Gaps in Health System

Here we will discuss two of the most important of these gaps: doctorpatient relationship & lack of resources.

The Doctor–Patient Relationship

Why is the doctor-patient relationship so important?

The doctor-patient relationship involves vulnerability and trust. It is one of the most moving and meaningful experiences shared by human beings. However, this relationship and the encounters that flow from it are not always perfect.

The doctor-patient relationship has been defined as “a consensual relationship in which the patient knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person as a patient. the doctor-patient relationship represents a fiduciary relationship in which, by entering into the relationship, the physician agrees to respect the patient’s autonomy, maintain confidentiality, explain treatment options, obtain informed consent, provide the highest standard of care, and commit not to abandon the patient without giving him or her adequate time to find a new doctor.

However, such a contractual definition fails to portray the immense and profound nature of the doctor-patient relationship. Patients sometimes reveal secrets, worries, and fears to physicians that they have not yet disclosed to friends or family members. Placing trust in a doctor helps them maintain or regain their health and well-being.

اow does the nature and quality of the doctor-patient relationship affect health outcomes?

Gordon and Beresin asserted that poor outcomes (objective measures or standardized subjective metrics that are assessed after an encounter) flow from an impaired doctor-patient relationship (eg, when patients feel unheard, disrespected, or otherwise out of partnership with their physicians). Thus, there are many different outcome measures. However, these measures can be divided into 3 main domains: physiologic/objective measures, behavioral measures, and subjective measures.

What is patient satisfaction and how is it affected by the doctor-patient relationship?

Patient satisfaction is defined as “the degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, RELATIONSl.” Moreover, all 4 elements of the doctor-patient relationship impact patient satisfaction.

Trust: Bennett et al found that, among patients with systemic lupus erythematosus, those who trust and “like” their physician had higher levels of satisfaction. In another study, patients’ perceptions of their physician’s trustworthiness were the drivers of patient satisfaction.

Knowledge: When doctors discovered patient concerns and addressed patient expectations, patient satisfaction increased as it did when doctors allowed a patient to give information.

Regard: Ratings of a physician’s friendliness, warmth, emotional support, and caring have been associated with patient satisfaction.

Loyalty: Patients feel more satisfied when doctors offer continued support; continuity of care improves patient satisfaction.

Which factors can adversely influence the doctor-patient relationship?

While the attributes and benefits of a favorable doctor-patient relationship have been characterized, few studies have provided solutions for an impaired relationship. Therefore, we propose 4 categories (patient factors, provider factors, patient-provider mismatch factors, and systemic factors) that can interfere with the doctor-patient relationship.

Lack of resources

What is the impact of resource limitations on care delivery and outcomes?

Resource limitation, or capacity strain, has been associated with changes in care delivery, and in some cases, poorer outcomes among critically ill patients. This may result from normal variation in strain on available resources, chronic strain in persistently under-resourced settings, and less commonly because of acute surges in demand, as seen during the coronavirus disease 2019 (COVID-19) pandemic.

How can we Improve health-care quality in resource-poor settings?

Improvements in health-care quality can contribute to healthier populations. However, many global and national health strategies are not sufficiently considering the issues of measuring and improving health-care quality in low-resource settings. similar across different health systems. However, the extent and mechanisms through which these barriers affect quality improvement interventions may be different in resource-poor settings.

Investments in health systems strengthening without continuous quality improvement is thought to be a useless effort. Conversely, only focusing on quality improvement in a resource-poor context without engaging the broader health system for support is of limited value. Hence, both areas must be improved simultaneously.

Here, we call for renewed focus on quality improvement of health-system delivery by policy-makers, managers and health-care providers, working at all levels of health-care systems in resource-poor settings. To maximize the potential of quality improvements, we propose an approach focusing on five elements: (i) systems thinking; (ii) stakeholders’ participation; (iii) accountability; (iv) evidence-based interventions; and (v) innovative evaluation.

some of the elements are well supported by peer-reviewed literature, while other elements are lacking good evidence. We base our ideas on our experience in diverse countries and settings. We hope that bringing all these elements together into a unified approach will stimulate debate, highlight important research gaps and support policy-makers, health-care providers and patient and community representatives working in this field.