Why doctors and patients in Ukraine remain opponents, not partners: Oleksandr Bablyak explained the situation in medicine

Modern Ukrainian medicine remains at a point where the relationship between a doctor and a patient often resembles a confrontation. This situation has deep historical, psychological and systemic roots. About why a real partnership model of relations between doctors and patients has not yet been formed in Ukraine, what factors prevent this and how to correct the situation, ponders Oleksandr Bablyak, head of the Cardiosurgical Care Center of the “Dobrobut” medical network.

He believes that the contradictions between the doctor and the patient in most cases arise due to the difference in the expectations of both parties. The patient seeks help with pain, symptoms, often with a feeling of fatigue, fear and distrust, which have accumulated as a result of years of frustration in the health care system. A person expects to receive qualified, fast and human assistance.

The doctor hopes that the patient will cooperate, trust professional recommendations, adhere to appointments and take an active interest in their own health. Not every doctor normally perceives when the patient treats him as a service person or the last person to blame for all the problems of the medical system.

In the end, according to Bablyak, both doctors and patients want one thing: that the treatment process be clear, effective and predictable. However, they approach it from completely different positions, and it is this difference that often becomes a source of conflict. He explained that historically, medicine was built on the principle of paternalism, when the doctor was the absolute authority, and the patient had to trust him without question. This was especially evident in surgery, which began to actively develop only after the invention of anesthesia in 1846. There were few doctors then, and their word had undeniable weight.

Over time, Bablyak emphasized, with the decrease in the risk of death and the increase in the importance of quality of life, this approach gradually changed. In parallel, the concept of patient-oriented medicine emerged. Its key idea is to involve the patient in choosing treatment options. The doctor noted that this model still balances between two extremes: when the patient’s opinion is not taken into account at all, or when the patient decides everything on his own. It is difficult to find the optimal border between these two positions, since medicine has its own boundaries, rules and professional limitations.

As an example of such restrictions, he cited cases where certain types of treatment are not provided if the patient does not comply with certain medical conditions. For example, surgical treatment of pulmonary emphysema will not be performed unless the patient has stopped smoking for at least six months prior to surgery. And repeated treatment of bacterial endocarditis in drug addicts is not carried out due to the high probability of relapse in case of continued drug use. At the same time, there are situations where the treatment is carried out despite the patient’s non-ideal behavior, for example, coronary bypass surgery is performed on people who neglect their diet, smoke or do not control their diabetes. In such cases, regime violations complicate the prognosis, but do not critically affect the immediate outcome of the operation.

Bablyak emphasized that this problem of choosing between the doctor’s optimal solution and the patient’s wishes is universal — both for Ukraine and for other countries, but in Ukraine it is particularly acute due to the general distrust of medicine. He explained that over the past decades, a negative information background has formed in Ukrainian society around the health care system. The reasons for this were both real problems and peculiarities of the perception of reforms: every attempt at change inevitably focuses attention on shortcomings that need to be corrected. It is these weak points that are actively covered by the media and social networks, while positive changes are often overlooked.

According to Bablyak, the reform demonstrated how underfunded the system is. He cited data that more than 50% of medical care expenses are paid by patients themselves — this is 5-10 times more than in European countries. At the same time, clear co-financing mechanisms have not been created. In addition, as Bablyak noted, shadow payments that arose due to the unregulated economic activity of doctors undermine trust even more.

The patient finds himself in a situation where the state declares that medical services are free of charge, but in practice he has to find financing on his own. This creates in him a feeling of disappointment and mistrust, which become the main obstacle to the development of quality medicine.

An additional factor, according to Bablyak, is the spread of dubious information via the Internet. Patients often come to an appointment with knowledge obtained from “Dr. Google” or artificial intelligence, which creates additional complications in the doctor’s work. However, sometimes such patient activity can even be useful. He gave an example from his own practice, when the patient wanted to know in detail all the stages of the operation — from the skin incision to manipulations on the heart. This allowed the doctor to better understand the internal state of the patient and to focus on objective criteria when discussing treatment.

Bablyak believes that it is distrust that becomes the basis for the development of conflicts. It creates prejudice among both doctors and patients. On the part of doctors, these prejudices are reinforced by the large amount of fake, unverified or emotional information that circulates in the public space. This forces doctors to form their “fortress of expertise”, where the patient is perceived more as an additional risk factor, rather than as a partner.

Patients, in turn, also lose confidence in the system as a whole. Bablyak recalled how at one time the spread of stories about “black transplant specialists” slowed down the development of transplantology in Ukraine for years. Such fears are deeply entrenched in the public consciousness. He drew attention to another feature of Ukrainian medicine that contributes to the formation of mistrust: the lack of direct legal responsibility of a specific doctor to the patient. According to current legislation, the health care institution bears all responsibility, not the doctor personally. At the same time, the patient, seeking help, expects responsibility from the doctor as a person. This creates a gap in perception: the patient thinks that he is negotiating with a specific person, but in fact he is entering into a legal relationship with the system.

The doctor emphasized that the patient does not understand why the doctor cannot provide the expected care, for example, to hospitalize a serious patient. In fact, there are complex internal procedures behind this: financial obligations of the institution, responsibility of the management, tariffs for services. As a result, both parties remain dissatisfied, further eroding trust.

According to Bablyak, in order to change the situation, it is necessary to change the very architecture of relations in medicine — to make them transparent, honest and partner-like. On the part of the state, in his opinion, doctors should receive a professional license, which will give them not only rights, but also economic freedom and personal responsibility for the decisions made. This will allow patients to better understand the limits of the doctor’s responsibility, and medical professionals to have more freedom to make clinically optimal decisions. Also, clinical guidelines should be perceived as recommendations, and not as a strict control mechanism for any treatment outcome.

On the part of doctors, it is necessary to constantly work on the expansion of professional competences. The wider the doctor’s knowledge, the more calmly he accepts the difficult decisions of patients, better understands the permissible limits of decision-making and can reasonedly explain his recommendations.

According to Bablyak, an experienced doctor is not limited to the narrow practice of his institution, but relies on global statistical and clinical experience, sees trends even before they fall into standardized clinical guidelines. After all, many recommendations are formed on the basis of research, and sometimes — consensus of experts in those issues where research is impossible.

On the part of patients, Bablyak advises to leave their professional roles outside the doctor’s office. He explained that often patients unknowingly transfer their professional behavior patterns to the doctor’s office: businessmen look for benefits, lawyers for hidden traps, police officers for intent. Each visit to the doctor should be perceived as a new experience without the baggage of prejudices.

Bablyak emphasized that trust between the doctor and the patient is the key to effective medicine. It is not built in one meeting, but is formed gradually through honesty, clarity and professional work in every contact.