1. Sangam Yadav, 35, a taxi-driver had severe abdominal pain, he was treated in casualty department but did not get relief and wanted admission. But the lady doctor did not feel he was serious enough to need admission. A scuffle and doctor-bashing. Indeed – patient was not serious.
2. Ramdas Patil, 33, an auto-driver attended V.N. Desai Hospital in Santa-Cruz(E), in early morning hours. He was given an injection but died within 10 minutes. Doctors were blamed for “delay” and for “wrong” injection. Mob-Fury, Hospital property damage, Dharana, doctors’ strike. Finally, diagnosis haemorrhagic pancreatitis – nothing could have been done. The injection was innocuous.
3. End stage renal disease, patient admitted repeatedly-died. Yet Dr. Dahake assaulted and injured in K.E.M. Hospital.
4. A patient delivers in private nursing home, but starts bleeding profusely. The doctor transfers the patient urgently, even accompanies the patient – inspite of transfusions and efforts, patient dies. The relatives go back to the Nursing Home and destroy furniture and equipment. Postpartum haemorrhage is a rare but known dreaded complication of even a normal delivery.
Incidences are galore, but the reaction of the Press and general public is same. ‘Doctors/hospitals are negligent, and sympathy for the mob’. Even if their violent acts are mildly condemned, they were ‘Angry’, ‘Upset’ ‘Agitated’- Never ‘Roudy’ ‘Hooligans’. There is hardly any word supporting the claims of the doctors/hospitals that the violent incidences were totally unjustified. It is left to the Association of the medical professionals to defend themselves. Naturally, ‘Bandh’ and Strikes are becoming part of their professional life.
But is that all? No. The escalating costs of health services and over crowding of the tertiary hospitals are directly related to these strained relationships. Generally, the doctors are highly sensitive about-even scared of – complications or deaths at their hands; these cause disrepute and adversely affect their practice. Therefore, by nature, doctors advise more investigations and more precautions than really necessary-to be on the safer side. But two generations back, they took into account the patient’s economic and social condition and often took upon themselves the burden of deciding not to overburden him with heavy expenses, by avoiding costly modes of investigation and treatment. Now no more! With the dangers of law suits and even more – of assaults and damage to property– Darwin’s law of ‘Preservation of self and preservation of species’ overrides all other considerations.
Doctors ask for every investigation, prescribe the most-modern costliest of medicines and on the patients’ raising slightest doubts, seek self-protection by calling higher specialists, cardiologist for chest-pain, diabetologist for diabetes, and nephrologist for urine trouble. Too many cooks easily spoil your (health care) broth. (Crooks? No. I really meant cooks). Normally, faith heals; but when suspicion and antogornism grow, faith cannot heal. Every symptom has to be proved objectively to be inconsequential. Therefore, your headache is cured by the same aspirin but only after MRI of the brain, and fundoscopy by an ophthalmologist. Your pricking pain in the chest calls for Angio-graphy, after ECG, Stress-test and 2-D Echo, to be declared as due to indigestion and gases.
But this is not all! if you get admitted to a nursing home or a small hospital, you will certainly be treated well as long as your condition is relatively stable or you need a relatively straight forward operation. But, if the patient becomes even a bit serious and/or relatives start asking too many questions, most of the average doctors play safe and advise the patient to go to a major hospital –even when he has enough knowledge and skill to treat the condition – ‘No Assault, No Destruction, No Law–suit, please’, they seem to say. Thus, many I.C.U. patients are transferred to 5-star hospitals. This explains the strange paradoxical phenomenon that there is no bed available in a 40-50 bedded I.C.U. of 5-Star Hospitals despite exorbitant costs while I.C.U.s in small hospitals are virtually vacant.
The situation in public hospitals is even worse. At one time, peripheral hospitals were bristling with activity. Lecturers and post-graduate student residents were posted and fresh young honorary specialists were keen to gain experience. Learning Experience was a great motivational force. No more so now. Now it is drab routine working. With fixed (low) salary or honorarium, money-incentive is zero. Job satisfaction would have been a good motivational force if, indeed, there was any job satisfaction. Are the patients grateful? Instead, there are mostly complaints and grievances and the ‘elected’ ‘rulers’ come shouting and cursing the doctors who are only ‘Paid’ ‘Servants’. Why should they risk assaults and damages at all? It is better to pack off every risky patient, be he a medically risky patient or a socially risky person. Everyone is advised to go to major teaching Hospital-Sion, KEM etc.. The simplest excuse is lack of staff and/or lack of equipment. A clamour for more staff and modern equipment is strongly supported by people, the Press and the Media. This explains another strange phenomenon that teaching hospitals are over-over-crowded while peripheral hospitals work with ‘Susegad’ style upto 2pm or so and then virtually go to sleep. When someone like Ramdas Patil suddenly disturbs this sleepy atmosphere in early morning hours, at V.N. Desai hospital in Santa-Cruz, it is no wonder that things go wrong. The ‘Susegad’ style of working can not suddenly change into Jet’ style, anywhere in the world. Some scape-goats are massacred and everything continues as usual.
Much more attention is required in various other directions. Medical Education has to be re-oriented to become compatible with social needs. System of working must be changed, proper motivation ought to be created for doctors to work – and performance based emoluments has to be one of them. But at the same time, ‘Riots, Assaults and Destructions’ ought to be condemned outright – whether the doctor/hospital is right or wrong. It can not help – It certainly worsens the situation – and people will suffer more. People will have to develope a little more faith in doctors – at least those who talk and explain – and allow them to make errors of judgment; often not even that – the death or the complication could be inevitable, unavoidable. Please allow Doctors to make mistakes – so they will be willing to treat you at reasonable costs and available facilities.
About: Dr. Sadanand Nadkarni
General Surgeon, Former Dean, L.T.Med.College, Sion.
Contact: firstname.lastname@example.org, 9320044525
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