- On Patient-Physician Relationships: A Bangladesh Perspective
The patient-physician relationship is one of the major issues in Bangladesh healthcare. It touches everyone’s lives from villages to the capital city, Dhaka. The relationship is rather complex in Bangladesh because physicians claim that it is not possible to maintain an ideal relationship with patients since they have to provide services for a huge population within a limited timeframe. For instance, writing on patients’ expectations, two renowned physicians in Bangladesh pointed out, “Apparently there are many expectations which can only be met if a doctor is a missionary … He is a professional rather than a missionary”.1
By contrast, patients claim that physicians are not only careless but they also ignore patients’ rights very often. For example, in an in-depth study conducted in Dhaka Medical College and Hospital (DMCH), the country’s main centre of public health services reports that 43% of outpatients were dissatisfied due to an “absence of doctors on time, careless treatment and presence of other people (such as medical representatives) during treatment” and 48% of inpatients mentioned “irregular visit by the doctors”.2 So the question is: what is the appropriate model of a patient-physician relationship for a developing country with a large population and high illiteracy rate, such as Bangladesh? Should we follow the same models proposed for the Western societies? Are illiteracy, scarcity, and cultural differences morally significant when we consider the patient-physician relationship?
In the 1990s, the American Medical Association set forth some fundamental elements of the patient-physician relationship where not only the physicians’ obligation but also the patients’ rights, right to get information, and decision-making process, are given highest priority.3 Nowadays, the basis of the [End Page 65] patient-physician relationship is more patient-centric rather than physiciancentric. As a result, the traditional paternalistic model which says that “Doctor knows best” has been replaced by new models. However, each and every model has attempted to answer some fundamental questions about the physician’s authority, patient’s rights, and their autonomy.
I will discuss the patient-physician practice in Bangladesh after providing a brief overview of the country’s healthcare system. Then, I will explain recent patientphysician relationship models which are influential in Western societies. Finally, I will examine whether any of these models are appropriate to Bangladesh.
An Overview of the Healthcare System in Bangladesh
Bangladesh is a small country with a large population in the South Asian region. The country became independent by a War of Liberation in 1971. Most of the population is Muslim (88%) while a considerable number of citizens are Hindus (10%), Christians (1%), and Buddhists (1%). Although Bangladesh has a good tradition of religious harmony, rich cultural heritage, and international reputation for micro credit innovation, the country faces many problems like massive corruption in all sectors, poverty, political instability, and a low literacy rate.
According to the Human Development Report, United Nations Development Programmme, UNDP 2009, it ranks 112th in the Human Poverty Index (HPI-1) among 135 developing countries in the world. About 40% of the population is living below the national poverty line. Bangladesh has a life expectancy at birth of 66.7 (F) and 64.7 (M), adult illiteracy rate 46.5%, and GDP per capita of US$423. Total Health Expenditure (THE) of Bangladesh per capita is about US$10 and per capita public expenditure on health is US$3.4 Nonetheless, the millennium goal of the country is “health for all” and a citizen has constitutional right to get healthcare.
The health sector in Bangladesh can be divided into two categories: education and service. The country has a well-equipped medical university and hospital, 18 government medical colleges, 41 private medical colleges, 11 private dental colleges, and 39 private institutes of health technology. There are 589 government hospitals in the health sector and the number of non-government hospitals is 2,271.5 Three types of healthcare services, namely public, private, and NGO, are available in Bangladesh. Public healthcare services are basically based on the medical college hospitals, postgraduate hospitals, specialised hospitals, district hospitals, Maternal and Child Welfare Centre, Upazila Health...