maslow's 'Hierarchy of Need' where level of needs act as the motivator to attitude and action. When organizational goal and the individual interest do not conform and complement each other, malpractices set in and organization sufferer in qualitative output. Another issue to address is the neglect in representation of health care personnel in health policy making decisions.
In leadership theory, it emphatically emphasizes that knowing the under-command is the key to effective leadership. Some non-medical bureaucrats empowered to formulate health policy, guide and to propel the medical professionals to action is ridiculous to think to know-how the psyche of their under-commands to effectively lead them rather than to thump on them to action. Without representation, they feel marooned and   decisions lack crucial technical components.
Amid all these odds, as members of a noble profession, we can not but uphold the ethos and values inherent in it. Set amidst resource constrains, we have to accommodate ourselves to provide the best. To bridge the gap between the need and the availability of resources, the only tool to ensure a reasonably quality care, is a change in our mental frame and attitude of both the service givers and the takers. Graciousness, humanity, social responsibility should overrule our tunnel vision centered around self only. We should take care that medicine concerns the experiences, feelings, and interpretations of human beings in often extraordinary moments of fear, anxiety, and doubt.
As we learnt in medical colleges that a patient is 60 percent cured by appropriate medication and rest 40 percent by our dealings, empathy to their sufferings and by their conviction to our sincerity, is the way out to improve our abysmal quality of health care.
On the other hand, service takers also need to consider the human aspect and limitations of the professionals and resource paucity committed to the health sector. With scores of patients with meager health care resources, it is difficult but not impossible. Professional ethos, self motivation, sense of humanity and patriotism can be the driving force to forgo our discontent of 'quite within the right but not haves'.
One of the oldest and most fundamental tenets of the medical profession has been the obligation to achieve patient benefit. From the days when the Hippocratic traditions were developed, generations of physicians have pledged to do their best to protect patients from harm, and to restore them to health. To attain this, we need to humanely apply our expertise, share appropriate responsibilities and cultivate a positive attitude.
It is immoral to consider the patients as a machine and illness as a malfunction of some of its parts which needs mechanical repair. We need to consider an illness as a part of our patient's life-experience which must be understood simultaneously in physical, psychological and social terms. Allocation of optimum resources are a binding need for the health sector but without a paradigm shift of attitude of service providers and takers, resource alone is an effort in vain. The key to professional success is to believe in the core of clinical medicine that medicine is about understanding a person's story - not just their illnesses alone.

 (Writer a physician and specialist in Hospital Management, is Deputy Assistant Director of Medical Services, Comilla Can'tt)