MCI prohibits doctors from taking gifts

Being in the pharmaceutical industry for 9 years I can understand both sides. According to industry people, doctors don’t want to know about science so there is no other way of promotion. Now it is doctors who started the practice or it is the industry who started pampering doctors???? This is like chicken came first or the egg !!!!

Well this was a conventional way of relationship between healthcare industry and the doctors. What it should be now ????

In my opinion now the relationship between healthcare industry and the doctors should be of “ Empowerment “ . This should include industry to focus more on gifting updated scientific information to doctors, making promotional strategy more science driven, providing a platform for doctors to educate their patients etc. From Industry to Doctor relationship, now it should be Industry to Doctor to Patient relationship. This would help doctors gain more credibility in the eyes of their patients. This would also improve Doctor-Patient Relationship and ultimately Industry-Doctor Relationship.

I feel rather than finding the loopholes in the policy both Industry and Doctors should embrace the idea and work on it with mutual understanding.

Changing attitude towards Patient - Physician Relationship

What is meant by being a Patient?

A person who has physical or mental ailment which can lead to some dissociation between body and mind. This state makes the person vulnerable, stressed, anxious, scared with lot of expectations and demands from the healthcare provider. From here evolves a special bonding when a prospective patient seeks the advice, care, and/or treatment of a physician. This is Physician-Patient Relationship.

The physician is readily recognized and accepted as the guardian who uses his specialized knowledge and training to benefit patients, including deciding unilaterally what constitutes a benefit. Until about 30 years ago, it was the typical mode of medical practice. One advantage to this approach was that patients did not have to bear the burden of decision making.

According to Med J of Bioethics, 2004 this “paternalistic model” of medical decision-making have treated the patient alone outside of his or her social context as the subject in the physician-patient relationship.

In the “informative model”, the role of the physician is relegated to that of a technical specialist who only provides the patient with the relevant information, leaving the patient to decide on his own. The advantage of this model is that patients are empowered as active participants in the decision making process.But this may be more harmful for patients to exercise their rights of autonomy to overrule doctor’s choice.

These two models may be viewed as two extremes of a swinging pendulum.
Many patients may not be prepared or ready for absolute autonomy, and may be best served by a model called “guided paternalism” whose objective is to strive to enhance and optimize the patient’s autonomy.

So in the “deliberative model” the final say ultimately reside with the patient who has to live with the consequences of the medical decision and the physician is seen as a teacher and a friend who helps the patient in value clarification and in processing the various potential interventions.

The aim is not only to discuss what the patient could do, but also what the patient should do in a particular situation. This will help the patient to formulate plans and make decisions that are most authentic and relevant to him. Such a model that provides for professional guidance is especially relevant in this Internet age, where patients are flooded with information, some of which are unprocessed and lack validation.

The physician needs to cultivate a partnership with the patient, and together negotiate a management plan which allows for physician’s professional recommendations and for patient’s ideas, concerns and expectations.

In this relationship doctors are medical experts and patients are personal experts. Each participant learns from each other’s expertise and using that gained knowledge arrive at a mutually agreeable treatment plan.

It is important for physicians to acquire effective patient centered communication skills that are essential tools to promote patient understanding and participation.
This model of care can be described using various terms -- empowerment, informed choice, patient centered where patient is at the center and is actively involved in his or her own health care.

Patients and Internet

E-Patients
E-Patients, also known as internet patient, or internet-savvy patient are health consumers who use the internet to gather information about a medical condition of particular interest to them.
According to the 5th Health On the Net Foundation Survey on the Evolution of Internet Use for Health Purposes, individuals around the world are turning to the Internet for health-related knowledge.1 There are various health related websites which give medical information, health advice and help patients in making online support groups.
Until recently, in the clinical visit the physician had the sole responsibility for medical knowledge, whereas the patient was only accountable for his or her own preferences. But now access to health-related information on the web allows them to exert much more control over their own health care than ever before.2 Now, by more easily obtaining medical information prior to seeing their doctors, patients potentially have a different position in the decision-making process.3 But this information-seeking activity has led the physicians have expressed concern regarding access to misinformation and patients' interpretation of available online content.3 There is great concern about the accuracy and validity of medical information found on the Internet. 4
Physicians must ensure that the information a patient wishes to use in making a decision is not a misconception or falsehood. In addition, proposed treatment options must be weighed with assistance from physicians. Many times the educated people approach the doctor for the confirmation of their own diagnosis made online. This could be a misinterpretation either giving hopes to the patient for a condition with poor prognosis or else taking away hopes for a non-serious treatable condition. The physicians must be open to these highly motivated patients who are active participants in their healthcare.3 and at the same time clarify the information gathered by the patient from external sources.
Sometimes patients also try to search about their condition once diagnosed by the physician. This might help the clinicians in making the patient understand the disease pathophysiology and available treatment options in a much easier and simple way. This would help in saving time of the doctor and patient, building up rapport between them and also in mutual decision making.
To combat online misinformation, healthcare providers must positively influence patient selection of online materials. A physician-recommended Web site could be thought of as an Internet prescription.3 The potential benefit of the Internet prescription would be that the patient would be viewing suggested information and will give it preference because his or her physician provided it. Furthermore, patients who find additional sources of information on the Internet have the option of obtaining another opinion through their physicians.3

E-patients are 5 :
equipped with the skills to manage their own condition
enabled to make choices about self-care and those choices are respected
empowered
engaged in their own care
equals in their partnerships with the various physicians involved in their care
Although many individuals have the potential to gain medical knowledge easily through on-line information, others do not. This includes patients who are with poor literacy skills or educated patient population with income levels. This group is less likely to take advantage of the Internet in order to acquire additional medical knowledge. Unfortunately, because these individuals are more likely to have worse health, their needs for health education are greater, especially for those with chronic illnesses.6 If this patient populations are to become active participants in the Internet age, it is necessary to continue to devote greater resources to improving easy access of electronic information. There is a definite need for interventions that empower ethnic minority patients and help them become informed and active healthcare consumers.7
The Internet Age is altering the patient-physician relationship. If physicians actively assist patients in the information-gathering process, an improved relationship may result. Through the understanding of evolving professional roles, the decision-making process between physicians and patients may improve with efforts to share the burden of responsibility for knowledge.3
References :
1. Health On the Net Foundation. HON's Fifth Survey on the Use of the Internet for Medical & Health Purposes. Accessed on 14th Jan 2010.
2. Smith R. The future of healthcare systems. BMJ. 1997;314:1495-1496.
3. Ben S Gerber, Arnold R Eiser. Med Internet Res 2001;3(2):e15
4. Eysenbach G, Diepgen TL. Towards quality management of medical information on the internet: evaluation, labelling, and filtering of information. BMJ 1998 Nov 28;317(7171):1496-1500
5. E-patient. Available at http://en.wikipedia.org/wiki/E-Patient. Accessed on 14-1-2001
6. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med 1998 Jan 26;158(2):166-172.
7. Cooper-patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999; Aug 11;282(6):583-589.