Trust, regulation, and stewardship of the medical profession in India

In this paper we discuss the consequences of commercialisation of medicine and the associated shift in professional values, identity, and practices for patients, doctors, and health care organisations in India. We do so within the broader frame of the widely reported fall in trust in the health system in India, and with a view to reflect on how trust may be restored to a level which sustains a different but effective type of relationship between the medical profession and society. We draw on interviews with high-level health system and social actors in India to shed light on the key influences which shape the stewardship and governance of the health care system and the medical profession in the light of mounting evidence of and concerns around the erosion of public and patient trust in these institutions in India. Analysis is presented through four interrelated thematic articulations. Two themes highlight the practices of doctors and the actions of patients which contributed to changes in their relations and particularly a decline in trust. Two further themes focus on the policy and practice implications for regulation and stewardship of the health system and the medical profession.