Caring for patients is a deep-rooted moral obligation in medicine. Apart from technical knowledge, good clinical acumen, politeness is a sign of a good doctor. Due to many pressures and high expectations from his profession, arrogance and verbal abuse to patients is not uncommon.  While community expects the doctor to be ’Mahatma Gandhi’ who offered another cheek after being slapped, the immense demands of the career place a lot of stress on the clinicians and often impoliteness creeps into practice. Due to the role played by healthcare in individual’s life, persona of the doctor is portrayed conflictingly as a hero or villain. Polite doctors make better doctors, which in turn results in healthier patients, according to several studies. It has been observed that doctors give attention to biomedical aspects but play down patients’ own values and feelings. This interpreted as impoliteness by the patient. Lack of respect and empathy are among the most common complaints made by patients. Doctor’s politeness is important for his team members as well; when a surgeon, who is in the position of power, is rude and belittles the rest of the staff, it affects everything.

A doctor-patient interaction no longer focuses on the technical or biomedical aspects alone but is expected to balance between the responsibility to improve patient’s health and respect for patient feelings. It is not uncommon when doctor is asked about the diagnosis, treatment and prognosis soon after entering in his chamber, even before the doctor has examined or taken history of the ailment.

It is accepted that patient centered approaches improve the overall outcome of therapy. A thoroughly informed patient and a shared decision making have at least proven to lower litigation issues. A lot of patience would be required to understand what the patient wants and differentiate it from what he actually needs. A thoroughly informed patient should be aware of all healthcare options available for his condition and also the final outcome of each of them. In many cases, the patient may chose an option that may be different from what the treating clinician thinks is best for him. These situations need to be adequately handled without restricting the patient’s autonomy. The underlying principle of ‘do no harm’ holds true even in a shared decision.  In fact doctor has to choose what is good for the patient and also what pleases him.

A tense situation does prevail in the current era due to the increasing incidence of assaults against doctors. The sad part of the story is the ineffectiveness of the justice system on providing a secure environment for doctors. The ultimate result is a suppressed hostility which cannot be ignored. Doctor often tries to save his own skin than doing best possible for the patient, when in crisis. The elements that lead to a conflicting situation often start with the initial interaction of the patient with healthcare. Most often the lack of empathy and respect are the reasons for patient’s dissatisfaction. The doctor may not always be the source of dissatisfaction, but most often he remains at the receiving end of all conflict, even caused by paramedical and lower staff. All professional interpersonal relationships dictate a linguistic standard that can necessarily be applied to doctor – patient relationships.  Culturally appropriate politeness and linguistic standards can repair any form of broken or hostile conversation. Often the doctor and patients belong to different social categories and a compliant interaction requires assurance of respect to the patient. Improved communication increases the confidence of the patient in his doctor. When technical and biomedical jargon is presented in a simplified version, it aligns the patient’s understanding with the healthcare interests and the patient’s respect for the doctor’s knowledge of his condition also improves. Consent is also an integral part of every interaction with the patient. Informed written consents should not be reduced to signatures at the bottom of a page of illegible jargon. A patient undergoing a procedure should be appropriately informed and allowed the freedom to refuse. Day to day clinical consultations have multiple instances of implied or required consent. Even enquiry into personal aspects of the patient’s life should be politely worded. “If it is okay, may ask you about any sexual encounters or addictions or substance abuse you may have?” sounds much better than a “Do you have any extra marital contacts or addictions or substance abuse?”

 

It would be essential to ensure that the patient understands and comprehends what is being told. When doctors disregard patients’ personal accounts, they risk missing information that is clinically important, making the consultations less medically effective. Also doctor needs to guide the patient to take an appropriate decision with complete understanding of treatment outcomes and adversities. Even when the patient waves his autonomy ensure that he fully understands what he is doing.

Nobody likes to be shouted upon. Even in a conflicting situation maintaining a professional tone of voice reduces the chances of provoking the patient. Never ridicule the patient’s weaknesses or life style. Politeness does not mean being a friend of the patient. Practicing politeness requires objectivity. Curriculum of medical education does not deal adequately with issues such as interpersonal relationships and professional communications or politeness. Changes must include a comprehensive understanding of behavioral science and how this can be applied to teach students and professionals to handle difficult communication. Every doctor is expected to be considerate and polite to their patients. Studies have shown that rudeness negatively affects the outcome of clinical interventions. An obnoxious spirit breaks down interactions and loses the point of doing the ‘best’ for the patient. Ultimately the patient wants to be cured and also feel pleased.

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