Improving the impact of health services delivery: The relationship between physician and patient in the Aravind Eye Care System Outreach Camp Project in Rayavaram, India

Abstract

This paper investigates the relationship between physician and patient at an outreach eye camp in Rayavaram, Tamilnadu, India. This outreach eye camp represents free ophthalmic care delivery to a rural, medically underserved population (n=32). In order to distinguish the effects of two different determinants (rural vs. urban setting and free vs. full cost care), the study included two additionally patient cohorts: urban, non-paying patients (n=33) and urban, paying patients (n=30). Audio recordings and interviews constituted data collection methods. The three components of a doctor-patient relationship that were studied through these data were power dynamics, treatment decision-making, and communication. Results indicate that the doctor-patient relationship in a rural, non-paying setting is characterized by a paternalistic power dynamic, paternalistic treatment decision making model, and moderately effective communication. This means that medical consultations were largely driven by the physician and fostered little patient control. The physician alone made decisions about treatment (when choices were available). Furthermore, there was a moderate level of communication from doctor to patient about the diagnosis and treatment protocol. Lastly, each consultation was largely a one-sided exchange as it offered little opportunity for the patient to express concerns or ask questions. Though medicine of the western world has increasingly come to embrace the concept of patient-centered medicine, the study discusses the harm associated with activating rural, poor patients who are ill-equipped to take personal health into their own hands. The study hopes that this understanding of the doctor-patient relationship will lay the groundwork for future research and inform strategies to enhance this interaction, thereby improving health outcomes of global health development projects.