Treatment for the Patient, or the Patient for the Treatment?

When people fall ill, they turn to doctors and hospitals with the hope of getting relief. Yet in Bangladesh, seeking medical treatment has itself become a source of considerable suffering for many patients.

Getting an appointment with a reputed specialist can be a matter of luck. And securing an appointment is only the beginning of the ordeal.

A patient may call a hospital hotline and receive an appointment for 8:00 pm, only to be instructed to arrive at the doctor’s chamber at 5:00 pm.

If the patient’s serial number is 20, waiting for three or four hours may be unavoidable. For a working person, an elderly patient or someone who has travelled a long distance, such a system can be physically and mentally exhausting.

The question is simple: why should a patient have to spend several hours waiting when the hospital already knows the approximate time at which the patient will be seen?
When a consultation becomes a prolonged process

The difficulties do not necessarily end after seeing the doctor. In many cases, the doctor advises several diagnostic tests and asks the patient to return with the reports. The patient then has to make another appointment merely to show the reports.

Thus, what should ideally be a single, reasonably efficient medical consultation can turn into a process requiring several visits, repeated waiting, additional transport costs and lost working hours.

Many people, understandably, become reluctant to seek medical attention because of this ordeal. Not everyone is retired. Most people have jobs, businesses, family responsibilities and limited time. Nor does everyone have the physical stamina or patience to sit in a hospital for hours.

A health system should take these realities into account
Where is the patient in the system? Perhaps the most disturbing aspect is that patient management appears to receive insufficient attention in many major public and private hospitals and clinics in Dhaka and elsewhere.

Long queues, uncertain waiting times, overcrowded waiting areas and appointments that bear little relation to actual consultation times are common experiences.

The burden of adjusting to the system is placed almost entirely on the patient. But should it not be the other way around?

In the age of smartphones, digital appointments and real-time communication, hospitals should be able to inform patients when their turn is approaching.

If a patient is number 20, there is little justification for requiring that person to sit in the hospital from 5:00 pm simply because the doctor is expected to see them at 8:00 pm.

A text message or mobile notification could inform the patient when to arrive. If the doctor is running late, the patient could be informed automatically. Such simple measures could save thousands of people countless hours every day.

The problem, therefore, is not always a lack of technology. It is often a lack of patient-centred management.

Modern medicine and the specialist maze
Modern medicine has brought enormous benefits. Specialisation has made it possible to diagnose and treat complex diseases with a level of expertise that was previously unimaginable. But specialisation also has a downside.

Consider a patient suffering from diabetes and hypertension. The patient may have to consult an endocrinologist and a cardiologist.

If there is also asthma or a persistent cough, a chest specialist may be required. Digestive problems may lead to a gastroenterologist; kidney problems to a nephrologist or urologist; skin disorders to a dermatologist; and neurological problems to a neurologist.

The human body, however, is not a collection of independent machines. Its organs and systems are interconnected. A patient may suffer from several conditions simultaneously, and one disease or medication may affect another.

This raises an important question: Who takes responsibility for seeing the patient as a whole?
When a patient visits several specialists, who coordinate the treatment? Who reviews all the medicines being prescribed? Who ensures that one treatment does not adversely interact with another? And who considers the patient’s overall health rather than focusing on a single organ?
The need for integrated care
This is where primary care and family medicine become particularly important.

A competent primary-care physician can assess the patient as a whole—taking into account medical history, existing illnesses, medications, lifestyle and family history—and then refer the patient to the appropriate specialist when necessary.

Such a system would reduce unnecessary visits to multiple specialists and prevent patients from becoming lost in a maze of specialised services.

Modern healthcare should not mean simply having more specialists, more diagnostic tests and more sophisticated equipment. It should mean getting the right patient to the right doctor at the right time, while ensuring continuity and coordination of care.

Technology should reduce suffering, not create another layer
Bangladesh has made significant progress in adopting digital technology in healthcare. Online appointments, hotlines, mobile applications, SMS notifications and electronic records can potentially transform patient management.

But technology is meaningful only when it makes healthcare easier.

Hospitals should consider time-slot-based appointments rather than vague serial systems. Patients should be informed electronically when their turn approaches. Diagnostic reports should, wherever possible, be made available electronically to doctors. Follow-up consultations could sometimes be conducted remotely when a physical examination is unnecessary.

A properly integrated electronic medical record could also help doctors see a patient’s previous test results, diagnoses and medications, reducing duplication and unnecessary investigations.
The responsibility of government and hospitals

Healthcare is not an ordinary commercial service. A patient comes to a hospital at a time of vulnerability. Respecting that person’s time, dignity, financial limitations and physical condition should therefore be regarded as a basic responsibility of healthcare providers.

The government should establish clear standards for appointment systems, waiting times, patient communication, complaint handling and continuity of care in both public and private hospitals.

At the same time, doctors should not be blamed for every failure. Heavy patient loads, inadequate staffing, working conditions and institutional limitations also contribute to the problem. Reform must therefore address the entire healthcare system rather than placing responsibility on individual physicians alone.

The patient must come first
Bangladesh has expanded its hospitals, specialists, diagnostic facilities and modern medical technologies. But the success of a healthcare system cannot be measured merely by the number of hospitals or specialists it possesses.

The real measure of success is much simpler: How easily can an ordinary citizen receive appropriate treatment? How long must the patient wait? How much does the process cost? And how respectfully is the patient treated? A sick person should not have to fight the healthcare system before receiving healthcare.

The fundamental question, therefore, is not whether Bangladesh has modern medicine. It does. The real question is whether Bangladesh has a modern, coordinated and patient-centred healthcare system.

The answer will remain unsatisfactory as long as hospitals expect patients to adjust themselves to the system rather than designing the system around patients.

Treatment must be organised for the patient—not the patient for the treatment. Unless this basic perspective changes, the suffering of patients will continue, regardless of how advanced our hospitals and medical technologies become.

(The writer is the Advisory Editor of The New Nation)