Thesis on Doctor And Patients Relationship


The Dhaka Medical College Hospital (DMCH) is the central point of public health services of all the government hospitals in Bangladesh. It was established in 1946. Everyday, on an average, 1,432 patients come to the outdoor and 450 to the emergency units of the hospital, while 184 patients are admitted to the indoor for treatment. The patients are supposed to receive medical treatment at a low cost as it is a government-run hospital. However, it is alleged that the patients are regularly deprived of the health facilities due to a number of irregularities and corrupt practices. This paper contributions and applications in the field of healthcare & hospital management. The paper summarizes a range of Max Weber theory of bureaucracy, results in the following areas: waiting time in taking medical facilities, health facilities and utilization analysis, system design of Dhaka Medical College Hospital (DMCH) and appointment systems of nurses, 

doctors and hospital staffs. The paper also considers results for systems at different scales, including individual departments or units (outdoor, indoor and emergency department in DMCH), healthcare facilities, barriers and healthcare systems in district level. The goal is to provide sufficient information to analyze organizational management, health services management to model a healthcare process and want to locate the details of relevant models. 

The organizations that care for persons who are ill and injured vary widely in scope and scale, from specialized outpatient clinics to large, urban hospitals to rural healthcare systems. Despite these differences, one can view the healthcare processes that these Organizations provide as bureaucracy systems in which patients arrive, wait for service, obtain service, and then depart. The healthcare processes also vary in complexity and scope, but they all consist of a set of activities and procedures (both medical and non-medical) that the patient must undergo in order to receive the needed treatment.

The main starting point of this paper is the idea that trade unions do not only care about real wage level but also about a reference or aspiration wage level. After citing a number of empirical works, the paper argues that the attainment of the reference wage is a priority for the union. This implies that there is a hierarchical character in union objectives. A two-step union utility function is suggested in order to capture the change in priority once the prime objective (the reference wage level) was reached. The analysis is conducted in an efficient bargain framework, and shows that employment-wage combinations come into the picture only when the reference wage is reached. In a unionized economy, this implies that substantial increases in employment will take place only after the union reference wage has been met.

Health is a state of complete physical, mental and social well being and merely not an absence of disease or infirmity. Health is universally regarded as an important index of human development. Health is also a fundamental right of the population. Constitutionally the Government of Bangladesh is obligated to ensure provision of basic necessities of life including medical care to its citizens [Article 15(a)] and to raise the level of nutrition and to improve public health [Article 18(1)]. Bangladesh is committed to achieving the millennium development goals (MDGs) by 2015 and has been pursuing various programs to translate the MDGs into reality. 

In urban health, good health remains beyond the reach of many of the urban poor and particularly of slum dwellers. Morbidity and mortality is the highest for children from urban slums. The pace of urbanization has outstripped the pace of development of social services and infrastructure required to meet people’s need. Concurrently, uncontrolled urbanization is leading to creation of slums, overcrowding, poor housing, inadequate water supply and poor environmental sanitation, with detrimental effects on quality of life and outbreak of infectious diseases like the dengue outbreak over the last few years. Meeting the health needs of the fast growing urban poor of Bangladesh will continue to pose major challenges for the government. 

Since independence Bangladesh has made significant progress in health outcomes. Infant and Child mortality rates have been markedly reduced. The under-five mortality rate in Bangladesh declined from 151 deaths per thousand live births in 1991 to 62 deaths/1000 live births in 2006 and during the same period infant mortality rate reduced from 94 deaths per 1000 live births to 45. EPI coverage extended its reach from 54 per cent in 1991 to 87.2 per cent in 2006. The MMR reduced from 574/100,000 live births in 1991 to 290 in 2006. Deliveries attended by skilled birth attendants increased from only 5 per cent in 1990 to 20 per cent in 2006. The prevalence of malaria dropped from 42 cases /100,000 in 2001 to 34 in 2005. Bangladesh has also achieved significant success in halting and reversing the spread of tuberculosis (TB). Detection of TB by the Directly Observed Treatment Short-course (DOTS) has more than doubled between 2002 and 2005, from 34 to 71 per cent. The successful treatment of tuberculosis has progressed from 84 per cent in 2002 to 91 per cent in 2005. Polio and leprosy are virtually eliminated. HIV prevalence is still very low. Development of countrywide network of health care infrastructure in public sector is remarkable. However, availability of drugs at the health facilities, deployment of adequate health professionals along with maintenance of the health care facilities remain as crucial issues, impacting on optimum utilization of public health facilities

Medicare services are designed to meet the health needs of the community through the use of available knowledge and resources. Health services are delivered by the health system which includes management and organization matters.

The health services organization of Bangladesh follows the general administrative divisions of the country. Administratively the country is divided into 4 divisions, 21 religions (former districts) 64 districts (former sub-divisions), 512 Thana and 4708 unions.