On a dreary December morning, I sat leafing through hundreds of pages of reports, ultrasounds, surgical notes and prescriptions but found no mention of a diagnosis. When the woman patient complained once too often about her doctor, I asked her why she continued to go to her when her condition was not improving? “Because she is very sweet to talk to,” she replied.
My mind went back several years to the government hospital where her doctor and I once trained. In government hospitals, being rude was common, shouting was not rare, swear words or even slapping was not unheard of. Most of us were guilty of such behaviour, but the words this doctor used then were part of medical school folklore. The same person is now “sweet”? People grow up, learn and improve, and that must have happened to her. I wonder, though, if the real reason was that this doctor was dealing with poor, hapless “patients” then but now had “clients” or indeed “customers”.
Of course, as young doctors, we were all stretched to the hilt. We were studying, teaching, working long hours in pathetic conditions, bullied by seniors 24×7, permanently short of sleep, never ate on time and were paid a pittance. None of these could, however, justify our appalling behaviour. Eventually, what we learnt by operating upon those poor women, paid for by the State, had made us the ‘specialists’ we are today. We never appreciated that and were arrogant, stupid and insensitive, as privileged people usually are. Simply put, we were terrible doctors, even when most patients got fairly good medical treatment.
Last month (on October 8), Lancet published a cross-sectional study based on observations made in labour wards in 12 health centres —three each in Ghana, Guinea, Myanmar and Nigeria — over 15 months. They found that over a third of the women experienced verbal or physical abuse, discrimination or stigma, and episiotomies were performed without consent. The abuse was more common when women were younger, less educated and poor. The study comes as no surprise to us doctors in India. A study like this one is much needed in India, but this one should wake us all up. I would only be speculating without a country-wide study, but over and above the abuse mentioned in the study, women from minorities and the oppressed castes would experience prejudice and neglect.
While verbal and physical abuse is obvious, other forms of violence perpetuated by unscrupulous medical practitioners is less noticeable but more harmful. Informed consent is often bypassed. Unnecessary Caesarean sections are more common in the private sector. Similarly, tests and procedures of little benefit for conditions such as infertility and menstrual disorders are ordered if the patient can pay.
Ultrasound, invented to make childbirth safer, has already led to the genocide of female foeticide. The same ultrasound and foetal monitors are now used to raise alarm and justify planned Caesareans, though there is no proof that these make childbirth safer. Latrogenic prematurity is now the most common cause of neonatal complications. Hysterectomy, laparoscopy and Artificial Reproductive Technologies such as IVF are also being fervently sold with detrimental effects on women. No real cost-benefit analysis has been done by this unregulated industry.
What has gone wrong then? The whole system — from selection to medical schools to teaching and working of government hospitals — is broken. To change, we must go back to the drawing board. The social divide between a doctor and a patient is wide and the current medical education desensitises students further. We now need to make clear guidelines and everyone, from the top professors down to the last intern, must be accountable. Of course, not all doctors are insensitive and mercenary, but too many are. While things are unlikely to improve without overall improvement in the status of women, steps necessary for gender sensitisation, informed consent, rights of LGBT must be ingrained in doctors.
Ethicists, social scientists, planners should sit together and work out solutions NOW. Women’s health has never been an issue, not even with feminists in India, but we must make it an issue now.
Too many doctors, too few good medical teachers, no standardisation of education in India today is like France three centuries ago, explained in French philosopher Michel Foucault’s The Birth of the Clinic. Half-baked professionals and lack of employment are making a whole generation desperate.
“Desperate doctors are a threat to society,” Sir G B Shaw wrote over a hundred years ago in Doctor’s Dilemma. We have to do something and NOW!
(The article appeared in print under the headline ‘A doctor’s true tales from a labour ward’. The writer is a practising obstetrician, gynaecologist and women’s health activist)