The good Indian doctor: People’s perspectives

INTRODUCTION

The concept of a ‘good doctor’ has been changing over the years. From an era where all doctors were considered good, we have moved to an era of healthcare consumerism where the patient has a right to shop for and access healthcare and their ‘good doctor’. While there is a high regard for doctors’ skills and advice in the general population, patients often feel that their desire for information, education and empowerment is not adequately addressed.¹ In an era of growing healthcare consumerism, patients have become important partners in making medical decisions. As suggested by numerous studies in the past, patients want their physicians to be professional and expert clinicians, while also showing humaneness and support; however, their first priority is respect for their autonomy.^2,3 Doctors can earn trust from their patients only by answering their questions clearly, listening to them and involving them in decision-making.^2,4,5

Since Mangaluru city (Karnataka, India) has a variable population with differences in status, education, and culture, we aimed to determine the characteristics that the general public in Mangaluru considers important in doctors who would treat them or a family member.

METHODS

Following an institutional ethical clearance, a cross-sectional questionnaire-based study was conducted using the snowball technique. All consenting adult participants, excluding doctors (402), were asked to fill a questionnaire using Google Forms. The questionnaire was based on a study by Schattner et al.² The original questionnaire consisted of 21 physicians’ characteristics or behaviours regarding patient care, and participants were asked to select 4 qualities they valued most. A few of the questions were modified to suit the requirements of the Indian population, including translations in two native languages, Kannada and Malayalam, to ensure greater participation. The questionnaire aimed to assess the patient’s image of an ideal physician in general and did not specify whether the physician was hospital-based or in a clinic. The 21 attributes included 7 characteristics in each of 3 domains: reflecting professional expertize and care, humanism and empathy, and patient autonomy. The order of the attributes was shuffled to prevent bias due to an item’s position on the list.

Statistical analysis was done using the Statistical Package for the Social Sciences version 23.0. Descriptive statistics were calculated and summarized, including frequency, percentage, mean and standard deviation (SD). Inferential statistics were included in the study. Categorical variables were analysed using the Chi-square test. The level of significance was set at 5%.

RESULTS

We had 402 consenting participants in the study, ranging in age from 18 to 78 years. The mean (SD) age of the group was 35.2 (14.7) years (Table 1), with the majority of patients in our study being females (61.2%).

The majority of participants (273; 67.9%) preferred their doctor to provide a clear explanation of the treatment options available and the associated adverse outcomes; 218 patients (54.2%) wanted their doctor to disclose the whole truth about the condition, disease, and treatment (Table 2; Fig. 1).

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FIG 1.

Percentage of physician attributes selected in each of the three domains

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When the attributes were distributed into domains, we found that 339 patients (84.3%) selected autonomy as the most preferred domain (at least 2 or more choices from a particular domain), 300 patients (74.6%) and 302 patients (75.1%) selected professional expertise and humane attitude as the most preferred domain, respectively.

Our study showed a significant difference when patients who preferred most questions and those who entirely disregarded a domain were analyzed and compared with another domain. For example, significant differences were found (p<0.02) when the autonomy domain was compared with the professional expertise domain. Significant differences were noted when the professional expertise domain was compared to the humane attitude (p<0.001). Furthermore, significant differences were noted (p<0.001) when the autonomy domain and humane attitude were compared (Table 3).

The patient’s preference for what they expected from their ‘Good doctor’ varied by age group, with statistically significant differences. Despite the difference in opinion between age groups, the majority of patients wanted their doctor to ask their opinion on ‘what is wrong with them’ (p<0.001), with 67.7% of people in the 18–29 years age group preferring this choice.

A significant number of patients (p<0.024) preferred their doctor ‘who would readily consult another doctor in case of any complication’, a second opinion with the patient in the second decade preferring this option in the majority (40.3%). A significant number of patients, the majority from the third decade (50%), preferred their doctors to ‘know them and their relatives personally’ (p<0.042). Patients from all age groups, the majority of whom were from the second decade (54%), expected their doctors to ‘show empathy’ (p<0.026).

There was no statistical difference between genders regarding the various preferences, except for the option of a second opinion, where males preferred this the most (67.2%).

Significant differences were noted when educational qualifications were compared with preferences. For example, patients preferred their doctors to explain the condition, treatment, and outcome of the disease (p<0.006), with graduates more likely to prefer this option (51.9%). Patients, especially graduates (56.5%), also preferred their doctors to inform them completely about their condition and treatment (p<0.006). Patients preferred their doctor to be a competent teacher for medical students and junior doctors (p<0.009).

DISCUSSION

Since ancient times, a ‘doctor’ has occupied the highest respect in society. Even the Bhagavad Gita, a classic Sanskrit epic, mentions the teachings of Lord Krishna, suggesting that a physician must possess 3 essential skills: Excellent knowledge, equanimity, and emotional attributes.⁶ Over time, doctor–patient relationships have evolved, giving rise to a new approach: patient-centred care. Parallel to these changes in physician– patient relationships, several studies have been done to identify who makes a good doctor.^2,3,7 We did this study to understand what an ideal doctor means to the Indian population.

With growing health literacy in India and increased access to health facilities and media, we observed that 339 patients (84.3%) selected autonomy as their most preferred domain. Similar findings were noted in other studies^2,3 as well where autonomy took priority over professionalism and humanism. Autonomy refers to a patient’s ability to make decisions about their own healthcare and have control over their own lives. It instils personal dignity, value and respect, thereby increasing self-esteem and confidence. However, to achieve this, the participants felt that a patient needs to be well informed by the treating physician in an understandable matter (68% participants), and the physician needs to be truthful about the illness (54% participants); however, the need to consider the patient’s preferences were only felt by 34%. As medicine moves towards a more standardized approach, it is essential to strike a balance between formal guidelines and individualized treatment options that may be experienced differently by different patients, prioritizing their autonomy. This open and transparent communication with patients is also further reinforced by social pressure, legal requirements, and the large number of young, progressive physicians entering the field.

The characters of humanism and empathy were the second most preferred attributes selected by participants. Patients want their doctors to respect them first as human beings and treat them with dignity, rather than merely treating them as ‘cases’. Beyond medical knowledge and skills, a good physician must possess moral judgment and actions, a kind attitude, and a trusting relationship with patients and their families.⁸ Approximately 43% of our participants felt that the doctor should listen to them attentively. The same number also felt that the doctor should not be the serious type but should have an informal approach to them; 37% participants felt that doctors should possess the quality of patient hearing. Some (39%) felt that talking to the doctor should instil some hope in them for the forthcoming treatment. Although our study did not prioritize humanism, we found similar opinions among patients in other studies. This was reiterated in a study by Haron and Tran at a mental health hospital in Israel, where humaneness was selected as the most essential attribute that patients desired in their physicians.⁹ They too felt the need to be treated as individuals, not merely as cases of illness. In yet another study by Wensing et al., humaneness ranked the highest, by 86% of the participants, followed by ‘competence/accuracy’ (64%).¹⁰

The domain of professional expertise was selected by 300 participants in our study. About 42% of people felt that the doctor should consider counselling about effective preventive measures, not just treat the current chief complaint. Less than half the population (35%) placed importance on the doctor being updated with current treatment concepts. Only 39% gave importance to the method of decision-making by their doctor. This was unlike a study done in China, where the participants valued strong clinical competency (mentioned by 97% of participants). Chinese patients expected that primary care doctors have high educational attainment and a good personality (mentioned by 41% of participants).¹¹ This disparity may be due to the difference in health literacy between the two countries.

Our findings are limited to the general public in Mangaluru and our results may differ according to the education status from region to region.

Our study showed that the younger generation preferred the domain of autonomy. This may be attributed to several factors, namely increased access to education which has empowered them with knowledge about their rights and choices in healthcare decisions. Second, the pervasive influence of social media has heightened awareness about patient autonomy and the importance of having a voice in medical decisions. In addition to valuing autonomy, younger individuals also prioritize humanism over professional expertise, which contrasts with the priorities of older generations. Younger individuals seek healthcare providers who not only possess technical proficiency but also demonstrate genuine concern for their well-being and actively involve them in decision-making processes. This trend underscores the need for healthcare systems to adapt by adopting more patient-centered approaches that integrate autonomy and humanism into clinical practice, thereby enhancing overall patient satisfaction and outcomes.