>> Sunday, April 25, 2010
I am looking at the world a bit differently these days…not as a physician,but as a husband whose wife had a brief, dramatic encounter with the health care system, and as a father who had an ailing daughter in law at the hospital. Our experience started me thinking: How did we get in to the point where the driving force in medicine is the bottom line, where a system supposed to give care and compassion to the suffering has deteriorated in to something of a money spinning business.
Hospitals have mushroomed in our places over the last few years. Naturally it is commonsense knowledge to assume that investing millions in to a hospital is done because it has become lucrative, and their purpose is not simple service. Many of them look as good as five star hotels with designer lobbies, and charming receptionists dressed up like flight hostesses. Once you are admitted, the scenario changes in to an extraction business. Doctors are too busy to talk to patients. You see them walking in and out of ICUs, as if they are doing great life saving procedures ,never bothering to look at the faces of those waiting anxiously outside.
While waiting as an attendant outside the ICU, I also realized how ignorant our public are about common medical conditions, and how easy it is to mislead them giving half correct information. For someone at the height of stress having their dear ones kept unseen, and not knowing what is happening to them, money matters become of no concern. They will pledge what ever they have to save the lives of their dear ones. Human relations transcends all money matters, and it should be that way.
My wife had an attack of chest pain at the middle of the night. While she was in the emergency room, my wife informed the doctor that her husband is a physician and would like to know some details.
I introduced my self and started off the conversation. He gave me his name and said
“ I am the cardiologist here” and went in to explain that my wife had an attack of unstable angina.
“ We need some one to sign the consent” he said
“For what “ I asked
“ For angiography’ he said “ The senior cardiologist will come only if you sign the consent for angiography”
I was surprised and said” But how does he know she needs angiography without seeing her?”
“This is the policy here” was the reply.
I called a classmate of mine who was working as consultant cardiologist at the same hospital. From the history and ECG findings he said “ It is not that urgent to do an emergency angiography, and can be done electively, but I can’t see her today officially because I am not on call today” he managed to postpone the procedure temporarily. I took the earliest flight the next day morning. By the time I reached the hospital, they had already managed to get a consent from my son, and done the procedure. He said the doctor frightened himself and his mother so much, that they requested the doctor to do the procedure. What can we call this other than ‘ emotional blackmailing ‘? When doctors are paid incentives for the procedures they do, the number of procedures increase in proportion. I met the doctor to whom I had talked over the phone and found that he was a junior doctor in the department.
I work in a hospital where we deal with heart attacks on a regular basis. In fact, our most common emergencies are related to ischemic heart disease. In the last five years, we had the need to send very few patients for an emergency procedure. Most are treated conservatively and sent home, and we reassess them for further treatment options. There are no studies to show that the emergency interventions benefit the patients in a better way, except when carefully chosen. But, they are the main source of income for hospital and doctor alike.
“Hi Tech Hospital” is the term used to describe hospitals now. “ Super Speciality” is another terminology. Even small hospitals at the road side display big boards written “ Super Speciality hospital and Research Centre”. Research of what? I am yet to see the results of any studies or researches coming from these kind of hospitals. Ther are no more ordinay hospitals or ordinary doctors.
Technology is not what matters to the patients. They want to know someone will look after them and tell them what is going on. They want an assurance that their medical team is focused on their well being. Through words and actions they want to be told , “ we care about you”
It is ironic that with all the advances we’ve made in medical science, the thing patients remember is the one-on- one ,human side of medicine.
Everyone in a hospital helps deliver health care, from the security guard to the registration clerk, cleaning staff and cafeteria workers. They set the mood. Similarly physicians and nurses cal alleviate patient apprehensions with a few extra moments of personal time. A touch of hand or a pat on the shoulder can ease a worried mind and send a patient’s confidence soaring. If a physician simply sits down in a patient’s room, it makes a big difference. Patients sense you are focused on their problem. You’re not peering down at them.
Few weeks back, I was called to the resuscitation room in the E R. A young Indian man was being resuscitated. He was unresponsive and had shown no signs of life when brought in. The story was that the man was coming out of a travel agency and suddenly collapsed at the road side. The ER doctors had attempted a resuscitation which was unsuccessful. I often find it difficult to stand and witness such events even after years and years of experience. It was while I wasx trying to get some history of the event that the cell phone in his trouser pocket started ringing. The loud rings were annoying in the bleak silence of the room. We had no option other thn to extract the phone and answer. At the other end was his wife from India calling to inform that they will reach the airport in time to receive him. Also that his new born child was anxious to see her father. I could hear the sweet cries of the baby at the other end. I couldn’t talk to the lady for long and was relieved when some of his relatives arrived at the scene.Now is’ it inhuman to produce a huge bill form somewhere at that juncture ? I know of incidents where the dead body was not released for lack of payment!.
There are times when I think whether I should have chosen this career. Some times I worry that I have become part of a system of well planned looting of patients. I had no doubts when I started off as a young doctor. I believed I could do many things for people. I thought I had learned everything in medicine to heal the sick. Over time, I regretfully realized how wrong I was. Now I know, the very little I can do for them. Only those who destined to live reach the hospital. Roughly one third of patients with serious heart attacks die at the time of attack. And what if one developes it at the middle of no where, while travelling, or when alone without assistance to reach hospital? If the best of treatments could prolong life, the richest would have lived longer. But does it happen so? I remember having read in the Oxford Hand Book. There is a total disarray of deaths in nature. If nature had followed norms, the oldest should die first, and the youngest should live longer. But does it happen so? As doctors, it says, our only role is to bring some order to this total disarray of deaths. How true !
On the other side, everything loses value, if given free. It applies more to the services you offer free. I never refuse if someone asks me to bring a relative or friend to my clinic. The rules at my work place make it mandatory for patients to pay some fee for consultation. But then, there are many poor people who cannot afford to pay even that. But the sad part is that the person often doesn’t realize the value of the service. A doctor who sees the patient immediately, probably has no value. He becomes important when the patient waits for him for hours to get his turn to see the doctor.. And then, his value increases along with the cost of medicines he prescribes.
I don’t think there is any other profession which has been so much commercialized. With the result, medicine has lost the human touch. We do key hole surgeries ( and often do not care what is left behind. It is more money than open surgeries and apparently attractive) and even robotic surgeries. There are medical programmes now, which gives you diagnosis and treatment, if given sufficient data. And the time is not far, when an educated patient can do it himself with the help of a computer. The gentle, emotional tie between the doctor and patient is already broken. And that is why more and more of litigations and manhandling happens in the medical field. The profession has changed in to a business, like anything else. Some people invest crores of rupees to transform their incompetent children to doctors, and then more to make them specialists. It is not surprising that they see the career as an investment and try to reap the returns at the earliest.
There is all the more reason to include in the education the acquisition of” human touch”. One can always argue that however kind a doctor is, the patient will die if he lacks knowledge or skill. There is also the danger of too much emotional involvement of the doctor. Such considerations do not justify the doctor treating the disease, and not the patient. Because of the pressures of today’s medical education, nothing is demanded of the student than to acquire masses of of information, with little thought for integration and correlation. I have always thought, “ every one learns the same books ,but then how come some are good doctors and others not? I had often argued with my friends that medical field is something which does not need much intelligent people. What is needed is simple hard work. And it is the application of knowledge which makes some doctors good, and others bad. Some of the best students in my batch, were never able to practice clinical medicine, because they failed at practice. Some of the so called ‘chronic additionals’ became popular doctors and built up their own hospitals and businesses.
There is a factor which transcends all specializations and involves virtually every person in the medical profession..human personality, one of the most useful tools in the therapeutic arsenal. I could say a doctor is guilty of negligence if he neglects his own personality as a therapeutic device, leaving the “ human touch’ to the relatives or some of those prayer group members who are waiting to jump on to them. “ The most human of all arts” is becoming not an art at all, and degrading in to nothing other than a money making business.