free medical consultation

“The Free Fetish”
© Dr. Rajas Deshpande
“I want to treat all patients free all my life, Sir.” I told my most beloved professor on the day that I passed my MD Medicine exams. Always fair to me, my Prof. did not brush away my words as overexcited blabber of a passing student on the day of result .
“You cannot.” said Sir, “You will need enough money to maintain a good and secure lifestyle, and will need to provide decently for your family, which also is your duty”.
“But sir, patients come to us with problems, with folded hands, seeking help. We can solve their problems by our knowledge and wisdom, our skills. Patients will automatically pay good much money if they are happy” I said. He laughed and told me “Trust me, you do not see what I see from where I stand, and I tell you what is good for you”.
After a long argument (I wonder why he did not kick me out), we compromised on one principle.
“You tell the patient your fees, and if they can pay, you take it. If they cannot, you don’t ask the second time, let it be”. He told me. This was good. I promised him so.
Seventeen years have passed. I have kept my promise, and have regretted it many times.
Because, times taught me that society’s “taking advantage” coupled with severe deficiency of doctors leads to a horrible situation no other profession can understand.
Earlier I had two hours everyday reserved for free patients, who then came any time and quoted umpteen reasons for being late, still barged in and fought during consults with other patients who came with appointments, and expected a “full luxury” kind of consult where I must answer every question even if irrelevant to the current issue.
Then I kept one day per week for all free patients. This was occupied by government servants and other ‘scheme’ patients who had seen many specialists earlier, were treated correctly, but still wanted another opinion just because it was free. They had enough money for everything else including addictions, but ‘demanded’ free treatment as their right. Then again, most free patients expected that the pathology tests, other investigations be done at the cheapest or free places, and kept on calling on my mobile phone (given for emergency) to enquire about the free, the cheapest, and any other doubt as might pop up in their minds. Some even visited other specialists for a “paid consult”, thinking that the “free” must be lower standard. Many kept on treating the “emergency cellphone contact facility” as “general medical enquiry freedom” about everything.
© Dr. Rajas Deshpande
No doctor has time to scrutinize who is really poor. Those who really deserved help either couldn’t reach me or couldn’t be given enough time. Even in case of genuinely poor patients, the legal liability is the same as in paying patients. The more free patients you treat, the more legal risk you expose yourself to. This is also the illiterate class so easily flared up by their “local leaders” who take advantage of every situation. Almost every hospital has witnessed the local “Dadas” come in to solve a dispute, actually extracting money from the doctor / hospital by having a crowd with weapons standing outside the hospital. We have even seen some “mediators” holding the dead bodies hostage, negotiating extraction. Even when the doctor is not wrong in many such cases, by the time truth is unmasked, his / her reputation or the hospital’s name has already suffered irreparably.
Is there gratitude or respect for a doctor treating patients free? At the very first mistake, these doctors who may have treated thousands free are treated like criminals, and the language of our law, ever so droolingly sweet to the rich, glamorous and powerful, has seldom been kind to an erring doctor.
Add to this equally troublesome rich and upper class, who queue up just because it is “free”.
It was supposed to be a joy, peace and “inner satisfaction” to treat poor patients free. Now when they come stinking with alcohol or gutkha, with “reference notes” from politicians, arrogantly demand and bargain for what the doctor cannot arrange free like medicines or tests, and not only suspect, but abuse, manhandle and sue the doctors for whatever it is that they dislike, the spirits of a genuine doctor shrink from this “free trouble”.
© Dr. Rajas Deshpande
How can one call “poor” and invoke sympathy for those who get drunk, wield knives and guns, rape, kill, drive rash to race, insult law, fight upon the street, grope passing womenfolk, dance drunk to loud, lewd songs in front of children and women, behave arrogantly and use a fowl mothertongue, mannerlessly gesturing at anyone they don’t like, just for the “fun” of it? These are the “poor” who often abuse the doctors and break hospitals. The really poor don’t.
This “demanding free poor” class refuses to go to the govt. hospitals, and accuses the doctors in govt. hospitals of “ill treatment and arrogant behavior”. Well, you spend decades in a maddening, never ending rush of sick people that you have to treat without help, without resources or rewards, and see if you can behave well to all of them. Does the poor patient always behave well? Do they absolve the doctor of all legal liability, for the free treatment? Many relatives of admitted free patients who are critical actually bring in their “local leaders” to pressurize the treating staff, barge in anytime and threaten us, affecting the whole decision making process. These call up many times a day and even into deep nights, and really make the consultant regret his / her decision to treat free patients. I have had patients who physically fought with, and used foul language for other really sick patients in the queue.
There is only one option: to limit the free treatment and availability to the deserving poor who understand that they are being helped, refusing all arrogant, hostile, pressurizing poor who do not understand that the doctor is trying to help them.
I am sorry sir, I did not understand then. I will keep on treating free patients, but I will be careful now. Good is always taken advantage of all over the world, but “Free and concessional healthcare” tops the misuse in our country.
© Dr. Rajas Deshpande
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