The Hogwash called Medical Negligence

The Hogwash called Medical Negligence
© Dr. Rajas Deshpande

“Doc, why do you think she has epilepsy?”
Asked the angry Grandma (about 60y old) after I explained in detail for @40 min. about the diagnosis and treatment plan.

A 5 year old cute plump kid was brought to the OPD with the classical history of a fit/ convulsion/ seizure while playing on the prior day. She’d had sudden unconsciousness, tongue bite, frothing at mouth, jerky movements of hands and legs for a few minutes and then regained consciousness. Both her parents had epilepsy (repeated fits) and were first cousins to each other. They had chosen to marry within family out of certain obligations. (It wasn’t a love marriage). Even their parents (three of patient’s grandparents) had had fits. Someone had counseled them for genetic tests before marriage, but they were not done.
Physical examination and MRI brain were normal, other routine tests, EEG (graph of brain waves) showed non-specific changes.
The whole family, about 8 of them, sat around me, some faces anxious, upset and some angry. Being super-rich, they had access to the most influential, and I had instructions to “Please address their concerns” from a highly placed senior colleague. Partiality is against my genes, but so is disrespecting a colleague’s request.

“What else do you think it could be?” I asked.
“Can’t a normal child have fits?” She protested.
“Your child IS normal. However, fit is not a normal phenomenon in a healthy child. It is due to some reason”.
“But her parents have suffered so much because of the medicines they had to take since childhood. We are not even sure if the medicines given to them were correct. Sometimes they never had fits for years but still took the medicines”. She said. They were being treated by some of the best epilepsy experts in India.

“That’s the nature of epilepsy. Nobody can predict when and where fits will occur. There are only two options: take some form of treatment like medicine, ketogenic diet, surgery etc., or accept the gamble of risking patient’s life by not taking such treatment. Fits can come without a warning, anywhere”.
“Can you guarantee that there will be no fits if she takes treatment?”
“Nobody can guarantee that, we need to use minimal doses, and some time to find out what is the suitable dose and drug for her”.
“What are the side effects of these medicines? We read on the net that there are many dangerous side effects” asked the kid’s mom.
“I will tell you the common ones, but if you want to know all, I can give you websites to read from” I said, writing down few sites for them. “Beware though, if you read all of them, you will unnecessarily worry out of proportion and get anxious. Also, you may interpret every minor complaint like nausea, headache etc. to be related to the medicine always”.
“We have your phone number, doc. I will call you if required”.
“Sorry I don’t take calls except in emergency”.
“But then who should we ask if she has side effects?”
“Please visit her regular pediatrician or call the casualty here, they will guide you”.
“Doc, I don’t feel she should take medicines at this age”: Father.
“There are many other good Neurologists in the city, you can please avail of another opinion, so you will be able to decide better.” My usual answer.
“Actually we have already seen one senior Neurologist yesterday, he has advised treatment too, but we were not convinced”.

I looked at the innocent kid and regained my patience.
“Well, you have to take a call”.
“We will think and see you again doc, in two weeks, as we are all travelling to Singapore for a marriage”.
“Better start with this mild dose asap” I could not help feeling responsible for the kid.
“Her father wants to wait. We will get back to you later”. They left.

Another. Wife with chest pain at 2 AM, husband thought it was acidity, visiting doctor told to admit immediately, neglected advise. Patient died next morning.

Epilepsy patient. Advised not to drive. “Kuchh nahi hota (nothing happens)” he said and rammed his motorcycle in a truck, permanently disabling his younger brother and grievously injuring himself.

Stroke, educated patient. Given some herbal medicines. Now on dialysis permanently, renal failure due to unknown (?) reason.

Every doctor suffers these mental agonies when he / she has to see danger unfolding, risk amplified when responsible family members / patients make wrong health decisions for their dependents and there’s nothing one can do but to witness it happen. While it is a pleasant duty to fight disease and death, the society and media are totally blind to the wrong choices by parents / guardians/ caretakers / children of the elderly etc. which result in grievous consequences, often death.

Unfortunately, it is beyond what people know: one of the major stresses every doctor routinely faces is due to “Resisting, Uncooperative and Skeptical relatives / patients” who drain the time and energy meant for the other deserving patients.

Curiosity is acceptable, audacious challenging by the unlearned is not.

If doctors are given a chance to file “Medical negligence cases” against such irresponsible guardians of patients, God knows how many skeletons will jump out of the closet!
© Dr. Rajas Deshpande

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