Monday, 22 August 2016

IN DEFENCE OF A PROFESSION: A Doctor’s perspective


…………………………A Doctor’s perspective
Dr. Dharamvira Gandhi, MD   (Medicine)
                                                          Member Parliament, Patiala.

It is very disturbing and frustrating to read and watch almost daily, the painful stories of fast deteriorating patient-doctor relationship, in print and electronic media. The increasing incidents of patient’s relatives attacking doctors, ransacking hospitals and doctors retaliating with scuffles and strikes are bound to cause irreparable damage to ages—old historical sacred relationship and bring it to the lowest ebb in near future, if remedial measures are not taken quickly.

Our people and we the doctors can’t afford this tense relationship for long.  There is an urgent need for the medical fraternity and the society at large, (the community leaders and opinion makers in particular) to discuss thread bare, analyze and sort out the problem at both ends.  Moved by recent unfortunate happenings across the country, I am writing this article from a doctor’s perspective with a hope that all concerned will also respond and initiate a healthy debate, best in the interest of ailing humanity and society as a whole.  Let us put in sincere efforts and try hard not only to save, but take this sacred relationship to new heights of mutual understanding, confidence and glory.

During my medical career spread over 40 years, I have attended to and served my patients to the best of my knowledge and capability, with total devotion and professionalism, surely like my own family members. During these four decades, I have interacted with and treated lacs of people and have enjoyed their great affection, respect and gratitude, which continues to be and will always remain till my last breath, the greatest and richest treasure of my life.  I have never been and in fact, can never think of being negligent towards my patients.  Even at 63 today, I wake up at the first telephone or doorbell ring, not that I need to earn more money, but because of my professional commitment and sensitivity, I love to preserve. 

For me, my patient was never and neither will ever be a “consumer”. Patient doctor relationship is a sacred relationship bases on absolute and immense faith which patient reposes in his doctor, and offers his life or that of his beloved ones to a person, with whom he has no blood relations and at times, has met him (the doctor) for the first time.  I firmly believe that this faith has no parallel, in known human behavior.  As a doctor, I have always felt small, in front of this faith of the patient and it is this feeling which keeps me working day in and day out, for the welfare of my patients.  It is this faith which compels me to spend tiring and sleepless nights for my patients, swimming and sinking with their clinical state, reflecting upon and affecting not only my own mind and body, but that of my whole family.  No amount of money, no court, law or legislation can compensate my 30years of physical and more importantly my mental and psychological involvement of my wife, my daughter and my son.  Money, if at all is and always was, too small, rather too un-important part of this whole relationship.  I hereby declare that my patients can never ‘pay’ me for my exhaustive involvement in them. They are rather too poor to do that.  They can feel indebted and express gratitude to me throughout their life, as I feel indebted to them for the faith they put in me. It is this superb relationship which differentiates medical profession from any other profession.

Doctors who relish profession at this emotional and spiritual plane are now being made believe that their patients are now the ‘consumers’,. One cannot imagine how much this new definition of sacred patient-doctors relationship has tortured  and discouraged people like me during the recent years.  I express honestly and frankly, that his ‘patient as consumer’ concept, will adversely affect patients more, that the doctors.  It is the public large, which is going to be at the receiving end in this game and not the doctors, who will become smart enough over time ,to escape or guard themselves against legal aspects of increasing litigations, of course with high-tech investigative plans, taking insurance covers and ensuring bit of more legal formalities. Let somebody convince me as to, how one can do justice to his profession and provide scientific, rational and yet affordable treatment to great majority of patients in this poor country, when every patient one starts conceiving, as a potential litigator.

          We the doctors, working in developing countries like India, have to deal with vast majority to patient population which is took sick and too poor at the same time, to afford anything.  In a country, where govt. is totally apathetic, insensitive irresponsible towards the health of its people, where health insurance is still a distant dream, where religious heads instead of building health institutions are busy in making more and more of temples and gurudwaras, where NGO sector is weak and public at large gullible,  it is we the doctors, who are left to carry the burden of providing health care to the helpless majority. While   dealing with the semi-starved patient of course now a ‘consumer’, we the doctors often have to act as social activists, as social scientists and many times have to make compromises with our knowledge and tailor our science with the sole idea of helping the patient best, with the available resource in that given situation.  It is irony of the situation, that if such patient turned ‘consumer’ incited by smart ‘friend’s files a case against the doctor, the law wants us to have acted and performed according to the western standards.  This attitude and approach is totally divorced from the hard socio-economic realities, existing in the country today.

This attitude, of the law, state and society will certainly sap the already fast eluding spirit of sympathy and compassion from doctor’s community.  It will kill their remaining sensitivities and make them ‘full businessmen’ for whom patients will be the objects and just “consumers” as they are being made to believe today.

Now let me talk of medical science itself and plight of doctors thereof, from whom the law and “consumers” expect to deliver with mathematical precision and perfection.

The law makers and our ‘consumers’ are perhaps ignorant of the fact that medical sciences is an ever evolving and completely complete science.  The entire medical literature is full of its and buts, conflict and controversies, still grappling with thousands of unresolved questions and mysteries.  Till date, it is an imperfect science and probably will continue to remain so, for the times to come and may be for indefinite period. 

One would appreciate the fact that human body behavior is yet far from being completely understood.  Numerous, mysteries regarding functioning and ‘mal functioning’ of various human organ systems are still unsolved and continue to challenge the available global medical wisdom.

Harrison book on internal medicine, often quoted as the ‘Bible of medicine’ in chapter 125 of its latest edition, on ‘Fever of unknown origin’ clearly mentions that in spite of best available diagnostic tools and best input of medical knowledge,19%  cases of fever remain undiagnosed and this number  is not negligible

Let people clearly understand that medical science as it stands today, lays only broad guidelines regarding diagnostics and modalities of treatment and does not claim them to be mathematic-specific.  These guidelines are based on group data and not on individual data.  This simply means that while generalities may hold good, yet certain subsets of patients can behave and in-fact do behave in a totally unpredictable manner, which is beyond the comprehension of available medical knowledge, at lease today. Moreover, solutions to medical challenges are sought from animal models, while humans are much more advanced and complicated species that their ancestors.  You cannot extrapolate results of animal experimental  models with that level of precision, as required in  humans.  For any science to be perfect, it is mandatory that in order to understand the possible “wrongs”  with the machine, one wants to master, one should be free to dismantle it step by step and throw it into the dustbin, at the end of the day.  But the medical science is “tied down” science, on the account.  You cannot experiment on humans, not even those, going to be hanged the other day and now, not even on animals (“Thanks” to Ms. Menka Gandhi, who went to stop research on animals, at out prestigious All India Institute of Medical Sciences New Delhi)
          It is because of these historical handicaps and limitations that every test, every tablet, every injects, every procedure and every modality of treatment is fraught with some serious implications and complication.  No treatment, modality is absolutely safe.  Entire Medical Literature, each chapter of it, make special mention of some potential dangers, side effects, complications and even morbidity and mortality, associated with every that procedure or  modality of treatment, which otherwise provides relief and mitigates suffering of many.  I can quote several examples where the doctors themselves have suffered and even lost their lives, because of these uncertainties of medical science.  Whatsoever complication is mentioned in medical literature, it is incidence may be one amongst one lac, it does happen in one case or the other.  For some “smart”  and some ignorant people, it can well be  a case of ‘negligence’

          Moreover, sicker the patient more are the chances of facing problems during the procedure/treatment, Nowhere in the world not even in advanced economics a surgical  procedure ensure 100% success.  Nowhere in the world, an investigative procedure or treatment modality guarantees 100% success and safety.  If that be the case, no rich man should ever die, and why rich man, no doctor in first place, should ever dies.  But this is not true.

          Out of thousands of patient one treats in month, some may not do well in spite of one’s best professional judgment and input and occasionally one may even loss a patient, because of advances nature of disease.  It is not fair, at all, rather it is utter injustice, to label these unfortunate mishaps as “doctor’s negligence”, without taking into consideration the limitations of medical science and particularities of that case.

`It may look misplaced argument here, but I can’t help adding new dimensions to much hyped concept of ‘negligence’.  I can quote several instances, where wards of many patients ignored may advice for getting  their  seriously sick, old and helpless parents admitted  to hospital and instead let them die at home for want of required medical care, as they were busy with their school going children’s exams.  Will any law ever book these selfish and insensitive ‘educated’ and ‘not to ignorant’ consumers? In fact, such are the perfect cases of negligence.

          Let me emphasize the fact that it is with these historical limitations that medical science and we the doctors, who practice this science are expected to perform and deliver.  It is against these odds and handicaps that we the doctors are destined to work.  We the doctors and our families carry daily, the burden of this sickly poor and poorly sick society.  In a recent survey conducted in Ahmedabad, researches could find only two octogenarian doctors in a city with over 30 lac population.  This finding speaks volumes of the burdening and sickening nature of our job and the price, we the doctors are paying for the pursuance of  our duty and profession/

          Unmindful of our problems, hardships and contributions made by us towards the health of the society, the promptness shown by police in registering case against ‘erring’ doctors without seeking opinion from some independent body of medical professionals and ‘Masala’ stories flashed/published by electronic and print media, without ascertaining the facts and taking doctor’s version, only adds to our agony.  I firmly believe that our journalist  friends and the custodians of law  and order and the law itself, are well aware of the fact that such charges of ‘negligence’ are merely a ploy to extort money from doctors and hospitals,  in majority of cases.  This is evident from the fact that hardly and hulla-balloo is raised over such mishaps occurring in govt. hospitals.

In the entire west, it is on the record now that serious students long back stopped  opting  for medical profession, partly because of sickening nature of profession and mainly because their patients were made ‘consumers’ in mid seventies, by their capitalists  states, driven by laws of capital and profit in every sphere of human and social activity.  Health services there, are being largely managed today, by doctors from India, China, Latin America and other South East Asian countries.  With the advent of globalization, new economic  policy, structural reforms and privatization drive with resultant consumerism,  India is  shortly following suit.  In fact, the trend has  already started,

It is because of this attitude of some ‘smart’ and some ‘ignorant’ people that we the doctors now feel hesitant to treat lawyers, journalists, court people and VIPs, who we think are potential litigators.In case something goes wrong even in a natural way.  We prefer now, to avoid such ‘consumers’ even if we feel competent enough to treat them.

After expressing my heartfelt feelings on the plight of my once great and now ‘not so great’ profession, let me conclude saying that no doctor, how so ever ‘bad’ or ‘greedy’ (As some people complain about) he or she may be, will ever like to end up with this case in the post mortem room.  This sweeping statement I make universal truth for all my professional colleagues, even enough I differ with most of them on the issues of professional ethics and morality.

Place :- Patiala

Date: 08.08.2016

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