Medical Decision-Making in Bangladesh: A Triad Interplay (Family, Patients and Physicians)”

Abstract

<p>Three commonly cited models of medical decision making are used around the world: physician-centered, patient-centered and family-centered. The physician-centered model describes the physician alone taking the central role in determining medical interventions and treatments on behalf of the patient. Family members and patients often have only limited involvement in the decision-making process, with the assumption that the clinician’s decisions are in the best interests of the patient. In contrast to the physician-centered approach, the patient-centered model places the patient at the forefront of decision-making. It emphasizes the patient’s autonomy and their right to decide on medical treatment. Patients are encouraged to actively participate in decisions about their healthcare, with healthcare providers offering guidance and information to support them in their choices. This approach has become particularly prevalent in North America and Europe and emphasizes the rights and preferences of the individual. The family shared decision-making approach plays a central role in medical decisions, as it is assumed that their close relationship with the patient brings with it a moral and legal obligation to act in their best interests. Physicians and patients are expected to respect the views and concerns of the family. The family shared decision-making model is widespread in many South East and South –Asian countries. The focus of this study was on how Bangladeshis make medical treatment decisions for their patients. The main question of this study was: Which model is best suited for Bangladesh and what role do families, patients and clinicians play in medical decisions in this country? In addition to the observational method, this study also conducted 30 in-depth interviews with physicians and nurses, patients and their relatives (family members) in a publicly funded college medical hospital in the capital city of Dhaka, Bangladesh. This ethnography revealed that medical decision-making in Bangladesh is shared by families, patients and physicians. Religious ethics, societal ethos and economic realities support the practice of shared medical decision-making in Bangladesh to achieve good healthcare outcomes. However, this study emphasizes the importance of building trust in the healthcare system and empowering patients to make medical decisions.<br></p>