It’s 8 am on Friday and several pink files have started to pile up on his desk. Dr Sunil Kumar, associate professor of surgical oncology at the country’s top medical institute, AIIMS, is going through a list of patients who could possibly be scheduled for operation on Monday. A visit to the in-patient department, follow-up with patients who have been operated on, attending a four-hour OPD clinic, performing surgeries and pursuing academic projects is what makes up the day for most faculty members and doctors at Dr B R Ambedkar Institute Rotary Cancer Hospital in AIIMS.
The institute, while providing affordable medical services to patients, also has the responsibility of discovering new techniques in an ever-evolving healthcare system. Teeming with patients, the cancer institute witnesses a footfall of around 1,000 people per day. It has close to 210 beds, of which 45 are dedicated to cancer surgeries and six to the ICU. There are 70 faculty members and 100-120 trainee doctors.
Dr Kumar, who joined the institute as an MBBS student, has witnessed qualitative and quantitative changes on campus. And like almost every doctor, he has seen his fair share of stirs over violence against doctors.
“Sometimes, patience among patients is missing. But it’s not their fault. Everyone who is agitated or upset at the hospital has a reason. Violence happens because sometimes, the extent of delivery fails to meet expectations. But the problem is deep-rooted and not as simplistic as it looks from the outside. It is important to understand why someone is angry, but also why the person sitting on the opposite chair is not screaming,” he says.
A meeting with a team of doctors is slated after an hour. “Generally, this time of the day, with the OPDs, is the busiest. Today, I have a clinic from 2 pm to 6 pm, so before that, I have to look after patients who are already admitted, and those requiring special attention,” says Dr Kumar, leaving for a radiology meeting.
Around 9.45 am, nine doctors sit across a table examining CT scans, MRIs and other medical reports. One by one, reports are displayed on a screen, with each doctor expressing his or her opinion on the course of treatment for each patient. The meeting lasts an hour, and the green signal is given for five patients to be operated upon on Monday. “It’s time to visit the patients,” says Dr Kumar, moving towards the wards.
“Theek hain? Koi taqleef toh nahin paani peene mein? Nigal pa rahe hain na? (Are you facing any trouble while drinking water? Are you able to swallow?)” he asks a 50-year-old patient, who recently underwent surgery for oral cancer. A communication gap, he says, partly explains increasing friction between doctors and patients.
“All said and done, patients have huge respect for doctors. All they need to know is that there are people available to help them. Any patient waiting outside the OPD for hours will be agitated if not communicated with. Each patient should be explained, realistically, without hiding facts,” he says.
The next hour is spent in four wards on the second floor. At each bed, he tries to explain the patient’s condition, spending 10-15 minutes. A group of junior doctors walk with him, noting down observations and suggestions. “Teaching and learning are not confined to a classroom. We all are learning every day with the number of diverse cases coming to AIIMS. There are many things not explained in books, but we learn about them while dealing with the human body,” he says.
Talking about the emotional breakdown of several patients, he explains how mentioning the word “cancer” frightens almost everyone.
Every doctor at AIIMS clears rigorous entrance tests after beating thousands of competitors across the country. According to doctors, 95% of patients visiting the hospital cannot afford facilities at private institutes. “The cost of cancer treatment is huge and not everyone can meet the expenses. Plus it’s not just the money but the kind of expertise doctors at AIIMS have. Given a choice, every doctor would want to join the top medical institute as it gives freedom of intellectual expression and research opportunities. Of course, money is not equivalent to what is paid in a private set-up, but then people have a choice to make,” says Dr Kumar, walking to the ground floor to attend the OPD, which is already packed with hundreds of patients.
The cancer institute has a special clinic for every organ, each managed by a surgeon along with three specialist doctors. As the clinic starts at 2 pm, the rush outside the OPD is massive, especially since facilities were shut recently when AIIMS doctors joined nation-wide protests against the assault on two junior resident doctors at Kolkata’s NRS Medical College.
There are three-four patients inside the clinic at a time, and around four-five minutes are spent on each. “Achhi baat hai, you are lucky,” Dr Kumar tells a patient who was suspected to have lung cancer till tests ruled it out. After 10 minutes, a stack of a patient’s records is brought in. As two people try to enter, doctors request them to send only one. “But sir, he is my father, let him come inside,” says a man in his late 30s.
“Bohot bheed hai, hum sabko dekhenge. You come first, we’ll explain the situation and call your father if need be,” says Dr Kumar.
“If it is a follow-up, we ask one person to come inside so we can explain the situation,” he says. “A doctor is equally keen on giving more time to a patient. But giving extra time to one will reduce time slotted for the next. There is a huge gap between demand and supply in the health system, and specific infrastructure is required to tackle the load.”
Waiting time for getting a surgery date, for instance, is almost three months.
An hour into the OPD consultation, a 50-year-old patient and a guard get into an argument. Troubled by the shouting, Dr Kumar calls the patient inside. “I don’t have a valid document; will the doctor not see us? I have come from Bihar and the guard is not letting us in,” says the patient, holding a sheaf of papers.
Dr Kumar writes something on the OPD card and hands it to the man: “I have given him an exemption so that doctors from our department can have a look at him. We have to take such decisions to avoid confrontations.”
Dr S V S Deo, professor and head of department of surgical oncology at AIIMS, says: “Earlier, values among people were based on trust and respect for doctors, but the trend has changed in the last two-three decades. Volume and quality of time is a huge problem in India. The structure of hospitals is such that everything is left on doctors. There should be a support system in place. At times, we have to enter the OPD with a security guard. The government should work towards strengthening the peripheral system.”
At 4 pm, Dr Kumar leaves one clinic and moves to another, where he is greeted by more patients. “Namastey baba ji, ab tabiyat kaisi hai?” he asks a patient, the first of many he will see over the next two hours.