This Hippocratic Oath should apply to patients and their families too
My father, a hardworking civil surgeon posted in small towns in Uttar Pradesh in 1970-80s, began treating patients at 6 am every day. Each patient in the long queue would carry fresh vegetables, sweets, peanuts or even sugar cane as a gift for the doctor (besides the fee), irrespective of whether patient improved or succumbed to the illness.
Cut to the present. Now we hear reports of violence and destruction of property in hospitals and clinics, which reflects the society we live in — intolerant, bigoted, and parochial. In this general malaise of sectarianism, defiance and hostility, doctor-patient relations have taken a deep dive. The reasons are many. Doctors are easy targets. It is easy to misjudge actions they take while handling emergencies or in resuscitating patient from life-threatening situations.
Should a physician be faulted when patient dies? Of course, at times there are inadvertent human and system failures – hospital may not have echocardiogram or a CT scanner free at 3 am, a critical-care specialist may get delayed in a traffic jam, a nurse may be unable to inject adrenaline because of collapsed veins, or an emergency ambulance may take time to arrive.
Most often, the blame for all of the above goes to the doctor who faces the bereaved and highly emotional family, come of who lose control morph into an angry mob.
There is little follow-up of docors are injured or humiliated in violent physical and verbal attacks.
One reason is the growing distrust of doctors. I often hear patients say, “He charges a lot but my condition has worsened”, “my father was admitted in a critical condition and tests were done daily to increase the bill”.
Patients must understand that while doctors have the right to earn money for services rendered, these services concern amending dynamically deteriorating and a highly complex body systems that may not respond to the best possible treatment.
The result is ‘defensive’ or ‘aggressive’ medicine, where doctors opt for unnecessary referrals, tests etc. to ensure that a diagnosis is not missed and that there is a shared responsibility for all decisions. Additional referrals and tests add to the cost of treatment.
Many doctors and clinics now don’t even want to attempt treating critically ill patients, and instead direct them to overburdened public hospitals. The result is often counterproductive, as unnecessary referrals delay treatment and result in poorer outcomes.
Striking work is an ‘intense’ response and should not be part of a doctor’s life. Why, then, do strikes occur in India so frequently and not in developed countries? It is because the system in these countries makes sure that doctors are treated with respect, are provided a comfortable salary, good working conditions and adequate security.
That said, doctors must practice more transparent and honest medicine and action must be taken against cases of negligence. Financial transactions should be clear and accountable and above all, families must be clearly and frequently informed about disease progression.
Mending this broken system, mindsets, and assuaging hostilities and conflicts needs serious political introspection and specific actions. There should be faster police action, substantial legal and punitive damages to the perpetrators of crime, be it doctors who are negligent or patients who are violent.
State health ministers and secretaries should have an education in medicine and be sensitive to the problems of medical community.
Threat of physical violence is a deterrent to young people choosing a career in medicine, which anyway has fewer takers because of the long hours of study and work. The result could be poorly-skilled and inadequately-trained doctors constituting India’s future medical workforce, which would perpetuate and augment patient dissatisfaction and increase incidents of primal violence.
Dr Anoop Misra is a former professor of medicine at AIIMS and the head of Fortis CDOC Hospital for Diabetes in New Delhi