The Lawless Side of Medicine
© Dr. Rajas Deshpande
A well educated businessman driving in his car with his family had an accident. He had some bleeding wounds, but was fully conscious and alert after the accident. A few young college-going students stopped to help, picked him up, hailed an autorickshaw and took him to the hospital. The patient’s wife and child followed in another.The junior surgical and orthopedic residents examined the patient, stitched his bleeding wounds and started medicines. The wardboys and other staff carried the patient to the CT scanner, and shifted him to the casualty after the scan. Patient’s wife accompanied him throughout. When the senior surgeon came over and asked the details of his prior health status, the patient requested privacy and revealed that he had recently been diagnosed with HIV infection, and was taking some traditional medicine for that. Atleast 4 College students, the autorickshaw driver, and 2 wardboys had been exposed to direct contact with his blood by then. The treating doctors had their gloves on, but not the complete gear expected to be worn while treating such patients. He himself or his wife had not cared to tell helping hands to protect themselves.
There are many blood-borne diseases, some fatal and some dangerous. While the courts merrily write orders about help to the victim (which is must), no one cares about the risk to the helper’s life while executing such help. No court has ever ordered the government to make Universal precaution gear mandatory in hospitals, especially govt hospitals where thousands of budding doctors, nurses, wardboys, techs are exposed to blood contact daily, without knowing the infective status of the patient. No court has ever ordered the govt to implement precautionary measures to avoid accidents, drunk driving, or emergency roadside assistance. People can drink, drive reckless, cause accidents, govt can do away with wrong licencing, zero roadside assistance, but everyone including the press will pounce upon the treating doctor for a bad outcome! No court ever questioned the authority which issued licence to a driver involved in traffic accidents!
Another. A lady of 60 brought to the casualty unconscious, with drunk “mob” led by her son. The son tells that she never had any health problem till that evening, when she had convulsions. They demand immediate admission in ICU and treatment, and declare that they have no money. The hospital obliges and admits her as a free patient as an emergency as per court rules. Next morning the recovered lady revealed: that she had had convulsions till few years ago, was advised regular medicine, but stopped it many months ago. She was also an alcohol addict and had taken alcohol on the prior night. On the day of convulsion, her husband had had a big showdown with her. Upon questioning the same son next day, he replied to the junior doc: “I never said she didn’t have any health problem, and you never asked if she was addicted to alcohol”. They also didn’t have the BPL card they claimed they had.
Fortunately she went home all well, but one shivers at the idea of what would have ensued had she not improved. Probably another cruelly beaten up doctor and voluptuous bad press against the medical fraternity in general.
It is the responsibility of the doctor to be good, perfect and true in everything he / she does. But if the whole action / decision making of this doctor is based upon what the patient tells, any lying / hiding of information by the patient is then likely to impair the outcome. To presume that all patients always tell the truth is a joke. Many hide addictions. Many hide stigma-illnesses like Tuberculosis, Epilepsy etc. Many hide that they were beaten up by a family member. Many do not tell their drunk status during accident (some traffic accident deaths for which the casualty doctors are so often beaten up by relatives may likely be related to the patient being drunk).
The most dangerous patients are those who have themselves or because of family pressure neglected the disease until the time it has reached a critical level, often beyond cure. When something happens to such patients in the hospital, our society is quite impressed with only an innocent sentence: “The patient was completely alright till admission”.
Some patients do not tell that they missed medicines. Some do not follow precautions. Some take additional herbal / traditional / quackery-born medicines along with the standard treatment, without revealing it. The entire responsibility of outcome in every case in any hospital is pinned down upon the treating doctor.
While compassion and the art of “extracting” the correct details are essential for every doctor, it is not mandatory for the patient to tell the complete truth. In this medicolegal age in a mostly illiterate, superstitious society, it is essential to educate people about telling the truth and taking precautions while helping others.
If you have an open wound / cut / injury over your own skin, please refrain from touching a bleeding patient. Avoid blood contact of any person unless you are in a position to save life by taking that risk. It is wise to keep a box of gloves in your car / four wheeler, or carry a pair in your purse / office bag for such an emergency.
While it is expected that every doctor, irrespective of how busy he / she is, writes detailed notes and prescriptions in capital letters for every patient, there is no responsibility assigned to the patient. If the patient is a consumer and the doctor liable for even tiny mistakes or unfavourable outcome, then the clinical-legal responsibility of patients must also be defined. It must be mandatory for every patient to write the details of their health, prior conditions, all medicines, etc. in legible handwriting and sign it with witness to submit to the doctor / hospital, before treatment is begun.
Many patients, educated or not, know this responsibility and carefully, truly detail the doc about everything asked for. They also mostly respect the outcomes. They usually do not blame others / doctor for either their illness or addiction-complications.
However, there is a surge now a days in “blame it all upon the medic or the hospital”. It is high time some wise judges recognize these issues before deliberating a judgement.
Till then, the Indian Medical Profession is at the mercy of press-interpretation.
© Dr. Rajas Deshpande
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