Notes & Essays
'Doctor-Shaming,' and Why It's a Sign of a Deeper Problem
Not all doctor-patient relationships are equal. One doctor speaks out.
ILLUSTRATOR Jasrelle Serrano
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It usually starts with the patient's relatives. Someone who is furious, frustrated, grieving. The patient's story is told via social media. They'll talk about the less-than-ideal conditions at the hospital, the seemingly invasive procedures done to the patient, and the unrefined manners of the attending doctor. Words are used to paint a picture showing how disadvantaged the patient is; sometimes the post may imply that the healthcare team may have acted inhumanely.

Usually, it's the doctor who is the most vulnerable target. The post may range from aggressive to offensive, to outright libelous. The goal is the same: to strip the doctor of credibility. The worst photos of the patient's condition are chosen. Snaps of the doctor, usually with face visible, may also accompany the post, without the doctor's permission.

Within minutes of releasing the post into the internet, hundreds of commenters can flock to the narrative, offering criticism left and right. With the click of the Share button, sometimes accompanied by an incendiary caption, the story reaches thousands. However, to the public at large, their knowledge of the story is limited to what complainant wrote. This is doctor-shaming.

***

But, in every incident, there are always at least two sides. On the other side of this story is the healthcare team—particularly the doctor who took most of the direct blows from the online onslaught.

Now let's put things in perspective. Doctors usually work 24- to 36-hour shifts, so they're usually sleep-deprived, often skipping meals due to the sheer volume of work. They juggle several patients at a time, usually exceeding the recommended doctor-to-patient ratio. All of this happens in a less-than-ideal working environment, especially in government hospitals with limited resources and worn-out facilities.

As a physician sworn to uphold the Hippocratic oath, we promise to "do no harm"to exhaust all resources to heal their patients. A conscientious doctor has the purest intention of giving the best possible care to the patient. Diagnostic tests and procedures are not haphazardly requested and done; they are performed to ascertain the patient's condition to guide the doctor in giving the best treatment for the patient.

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Sometimes it may happen that little of these facts and realities are made known or made clear to the patient and his family. What results is a mismatch of what the doctor can offer, and what the patient wants to receive. This results in a rift—one that may ultimately cost the doctor's career.

When it comes to doctor-shaming, it must be pointed out that both sides have their shortcomings. The healthcare team may have lapses in properly communicating with the patient and relatives. Due to the overwhelming number of patients, doctors spend little time with each patient, sometimes regarding them as mere bed numbers that need to be diagnosed and treated.

The doctor-patient ratio and toll this all takes on a doctor's physical and mental condition are not valid excuses to ignore the value of patient rapport, which is a prerequisite to a good and lasting doctor-patient relationship. This lack of effective communication leads to unrealistic expectations, especially to the already distraught relatives who only want to see their sick family member get well.

On the other hand, raising these matters in a platform that's innately subjective and prone to misunderstanding only makes matters worse. Social media is a powerful and dangerous tool, especially if used by an emotionally blinded individual who click before thinking. There's little accountability when it comes to how we use social media, and it can be abused as a means of expression. Not to invalidate what the patient and the relatives are feeling, but getting sympathy in the form of Likes, Comments, and Shares will never achieve anything. If there is enough evidence to support the complaint, then the incident should be reported and channeled through proper avenues (i.e., the hospital administration) for redress.

Raising these matters in a platform that's innately subjective and prone to misunderstanding only makes matters worse.

Despite the flaws of both the doctor and patient, I believe that doctor-shaming is a manifestation of a deeper problem—our poor healthcare system. Imagine a hospital with sufficient nurses and doctors and adequate resources to accommodate all patients. An ill child could be brought to the emergency department without the mother worrying about the cost of laboratory tests and medicines. Down to the level of primary care, all well and sick members of the community are first seen by a general practitioner. In all levels of care, the environment would be conducive to foster a good doctor-patient relationship. Doctors could explain the patient's condition without rushing, and the patient can freely ask for clarifications.

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But reality check: This utopian healthcare system is one that no country has perfectly attained. The real deal here is that six out of ten Filipinos die without seeing a doctor. The geographically isolated and disadvantaged areas are mountains and seas away from the nearest health center. Government hospitals are congested with patients far outstripping capacity.

Here, mothers may be deeply anxious about her child's condition, but she is also fearful of the looming cost of lab tests and medicines. Most healthcare spending are still out-of-pocket, putting families in a vicious cycle of poverty and poor health.

The list goes on, and the truth remains: Our healthcare system is sick, and it needs treatment immediately. And as long as our healthcare system fails to improve, both doctors and patients are victims of an inefficient system, and we may never heal these broken doctor-patient relationships.

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About The Author
John Jefferson V. Besa, MD
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