10 Credibility in health care

The Shepherd's Boy and the Wolf: A shepherd boy used to derive great fun by fooling the people in the village. Often he used to pretend that a wolf was attacking his flock of sheep and shout loudly, “Wolf! Wolf! Please help!” When the villagers in the vicinity came to his rescue, he used to laugh at them. Over time, most villagers were aware of his pranks. Once a wolf really appeared on the scene and when the boy cried for help, no one took notice. The wolf had its own way and devoured the sheep at its leisure.

A) Provider's credibility

Acme Ultrasound Lab. became notorious for over diagnosing gall stones. Based on the report from this Lab., many surgeons initially 'burnt their fingers' by operating on normal gall bladders. Later they became more circumspect about reports from Acme lab. One day, a technician of the Lab. was seized with acute abdominal pain. His scan, done in the same Lab., apparently showed a gall stone. He was referred to a surgical unit. "Report from Acme Lab? Forget it," said the surgeon and ordered a repeat scan at a centre with more credibility.

Comments

To gain acceptability, it is very important for diagnostic services to establish credibility. Credibility is earned by providing high quality and reliable service over a long

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period. Some health care facilities try to purchase credibility by offering kickbacks and commissions. This may bring short term gains but will prove to be a poor long term strategy if the services are unreliable as "one cannot fool all the people all the time".

It is also true that in order to collect the kickback, unscrupulous care providers may use the credibility factor as an excuse to misguide care seekers to undergo additional tests at unethical health care services that indulge in 'cut-practice', i.e. giving a part of the fee collected as a cut to the referrer (see Chapter18).

B) Seeker's credibility

Raju, a 25 year old unemployed youth, was brought to the casualty with acute severe abdominal pain. The attending surgeon found four surgical scars on his abdomen. He told Raju, "Your history sounds just like acute abdomen but you have already been operated four times earlier. I think you may be a case of Munchausen syndrome and need psychiatric help."

Comments

A health care seeker (a patient) is in fact not a mere consumer but a co-provider - a provider of important historical information about the illness. It has been estimated that as much as 86% of diagnostic information comes from the history of illness. Physical examination and laboratory tests provide only 6% and 8% of information respectively (Hampton 1975). So it is quite easy for anyone to bluff his/her way into any hospital.

The ideas that a health care seeker is a co-provider and a partner in health care delivery have to be understood by health activists and public. The health professionals should endorse these views by cultivating the habit of talking with the patients instead of merely talking to them.

Munchausen's syndrome refers to a compulsive attention seeker who goes around with imagined illness and basks in the attention of health care providers. Raju is an extreme case who has fooled the surgeons into operating on him. Note: There are also some genuine

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medical conditions that present like a surgical abdomen leading to negative surgical explorations. These cases may be falsely labelled as Munchausen's syndrome and put under psychiatric care.

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