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Don’t blame the doctor

Targeting medical practitioners for all unfavourable outcomes is erroneous and dangerous

Written by Shwetank Bansal |
Updated: April 17, 2017 6:23:55 am
Dhule Government Hospital, Maharashtra, Doctor, Sion Hospital, Mumbai, Doctor protest, doctor strike, Indian Medical Association, Indian Express, Indian Express News The resident doctors during the strike in Chandigarh (Source: Express Photo)

Last month, grainy CCTV camera footage showed a mob of 20 people assaulting Rohan Mhamunkar, a post-graduate student and junior resident at the Dhule Government Hospital in Maharashtra. The doctor, having been flung onto one of the hospital beds by the angry crowd, is subjected to kicks in the chest while being battered with punches in the face from above. In the next week, two other incidents of a similar nature transpire in Mumbai’s Sion Hospital. Similar stories: The patient has an unfavourable outcome, the family is unhappy, the doctor gets assaulted. Lather, rinse, repeat.

The assaults sent shockwaves through the medical fraternity, with the Maharashtra Association of Resident Doctors resorting to a silent protest, which later intensified as doctors from other states joined in. Their demand: Provision of security and measures against those who assault doctors. The state machinery swiftly moved to snuff out the protests. The Dean of the Government Medical College, Nagpur, suspended over 300 resident doctors. The Bombay High Court called the agitation “shameful” and asked the doctors to have compassion for the patients.

In the Dhule incident, the patient had been in a traffic accident and suffered a head injury. Having been brought to the hospital emergency and examined by the doctor on duty, the patient’s relatives were informed that he needed an urgent CT scan and neurosurgical care, facilities for both of which were not available at that particular hospital. They were advised to take him to the hospitals in Aurangabad or Mumbai without delay. This infuriated the crowd, causing them to assault the doctor.

With a study by the Indian Medical Association revealing that 75 per cent of Indian doctors face violence at work, it’s quite clear that these are not isolated incidents. Whenever such events unfold, and are highlighted by the media, I find myself thinking about the evolution of healthcare and the doctor.

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Life expectancy over the last century has undergone major alterations. From 31 years in 1900, it now spans more than seven decades on an average. Among the main reasons cited for this is the development of modern medicine. Going through the healthcare indices, from infant mortality to maternal mortality rates, one finds that there is a steady reduction over time. The only figure that has remained unchanged and is expected to remain so for a long time, is that 100 per cent of humans eventually die.

We lose a part of us when we lose a patient. What else explains the fact that oncologists, who lose patients to cancer day in and day out, have the highest rates of depression among the medical fraternity, in spite of being among the highest paid?

The prime motive for anyone who seeks to get into the medical profession is to provide care. Apart from personal satisfaction, the basic idea is to bring a positive change in someone’s life, to make sure that a particular diagnosis is correct, the next operation is successful. The spirit of care is what makes it worth the hardship — working long hours in deplorable conditions, with death looking over the shoulder.

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I remember, while working as an intern at one of the biggest tertiary care government hospitals in Delhi in 2007, I happened to pass by the doctors’ duty room to find one of the surgical senior residents lying on the edge of the bed. He was sleeping on his side, balanced gingerly on the edge of the tattered black mattress, with what I could only imagine being dog faeces, resting in the middle of it. (Dogs were and continue to be a common nuisance at the hospital). Not only was the concept of fresh bed sheets alien, the staff in-charge had not bothered to lock the door when the room was not in use. The resident, in the middle of a 36-hour shift had found a couple of hours to rest, and had no stamina (or time) to pull up the administration.

I have personally carried oxygen cylinders around the ward during the process of resuscitating a patient since the nursing orderly whose job it was to do so was too intoxicated to do his duty. I know colleagues who gave travel fare to patients from their pockets. The risk of infection is an ever-present danger: Around 20 per cent of my colleagues developed TB during their time at the hospital; 30 per cent of them had to take preventive medicines for HIV after accidental exposures to people suspected of carrying or being infected with HIV. At least five became suicidal.

That said, there have been some horrific instances where doctors have shattered the dictum of Primum non nocere (First, do no harm). The cases of patients’ kidneys being removed without their knowledge or consent serve as haunting examples. Punishment in such cases, by law, is not only justified, it also leads to “professional death sentence” by way of erasure of one’s name from the Indian Medical Register. The medical community does and should strongly uphold the laws. Yet, the thought that “whenever something unfortunate related to healthcare happens, it’s the doctor’s fault”, is erroneous and dangerous to the doctor-patient relationship.

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When a colleague is manhandled, it rattles the very foundations of our professional existence. It is the expression (however inappropriate) of the belief that the patient has been “killed” by the doctor. Patients die, not because of us, but in spite of us. Not everyone can be saved. A knee-jerk reaction of outrage and violence in a field that routinely deals with life and death situations is to increase the chance of negative outcomes. One can’t put a gun to the operating surgeon’s head and expect the hand that holds the scalpel not to flinch even a little.

The writer, 32, is a Delhi-based psychiatrist.

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First published on: 17-04-2017 at 12:00:01 am
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