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2 January, 2019 11:53:10 AM

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Physicians must have necessary time for patients

In Bangladesh individual primary care physicians may undertake over 90 consultations a day with a considerable amount of time taken up providing repeat prescriptions
Prof. Sarwar Md. Saifullah Khaled
Physicians must have necessary time for patients

The patients go to the physicians with the hope to get proper healthcare facilities but unfortunately the physicians in Bangladesh usually invest only 48 seconds to a patient who seeks primary healthcare. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress.

This eloquently speaks of the deep soup our public healthcare system is in. We can cite too many instances of very recent times that bring to the fore the extreme example of carelessness from the physicians to the patients.

One hundred and seventy-nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries by the British Medical Journal or BMJ. The study findings showed that the average consultation length differed across the world, ranging from 48 seconds in Bangladesh to 22.5 minutes in Sweden. The studies say there are international variations in consultation length and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length adversely affects the patient healthcare.

There were 15 countries with their most recently reported consultation length at 5 minutes, 25 countries with a consultation length of 5-9.9 minutes, 11 countries with 10-14.9 minutes, 13 countries with a consultation length of 15-19.9 minutes and 3 countries with a consultation length of 20 minutes. Three countries had sufficient data points to determine long-term trends: Australia, the UK and the USA. In Australia, the consultation length was relatively stable, in the USA consultation length was increasing by 12 a year, and in UK consultation length was increasing by 4.2 a year.

This review demonstrates that the consultation length of primary care physicians varies markedly across the world. The study mentioned that it is concerning that those 18 countries covering 50 percent of the world's populations have a latest reported mean consultation length of 5 minutes or less. The reasons for such striking differences may reflect a number of factors, including issues relating to governance, workforce, access, continuity, comprehensiveness and coordination.

For example, the study said, in countries such as Pakistan, Bangladesh and China, there is no appointment system, and individual primary care physicians may undertake over 90 consultations a day with a considerable amount of time taken up providing repeat prescriptions. The study was carried out to describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes.  

But the profession of a physician is a noble one and the doctors have to be careful and dedicated to the needs of their patients in regard to their early healing. In the opinion of a renowned scholar God has created mothers and doctors to minister to the needs of children and patients.  Therefore, a doctor should be guilty of a serious dereliction of duty if he/she has too little time for patients. About 2,500 years ago the Greeks realised that there should be an ethical code binding the doctor to his patient, hence the introduction of the Hippocratic Oath taken by the physicians. Among many of its covenants one is that the doctor must abstain from whatever is harmful for the patient.

For centuries this sacred trust between doctors and patients gave the medical profession nobility that has endured. However, in recent times the sanctity of the doctor-patient relationship has become sullied by a pernicious combination of factors. The relationship has been commercialised to a large extent. A doctor has to attend to an ever-rising graph of patients which is an impossible task for them. Moreover, as per our experience there is hardly any accountability in Bangladesh and that has led to a worrying increase in cases of negligence and malpractice.

We Bangladeshis painfully observe that with the public healthcare system almost collapsing in Bangladesh, there has been mushrooming, largely unregulated, of private hospitals, clinics or diagnostic centres throughout the country which charge so exorbitant that the poor patients cannot afford. The poor patients have to go to the public hospitals which are not run efficiently. They do neither also offer state-of-the art treatment facilities for the poor patients; it certainly tantamount to gross offence if the doctors fail to give adequate time and attention to patients. The result is fatal. It is common knowledge that the doctors are, however, licensed not to kill patients, but to heal their afflictions as far as possible.

To repeat, the British Medical Journal or BMJ found that 18 countries representing about 50 percent of the global population spend 5 min or less with their primary care physicians. Further more, it also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, and physician efficiency and physician satisfaction.

In conclusion, it is to be noted again that the study said there are international variations in consultation length, and a large proportion of the global population have only a few minutes with their primary care physicians which is a matter of major concern. The situation in Bangladesh is alarmingly worse with 48 seconds of consultation and proper care is needed to be taken to improve the consultation length the patients have with their primary care physicians to get heal their afflictions as far as possible.   

The writer is a retired Professor of Economics, BCS General Education Cadre.

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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