Interaction, Information, Involvement (The 3I strategy): Rebuilding Trust in the Medical Profession (original) (raw)

Indian journal of endocrinology and metabolism

Erosion of trust in the medical profession is an important issue which cannot be ignored. [1] While experts have, for long, exhorted doctors to self-reflect on the state of their profession, its priorities, and its future directions, this has been done in a generic manner. In this editorial, we use chronic disease management philosophy as a framework to discuss action which can be taken to rebuild lost trust. We suggest three actionable items which can recreate this trust and resolve the issue. The 3I strategy, as we term it, proposes interaction, information, and involvement as the three pillars of action. Interaction or communication between physician and patient can be strengthened by practicing "therapy by the ear." "Information" implies that equipoise should be achieved between physician and patient's information levels, to minimize distrust. Involvement of all stakeholders as proposed in Atreya's quadruple (physician, patient, drugs, and attendants) helps facilitate this process. ChRoniC Disease The Indian medical profession has a humungous task at its hands. Underresourced and understaffed, it struggles to handle the preexisting burden of acute, mostly communicable disease. At the same time, the profession's capacity is being overstretched by the rapidly increasing noncommunicable diseases, including diabetes, cardiovascular disease, respiratory illness, and cancer. Some of these conditions, such as diabetes, seem to have become endemic to the country and show no signs of abating. [2] The patient with chronic disease has a long, almost indefinite interaction with the health-care system and with the health-care professionals. Such a long-term relationship can be fruitful only if there is a bond of trust between both patient and physician and between patient and the health-care system. Kane and Calnan's call for building trust, [1] therefore, assumes greater significance in a country with a high burden of metabolic disease. ChRoniC Disease ManageMent Chronic disease management, especially diabetes care, is marked by a shared responsibility. [3] Unlike in acute illness, the person living with diabetes shoulders the major part of responsibility in managing diabetes. This responsibility is fulfilled by a process of informed and shared decision-making. Patient and provider share the responsibility of taking management decisions. This is done after the provider has