"Studies have shown that patients often claim or sue because they are poorly informed about the benefits and risks of treatment, and are not given satisfactory explanations following adverse outcomes of treatment. Patients also sue because they perceive their doctors as uncaring or insensitive to their needs."
The reason I quote this is geography, not content. The speaker's perspective has been part of U.S. medical and nursing education for decades. The quote, however, comes from Heng Chee, the minister of health in Singapore.
Health care is increasingly a global process. Drugs and devices are part of international commerce. Health personnel migrate -- largely from developing to developed economies. Developing countries compete for medical tourism customers. And more.
Minister Heng Chee's comments suggest that as economies develop, as has happened in Singapore, citizens expect informed consent, respect for patient autonomy, and a more collaborative/less parentalistic clinical relationship. The U.S. has been in the lead in conceptualizing these values. We have much to teach.
At the same time, there is much for us to learn. Some years ago, on a visit to Benares Hindu University Hospital in India, I saw what I took to be a nurse lovingly combing the hair of a psychiatric patient. When I asked about the remarkable "nursing care" the psychiatry resident who was guiding me and my wife around the hospital explained that the "nurse" was the patient's mother, and that families accompanied patients to the hospital. When we -- guided by the U.S. preoccupation with autonomy -- asked the resident whether patients might be concerned about privacy, he didn't understand our question. Patients feared extrusion from the family, not loss of privacy. The family presence, he reported, was largely reassuring.
We can teach a lot about autonomy values. But we have much to learn about community!
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