Tuesday, 26 March 2013

Doctors

A school time friend's seventy six year old mother had been a victim of substandard care in one of the top corporate hospitals in Mumbai. She had had a fall with significant injuries when she had actually gone there for a minor planned procedure on her foot.



I cringed as I read this on the Facebook. I had recently attended a meeting in my hospital about such "SUIs", serious untoward incidents. Sadly, they happen everywhere.

There was an outburst of comments from friends all over the world. While some were sympathetic and wished and prayed for a speedy recovery, a lot of them were angry comments advising my friend to complain or take the legal route. I had expected this. (Serves me right for constantly berating other professions like administrators, on Facebook). At some point an outburst against my fraternity was going to happen.

When I decided to become a doctor, it was considered a respectable and noble profession but now if people around you in a party or in the train (in India) find out you are a doctor, you get to hear the worst horror stories of a disillusioned, suffering yet helpless populace, struggling against a society which treats Healthcare as a money making proposal.

When I heard about my friend's mum's predicament, I remembered our experience when my mother was admitted to a private hospital (in the Central Government Health Scheme panel), with fractures involving her back bone.

My brother, a plastic surgeon had given strict instructions, nobody, and he meant nobody was to move mother unless he was around. I now understand fully why he was so careful. He did not expect the staff to be aware of what multiple fractures in the spine meant, how one wrong move would impact mother's condition, present and future. Unfortunately he was right, most of the staff were clueless.

Today when I attend all the various training sessions which have been identified as mandatory for all the staff , we joke about how tedious they are and in spite of all the training, we don't completely avoid errors in the system. Manual handling, fire, infection control and medicines management are a few of the sessions which all staff have to do. But at least doing training sessions brings about awareness of the standard operating procedures and that minimises risks.

When my mother and my father in law fell ill, I realised how difficult it is to get accurate unbiased advice which one can trust, in the mayhem of private providers of healthcare in the city of Delhi. This was when there were so many doctors in the family and amongst friends.

Healthcare Costs are spiralling everywhere. It impacts in different ways. In America the cost of improved drugs, devices and treatment and better diagnostics along with more litigation, pushes up Health Insurance costs.

In UK, where the National Health Service is state funded, it has led to a tier of middle and more senior management whose job should have been to facilitate safety and quality in health care but has led to the opposite, while trying to drive down costs.

The  Francis enquiry into excessive deaths in one of the hospitals in NHS is now asking for a change in culture, a culture of openness, where staff and doctors are able to voice their concerns without being bullied for whistle blowing.

One is always suspicious of pharma companies' marketing budgets, which allow for multiple travels abroad for prescribing doctors in India and the cuts which diagnostic laboratories and imaging facilities have on offer for referring doctors.

When Aamir Khan brought this up in Satyamev Jayate, the doctors were up in arms. But in my view, the profession needs to introspect. It is because we have not been able to regulate ourselves, because our regulators and institutions are not working for the people, we are seeing a host of others joining in the feast, controlling and pushing up costs. Spiralling costs will lead to increased expectations, more litigation and mistrust in the profession.

The basic duty of care is something we should hold ourselves accountable for, morally and ethically before we think about the fact that we are legally accountable.


3 comments:

Rajiv Rattan said...

The best advise/comment on all of this that I have heard is from someone who you might just know- Dr Ajay Kanojia- " If you think that the patient in front of you could be your mother, father, brother or sister ... you will never do any wrong -whether it is your behavior, ethics or medical care".

Anonymous said...

A very candid appraisal of one's own profession, something as difficult as critically examining the face you see in the mirror. No need for self-castigation though. The advancements in technology are compensated in equal measure by losses in humane -ness all over. Whether it be a farmer, teacher, engineer or a soldier the effort is all about making a quick buck, the rest be damned. Hope lies in the fact , at least in the medical context , that the role of the body accounts for almost 90% of keeping itself healthy. Also in people like you who want to correct the wrongs they see

AJAY KANOJIA said...

I still believes and treat patients thinking as if they are my own relatives.

Unfortunately current corporate culture whether in private hospital in India, US and other countries or even state run NHS in UK, healthcare in controlled by managers and their prime objective is to justify their job by doing more work with less and less resources and at cheaper price...... They use all kind of statistics, data distortion tools and mind-games to achieve this.and they only care of datasheet bottom-line not individual patient.

Common-sense practice is uncommon in most of the big places, because you have to take care of managers, advocates, judges, media, and politics to survive in job.

But all is not so bad, there are still shinning examples you can see around you, who are still doing good work and treating patients ethically......and all the bad examples which we see in medical practice does exists everywhere now-a- days....in managers, advocates, judges, media and politics....and I do feel more doctors as percent-wise are still more humane and ethical than any other professionals.......