The Bullet Indian Doctors Bite
© Dr. Rajas Deshpande
“Her health is fluctuating. We need to admit her in ICU. Why didn’t you bring her earlier?” I asked the daughter of a 75 year old lady who had developed weakness in both hands and legs about two weeks ago.
“Doc, we thought she had weakness due to age, gave her some herbal boosters and vitamins, as we were scared of modern medicine. We hear a lot of bad things nowadays” there was no trace of any regrets in her voice that she was telling me this.
Wish I could tell her all that we hear about the reality of people criticising modern medicine nowadays. But who has that kind of time?
“Can we please treat her at home? She is scared. Also, we have limited finances, my husband is not in town. My daughter has her exams on”. she requested. We often accommodate many requests, but really, our society never stops asking for more than possible. I explained her in detail that not everything can be managed at home, admitted the old lady in ward and gave all instructions to the staff. She had had very low potassium levels, we corrected them. On the second day, she started feeling slightly better.
Third morning, as I continued my OPD, I got a call from the ward. The nurse had a panicky tone “Doc, this patient has become drowsy suddenly since a few minutes. Her daughter is not here, I noticed when I went to check her. Pulse rate is high, no fever, and oxygen levels nomal. But she is breathing faster”.
“Sis, please check her blood sugar and send her blood sodium- potassium levels, and haemogram, I will be there in a few minutes” I said. I called the lab and requested them to process her samples urgently.
The sugar level was low, we gave her sugar and she became alert. In a few minutes we got the electrolyte levels, her sodium was also low, we started the correction.
“I have informed her daughter, she is on the way” the agile nurse said. As much as doctors, the credit of saving lives goes to the millions of active and alert nurses and junior doctors. I went back to the opd, apologised to the waiting patients and started again.
In some time, I received a call again. The nurse was still panicky. “Doc, the patient’s daughter has just returned. She is creating a ruckus here, shouting and abusing. Please come asap”.
I went there again. Indeed the daughter was furious.
“I will post this on facebook, I will write about the hospital, I will sue them. How can they do any tests without my permission?” she went on.
I said hullo to her, stepping between her and the patient nurse. © Dr. Rajas Deshpande
“Why did you do her blood tests without asking me? We had done blood sugars last month, they were normal. Also we had done the sodium and potassium two days ago. You should have asked me before sending blood tests” she went on.
Two angry humans is too much of a mess. I summoned my inner peace. I had done what was good for the patient, I wasn’t scared of anyone. Especially ruckus makers. Her anger was her problem.
“Madam, may I explain?” I asked in a calm voice. Not that I am not short tempered, but I am a doctor.
I told her how some tests need to be repeated, and how there’s no time always to ask permissions by calling relatives. Patient’s life is always more important than the permission of relatives, especially if they are not on site. Sometimes, we need to do tests just based upon suspicion of certain complications. Every passing second increases the valley between life and death, the doctor and nurse must have the fastest brains and actions upon earth. To explain everything to every relative till they grasp and understand is another stupid, idiotic expectation in emergency. It’s like asking a soldier on the border to explain every citizen in the country why he fired each bullet. A medical soldier has to do the best, be medico-legally safe, document everything, explain to the relatives and obtain permissions, and still face anger, humiliation and social media threats, rating scams and attacks on reputation by anyone anytime. All this while having the best intention- saving the patient! © Dr. Rajas Deshpande
“You take fever by a thermometer many times a day – once is not enough as the condition is still persistent. Likewise some tests, even if costlier, need to be repeated. Unless you have written that we do not want any tests, we have to do what we think is good for the patient, that’s our sacred duty” I told her.
She calmed down.
“See, doc, I am sorry, I exploded, I am going through much stress at home due to issues with my daughter and my husband is not supportive. Now that you have explained I am okay with the tests”. she said.
“What about the shouting, the abuse, the insults to allopathic doctors treating you right now, the humiliation of the nursing staff and waste of my time, that caused discomfort and delays to other patients?” I wanted to ask, like most doctors, but we have no time. She wasn’t going to change anyway. Like most of our society.
When I discharged the patient, now walking on her own, the family was still upset, because the hospital did not comply with their expectation of a “discount”. A genuine “Thank You” is extremely rare in Indian hospitals, even when the critical walk home.
Three months fast forward. I received a call from the daughter again “Doc, my mom has become drowsy again, shall we come to the hospital?” she asked.
“Sorry, I am not available, please see another doctor at any hospital of your choice” I replied.
Many good doctors have exhausted their patience and will to be kind and compassionate due to such incidences happening every day. Now most are concentrating on patients who have better common sense and manners, politeness and willingness to understand the use and limitations of modern medicine. Money is the last thing a doctor can think of, but sadly it is the first and only thing that most relatives think about. While treating the patient, the first thing- patient’s life – has not remained the priority for most hospitals, it is now the safety about medico-legal aspects and reputation. A wise doctor has to learn how to balance in between.
Doctors in India must bite many such bullets every day!
© Dr. Rajas Deshpande
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