My entry for the Essay Competition 2015, Garima, I.M.A., Pune
Medical Services and Public Mindset
We had invited friends home, one day, for a get-together.
One friend’s husband is a Doctor who works in a Government Hospital. He
recounted an incident which happened, once, while he was on night-duty, at a
rural posting.
An emergency delivery operation was performed on
a pregnant lady with several medical complications, but her life as well as
that of her newborn infant couldn’t be saved, despite the painstaking efforts
of all the attending physicians. That deceased woman’s family members started
creating havoc by destroying the hospital’s property, threatening and
physically assaulting the Doctors. My friend’s husband, who was In-charge, that
night, had a tough time controlling that unruly and irate mob.
He tried explaining to them that precious
time had been wasted in referring and transferring her to various hospitals,
before reaching that Government Hospital, so she had already lost a lot of
blood when she had been brought in and had expired, despite all possible
treatment given to her. Thus it was not a case of negligence. But he was badly man-handled and
abused. At his wits’ end, he had to call the police.
All
of us assuaged his hurt feelings by reminding him of an oft-repeated proverb,
“Tough times never last, but tough people do!”
Indeed, it is tough being in the medical services profession these days.
Due to increasing awareness of their rights, patients and their relatives have
to be treated appropriately and with restraint too! A litigation case or a
Consumer Forum’s Redressal case, wherein a patient or his relative wins against
a Doctor or a Hospital; could damage his or the hospitals’ reputation!
The crux of this Doctor/Hospital/Medical Service Provider versus
patients/relatives/friends of patients’ issue is the perception of medical care
and its providers in the minds of the general public, which is the lay person.
We
may understand this issue by firstly defining the broad categories of medical services,
namely, Emergency services, Out-patient services, Primary care providers- Attending
physicians, Specialists, Allied services
like nursing, attendants, health insurers, Palliative and Hospice providers and
Administrative services for Billing and Transcription.
Each of these services is important and crucial in various contexts and could also prove to be the weak link
leading to customer, i.e. patient/relatives’ dissatisfaction and agony.
Emergency services provide urgent medical treatment. If the ambulance
arrives late, or if the patient arrives at the hospital within the golden hour,
but is refused treatment due to technical or legal procedural requirements, his/her
life is at stake. For instance, the hospital where he/she has been brought may
be an ill-equipped one, without an ECG machine, ventilator or have no spare
beds; or in case of road/train accident victims or attempted murder victims;
admission into a Government hospital may be mandatory. It may be necessary to
file an FIR in such cases and a spot panchnama
may be essential.
When
the persons accompanying such patients are informed about all these
conditions/requirements, they feel frustrated and victimized. Even routine formalities
like filling up admission forms seem time-consuming and irritating. Sometimes,
unfortunately, delay in fulfilling all the norms results in the patient losing
his life or becoming incapacitated for life, due to delay in treatment. The disconsolate
relatives blame the ‘insensitive doctors’ and the health-care system.
In hospitals,
it’s compulsory to pay the fees in advance, for tests and treatment. The
medicines, saline bottles, disposable syringes, etc. have to be purchased by
the relatives. Money is the crucial factor which aids speedy treatment.
The
Marathi movie ‘Anumati’ poignantly portrayed the utter helplessness and agony
of a man who tries to raise money for his terminally ill, beloved wife’s surgery
and refuses euthanasia. Ultimately, unable to do so, he loses the battle, both
for himself and his wife. Similarly, many people who cannot afford expensive
treatment for chronic diseases/ailments have to reconcile themselves to losing
their beloved ones. Some feel that if euthanasia is legalized, doctors will not
strive enough, to revive terminally-ill patients.
Prudent
people insure their health and lives. Some
are aware and desirous of insurance but can’t afford the premiums. Some think
that it’s futile to waste money on paying premiums. They may insure their
worldly possessions like cars, etc. but ignore their most important asset,
their own lives! Some even avoid opting for insurance as they find the schemes/claim
procedures confusing! Besides, they fear rejection of their claims on technical
grounds by the insurers, hence think that their premiums may not actually
guarantee life/health cover. Unscrupulous ones opt for policies with huge sums
assured, so that they can avail of expensive medical check-ups, at the
insurers’ costs.
With
the recent amendment to Section 45 of the Life Insurance Act, the entire death-
claim investigation process has been scrapped. Hence no claim can be repudiated
by the life insurers on basis of wrong-statement or non-disclosure of material
facts in the life insured’s proposal form for availing life insurance.
Recently, the Government has initiated some note-worthy initiatives in
group insurance like the Prime Minister’s Jeevan Jyoti Bima Yojana(PMJJBY) for
providing life cover and the Accident Insurance Scheme at nominal costs, to all
bank-account holders in India. The enormous response to these schemes shows
that the general public wants to provide a hedge against untimely demise or
probable disablement due to an accident.
Out-patient services provide treatment without hospitalization. If the
diagnosis is faulty, the patient will suffer needlessly. When I was 10 years
old, I fell very sick and was rushed to a private clinic. That doctor wrongly
diagnosed me as having typhoid and started treating me accordingly. When my
condition deteriorated, she referred my case to a renowned hospital. I was
immediately hospitalized. I had severe jaundice and not typhoid! We then
realized how patients’ utmost faith in their physicians could prove dangerous
if the physician wasn’t competent enough! My parents gave her a piece of their
mind and we never visited that doctor again!
Nowadays, doctors play it safe and immediately ask for certain lab-test
reports to confirm their diagnosis. Some unscrupulous ones unnecessarily ask
for the same as they have contacts with laboratories that pay them a fixed
commission per case referred. Patients have to pay through their noses for
expensive and needless tests. Some doctors treat patients like guinea-pigs, with
free drug samples obtained from salesmen of pharmaceutical companies, without
ascertaining their effectiveness. They even charge them for the same! Such
malpractices have largely eroded the patient-doctor intrinsic trust.
Hospitals
too, keep prolonging treatment, refuse to discharge patients soon and bill the
patients exorbitantly. Often, allied health-care providers like nurses and
ward-boys are negligent in their duties. Some of them expect money, the
ubiquitous “chai-pani”, to discharge
their duty!
Some
doctors in Government hospitals run a profitable private consultancy during
duty-hours and leave the hapless patients in the care of the compounders.
Recently I read a report about a compounder who acted as a doctor and
unsuccessfully tried to perform a delivery operation. He was unable to stem the
profuse bleeding; leading to that lady’s death.
This
feeds the public’s perception that medical treatment has become a commercial
activity these days. It feels that the Hippocratic Oath taken by the doctors
while stepping into this profession is just hypocrisy and they lack
involvement, commitment, ethics and integrity. This skepticism is also fueled
by reports like the Vyapam scam in Madhya Pradesh, wherein the entrance tests
to medical colleges, etc. was rigged. It rightly feels that persons qualifying
through such tests or through cheating in exams won’t become competent doctors.
When
Resident Doctors in Government Hospitals and other allied staff go on strikes
to press for their legitimate demands, the public is inconvenienced and
angered. It fails to consider the working conditions or long hours of their
duty. Many protest against those doctors who shirk practising in rural areas.
Medical negligence also irks people.
The
high premium placed by parents on their wards entering the medical or
engineering streams to later have lucrative careers in India, or abroad; and
the huge dowries demanded by them during the proposed marriages of their
‘qualified Doctor/Engineer sons’, to compensate for the cost incurred on their
studies; is a bane too!
The sensitivity and care of the earlier ‘family doctors’ who were more
like family members, seems to be missing these days. Some doctors don’t respect
the patient’s confidentiality while others speak rudely and refuse
after-duty-hour cases. While it is understandable that the doctor too needs his
‘me-time’ or may be genuinely busy with other patients, what rankles is his/her
apathetic and callous attitude. Specialists charge exorbitantly for
consultancy. A humane approach would be definitely welcome.
The unprecedented care and treatment accorded to nurse Aruna Shanbag,
the survivor of a vicious sexual assault; by the doctors, nurses and support
staff of KEM Hospital in Mumbai; for nearly 4 decades, is a shining testimonial
of such a humane approach.
Palliative and hospice providers help the terminally-ill or bed-ridden
patients. They must be knowledgeable, attentive and sensitive. Their charges
must be reasonable.
Hygiene also needs to be addressed in the health system. Some hospitals
have over-flowing garbage bins around them or don’t have a proper bio-waste
disposal system. The medical instruments aren’t sanitized sufficiently, leading
to risks of infection. The allied staff perform tasks without gloves, which
could endanger their and the patient’s health.
A recent news-item mentioned how the immunization centre at Faridpur Community
Health Centre(CHC) in Uttar Pradesh, had stocked hooch bottles in a
refrigerator instead of the heat-sensitive polio vaccine vials. Among the 208
infants exhibiting polio-like symptoms, 38 were confirmed as polio cases. Later,
files pertaining to the immunization records were found in the freezer there. Such
shoddy attempts to cover up crimes and criminal negligence must be severely punished,
as deterrence for the likely offenders and to instill faith in the minds of laymen.
Hence proper hospital-administration is the need of the hour. The Superintendents
and P.R.Os of the hospitals must ensure that the public’s complaints are
immediately redressed so that the hospitals’ image doesn’t suffer.
On the other hand, the layman must also stop popping OTC (Over- the- counter)
pills for minor ailments and consult doctors promptly, avoid hypochondria and
stop consulting the doctor for imaginary ailments or diseases, mustn’t ask the
doctor for fake certificates to prove that he is unfit for skipping duty or in
some cases; avoiding imprisonment, mustn’t illegally opt for
gender-determination sonography, must provide all the material facts in the
proposal form for life/health insurance to avoid the risk of the proposal’s
rejection by the insurance underwriters.
He must scrupulously follow the doctor’s
instructions regarding medication, treatment and follow-up to avoid reactions/complications.
He mustn’t avail of treatment through various medical streams (Allopathy,
Homeopathy, Ayurved, Unani, etc.) concurrently; to avoid complications. He must
avoid consulting quacks, must go for preventive health check-ups and avail of
consultancy and treatment, must stop blaming the doctor for negligence unless
he can really prove it.
The
Government must ensure that a robust health delivery system is in place. Proper
implementation of rules, stringent checks on unscrupulous practices of
doctors/laboratories/clinics/hospitals/pharmaceutical companies, strict penalty
and punishment to offenders and incentives/subsidies for innovation in preparing
effective drugs/vaccines, standardization of Doctors’/Specialists’ fees/Lab
test fees, provision of quality surgical instruments and accessories, reduction
in costs of surgeries through subsidies and crack-down on quacks is essential.
The
Government is currently considering a proposal to offer sex-change/re-alignment
operations for trans-genders at Public Hospitals, free of cost or with a
subsidy. Thus the economically weak trans-genders can lead new lives with
bodies of their choice/identity. Similarly affordable and reliable health
services will provide succor to all the citizens.
Nowadays, medical tourism is providing foreigners with excellent and
affordable surgeries in India.
Recently, in Chennai, the entire city’s
machinery coordinated seamlessly, in transporting vital organs for urgent
transplantation, for the life-saving surgery of a patient. It was an excellent
example of “Where there is a will, there is a way!” Such cases are heartening
and offer hope to the common man that someone genuinely cares for his
well-being. And values his precious life!
The copyright of this essay is with Mrs. Priya Ramesh Swaminathan.
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