© 2023 Aleksey Arkadyevich KRALKO, Victoria Yakovlevna KRALKO
2024 – № 1 (27)
DOI: https://doi.org/10.33876/2224-9680/2024-1-27/04
For citation: Kralko A.A., Kralko V.Ya. (2024) The Impact of Normative Regulation of Medical Activities on the Patient’s Trust in the Doctor, Medical Anthropology and Bioethics, No. 1(27).
Aleksey Arkadievich Kralko
Candidate of Medical Sciences, Associate Professor
Deputy Chief Physician
healthcare institution
Vitebsk Regional Clinical
Center of Psychiatry and Narcology”
(Vitebsk: Republic of Belarus)
http://orcid.org/0000-0001-7566-7529
E-mail: kralko2018@gmail.com
Victoria Yakovlevna Kralko
Doctor-methodologist
healthcare institution
Vitebsk Regional Clinical
Center of Psychiatry and Narcology”,
(Vitebsk: Republic of Belarus)
http://orcid.org/0000-0003-3186-0751
E-mail: kralko2017@gmail.com
Keywords: trust, medical ethics, bioethics, law, doctor, patient, interaction model, social norms, regulatory framework, medical activity, corporate culture, corporate norms
Abstract. The article analyzes the influence of social norms on the patient’s trust in the doctor. The influence of the norms of customs, norms of morality, corporate norms, norms of law on the formation of the institution of trust in the Republic of Belarus is considered. It has been established that the normative principles of legal regulation prevail in modern healthcare, but the influence of other social norms is no less significant. Violation of customs in medical practice can significantly reduce the patient’s trust in the doctor, as some patients have formed stereotypes about the behavior of the doctor. The degree of influence of normative regulation on trust also depends on the communication model of interaction between the doctor and the patient. The authors analyzed the influence of ethical principles on the degree of trusting relationships: the principle of respect for freedom, the principle of “do no harm”, the principle of benevolence, the principle of justice, the principle of respect for the integrity of the subject. The direct impact of legal norms on trusting relationships in medicine is considered, and a number of problematic areas requiring further study are identified. The article analyzes the norms of legislation on healthcare, the presence of which in itself can cause a patient to distrust a doctor. The role of corporate norms in healthcare, which are formed on the basis of corporate culture and corporate ethics, is shown. The conclusion is made about the great importance of bioethics in solving the problem of trust in medicine. The issue of teaching doctors modern bioethical approaches remains acutely relevant, the principles of bioethics need to be learned to implement in practice, as well as to take them into account when developing new regulatory legal acts and forming a corporate culture.
The authors analyzed the influence of social norms on patient trust in a doctor. The influence of customs, moral standards, corporate norms, and legal norms on the formation of the institution of trust is considered. It has been established that in modern healthcare, normative principles of regulation prevail, but the influence of other social norms is no less significant. Social norms are organically linked with each other and act as components of the general system of regulation of medical activity. Violation of customs in medical practice can significantly reduce patient trust in a doctor, since some patients have formed stereotypes about the behavior of a doctor. Patient trust in a doctor and the degree of influence of regulatory framework on trust also depend on the communication model of interaction between a doctor and a patient.
The patient’s trust in the doctor and the degree of influence of normative regulation on trust depend on the communication model of interaction between the doctor and the patient. Today, there are numerous classifications of models of interaction between the doctor and the patient. For example, R. Veatch distinguishes between the engineering, paternalistic, collegial and contractual models (Veatch 1994:67-72). In the engineering model of communication, the doctor considers the patient as a mechanism that needs to be returned to a position of equilibrium. At the same time, the patient’s opinion is useless and can even cause harm. In our opinion, with such interaction and direct provision of medical care, the doctor can widely use regulatory prescriptions and ignore the patient’s opinion, which will lead to a decrease in the level of trust. In turn, paternalism infringes on the rights of the patient as an autonomous person, since the interaction is not built as an equal, but as vertical, parent-child one. With paternalism, there is a significant risk of the doctor’s failure to apply the norms guaranteeing patient’s rights, which also does not contribute to the formation of complete trust. In the collegial model, the patient is more equal in interaction with the doctor, since there is an understanding of the common goal, and mutual trust is formed faster. The influence of regulatory control on trust in this case is favorable, provided that the patient understands the role of legal norms in health care and sees that the doctor applies them correctly. In the contract model, the doctor acts as a provider of medical services, and the patient is a client. In this case, clear legal and medical regulation of services will be applied, and trust may not be formed at all.
The authors analyzed the influence of ethical principles on the degree of patient trust in the doctor: the principle of respect for freedom, the principle of “do no harm”, the principle of beneficence, the principle of justice, the principle of respect for the integrity of the subject.
The direct influence of legal norms on the patient’s trust in the doctor is considered, and a number of problem areas that require further elaboration are identified. Considering the direct influence of legal norms on the patient’s trust in the doctor, a number of problem areas can be identified that require further elaboration. For example, the issue of patient mistrust in the diagnosis of diseases using artificial intelligence is currently being widely discussed. Even such a term as the phenomenon of “digital paternalism” has been introduced, which entails a loss of trust in qualified doctors. It is believed that the work of digital agents is the opposite of the traditional personal interaction of the patient with the doctor, which increases mistrust of medical services provided by people (Vvedenskaya 2024: 119). One of the proposed measures to increase trust in such cases is the creation of effective legal mechanisms that provide for liability measures for erroneous decisions of artificial intelligence, protecting the rights of doctors and patients when these programs are running (Kazakova, Tyulyakova 2023:64).
An ambiguous situation also arises with such a legal procedure as obtaining voluntary informed consent of the patient for medical intervention. On the one hand, obtaining such consent is intended to protect the rights of patients, but on the other hand, this procedure irritates the patient and contributes to the formation of mistrust. This increasingly translates the interactions between the doctor and the patient into commercial relations, likening them to a transaction between a service provider and a consumer, thereby reducing such a value as health to the level of a commodity. Trust, thus, goes into the business plane, in which each of the parties to the contract is forced to monitor the good faith of its implementation (Bashilov 2019: 119). The norms of healthcare legislation are analyzed, the presence of which in itself can cause patient mistrust of the doctor. In most cases, these norms are aimed at protecting the rights of patients, but not all citizens correctly understand their meaning and purpose, which gives rise to mistrust. Patient mistrust of the doctor and the healthcare system, as a rule, arises in cases where legislative restrictions are aimed at ensuring state and public interests. It is important to maintain a balance between the interests of the individual and the state, which in turn requires discussion in the field of bioethics and other social sciences.
The role of corporate norms in healthcare, which are formed on the basis of corporate culture and corporate ethics, is shown. A conclusion is made about the enormous importance of bioethics in solving the problem of trust in medicine. The issue of the need to train doctors in modern bioethical approaches continues to be relevant; it is necessary to learn how to implement bioethics principles in practical activities, as well as take them into account when developing new regulatory legal acts and when forming a corporate culture.
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