Medical Services and Public Mindset

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.