The “token” gift, and the “real” punishment!

(Things doctors don’t get time to say!)

© Dr. Rajas Deshpande

Wherever possible, and whenever they deal with “mature and understanding” relatives, most doctors explain and predict about the patients, but the moment they sense accusive, legality oriented, halfbaked googlecakes, doctors have no option but to turn on their guards in self-protection against stupid misinterpretations of what is being said in good faith.

Within minutes of admitting an unconscious patient in the emergency, or having just checked in OPD for headache, the relatives or patients naturally ask the doctor “So what is the exact reason?”. In most cases they will not be satisfied when the doctor says we need to investigate / run some tests. So the doctor has two options: to tell tentative causes based upon only the examination (clinical / working diagnosis) or to honestly admit that it is difficult to conclude diagnosis before running few tests. In either case we have to respect the relative’s choice whether they want to proceed with tests or not, and start treatment according to most likely possibility. This is still “presumption”, and may sometimes be wrong. Every medical textbook will mention standard test protocols for any medical condition, and these are also available on the internet freely. Most doctors limit their tests to confirm the “working diagnosis” and “critical / correctable other possibilities / life threatening possibilities”, knowing that most patients suspect that most doctors do tests to earn more money. However, many patients have more than one diagnosis (i.e. diabetes +blood pressure+ heart disease +stroke + kidney failure + asthma + allergies to medicines), in which case the complications geometrically increase, both for disease and its treatment.

There are over 50 causes of unexplained unconsciousness.
There are more than 40 types/ causes of headache.

Every Court / police / bank / government needs proof for everything you say / claim / did (including your existence!), nobody takes your word or understands readily. None of these will answer anything immediately (except a “NO”). Even the mechanic does not tell you what is wrong with the car unless he / she opens it up and verifies. So why is the big objection and suspicion about a doctor wanting to investigate? Some doctors may earn cuts and that is NOT acceptable, but the fact remains that the tests are required in most cases.

One can of course give in writing that “I do not want to do any tests, and want to try medicines at my own risk for the working diagnosis which is tentative”.. Gone are the days when the medical science in India was primitive, and a big smile, a reassuring pat on the back and a goodwill prescription based upon presumptive diagnosis did the trick. In that case if the patient died or suffered complications, no one questioned the intentions of a doctor. Today the first response is in the breaking of hospital, violence towards doctors, news in press, police cases, then the medical enquiry of correctness of allegations. Today, when a patient walks into the doc’s chamber all mixed up with suspicion, disbelief, improper net-based knowledge / research and media-fuelled prejudices, it is difficult for the doctor to freely speak and advise, as almost every word is google-scrutinized, and every intent to do tests is questioned. Like all fields, there are huge quality differences in various test centers, not all pathology labs/ imaging centers do things as per standards/protocols as many ‘short-course” doctors are being created. Cheaper does not convert into better.
(c) Dr. Rajas Deshpande

No doctor starts his / her day with the thought of ending someone’s life or looting patients. There is so much huge, unimaginably vast knowledge and advances to be remembered 24/7, so many drugs, their reactions, so many thousand medical conditions one needs to be aware of, so many complications that happen without any warnings, so many reactions of medicines that one must know, that there is a continuous extreme intellectual pressure / stress that occupies a doctor seriously practicing his science. Things can go wrong with any human being anywhere and when people die elsewhere in the world nobody objects, but when that happens in a hospital or while under treatment, the doctor is immediately blamed. If a patient rides a bike without helmet, drunk, and sustains head injury, nobody minds, but if the same patient slips on a hospital wet floor and sustains same head injury, there will be a hoopla about poor care in hospitals and damages in crores, with addition by some crying film star how the hospital’s doctors purposefully kept the floor wet for getting more patients!

Agreed there are other scientific fields where high intellectual performance and vast knowledgebase is required, but none of them is directly related to human health or death so intimately via a mistake. The stress of a mistake in medical field surpasses the same in any other field. And doctors, being humans, are not free of mistakes. To presume it was voluntary is the problem.

In surgical situations, the risk multiplies, and the stress a surgeon / anesthetist undergoes inside the OT is comparable only to a soldier in enemy camp. Patients are known develop reactions to anesthetic medicines, common painkillers , paracetamol, antibiotics etc. almost anything used, some rare and some common. There are unexplained heart related complications, worsening of neurological problems, stroke, heart attacks, shock which can happen without a warning, more common in the elderly but also in the young age group, in spite of prior checkups and care. Blood pressure may go very high or low without any apparent reason. Such complications are very well known, documented, studied and even accepted in the western world, but their acceptance in Indian society is poor. Of course in case of a suspicion one may ask questions and investigate, but the Indian investigation of a medical issue usually starts in media and parliament before it can reach the medical councils. I fail to understand how relations between patients and doctors will ever improve with some media running such vehement anti-doctor news based not upon the court’s judgment, but patient’s allegations and incomplete investigation.

Doctors are becoming curt / speaking in least possible words and explaining more in a legal language than compassion to the patient. This was inevitable. With the human body so unpredictable (can you exactly predict when next your mood will be sad, exactly how many of your favorite sweets you will eat, which new medicine will not suit you, which night you will not sleep well, when next will you have headache and how severe, what food will affect your digestion badly, after walking exactly how many steps your knee will hurt etc. about your own body?), one must refrain from expecting definite predictions from a doctor , and also accept the complications as a part of human health, not always as a doctor’s mistake.

By no means anyone will justify a preventable mistake committed by a doctor. But our extensive training (in most cases) usually ensures that “avoiding bad” comes equally high as “doing good” in our actions while making patient-care decisions.
(c) Dr. Rajas Deshpande

A doctor is as human as yourself. He / she feels bad when someone cries, when a patient suffers, when someone dies, or when things go wrong. There are stresses that a non doctor will never understand: seeing dead bodies, cries, helpless deaths, torn and tortured human bodies, blood and urine and stools around one for most of the day, panic, shock, cancers, tragedies every single day of your life for years, for decades is not an easy choice: it does not take away our sensitivity, it only makes us more and more aware of the futility of material world. Nobody knows better than a doctor how cruel, unexpected and sudden death may kill someone apparently healthy. The only solace in this profession is the ability to help, to relieve someone’s suffering and agony. How can then a doctor start his / her day thinking “I will complicate someone’s health, I will cause some deaths, I will extract more money from the helpless poor today”???… It requires immense courage even to survive this mental trauma of living all your life among tragedies, too see all this and still come home and smile for your kids.

We do have to put up a brave face always. If we cry for every bad thing we feel, we won’t be able to practice. If we don’t speak stern, people will harm themselves with self neglect. Every doctor has dealt with the situation of telling someone a very bad news at one moment and minutes later having to congratulate someone else for a newborn or survival. Both cannot be avoided. That does not mean we do not have emotions. We learn better self control (except few idiots like myself who need to explain this all to everyone!!).

There are many who get completely better, many who go home smiling, many who live all their life happily thanks to some doctor’s correct effort / treatment. There are many who survive only because a team / a doctor reached them in time risking his / her life driving fast, sacrificing most precious moments of his / her own life. Many a hospitals, corporate or otherwise, have saved near-impossible cases through heroic team / individual efforts.
One should never mention returns of saving a life. The following is mentioned only with the purpose of unmasking the social hypocrisy..

We are trained to remember everything, BUT NOT THE GOOD WE DO TO PATIENTS.
We do not expect any great gifts, but this also is a reality: that there are hundreds of examples of punishments in crores for the negligent doctor, but there are no examples of someone gifting the doctor in crores for saving a life. All the respect and love society claims to bestow upon the doctor suddenly goes mute and vanishes when some press/ media/ politician bashes medical profession/ doctors or goes violent. Of the so many intellectual characters speaking and writing everywhere in the media, rarely is someone seen acknowledging the contribution of doctors/ medical profession to Indian health care full of inadequacies in the system. The poor and uneducated actually gift the doctors costlier gifts than the affluent who do away with anything but money / expenses for doing good / saving lives. God knows how many “millionaires and billionaires” whom doctors save walk away with a shameless smile, sending a box of sweets later as thanks. Or greeting. Or something that is emotionally multimillion but financially broke.
We really do not crave / want gifts / thanks / or news for being good. But please also stop this hypocrisy: that mistakes are amplified and punishable in hard cash / defamation and loss of degree, while all the good done, lives saved are rewarded in words and small “tokens”.

Why not a “token” punishment, too, for a doctor’s mistake?

(c) Dr. Rajas Deshpande

Do share unedited with credits.

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