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Patient First; why quackery is flourishing!

Patient First; why quackery is flourishing!

A Government employee of Delhi was advised by AIIMS hospital on April 21, 1997 coronary artery bypass graft and asked to deposit Rs 70,000. He arranged the money and deposited it with the hospital on July 23, 1997.Two days later; he was rushed to the emergency ward at 2am with severe pain in the chest. The doctors there referred him to the Safdarjung hospital at 5am on the ground that it had no bed to spare. No ambulance was provided. However, the patient was referred back to the AIIMS on July 30, 1997 and he passed away at 9 pm the next day. His daughter sued the hospital for medical negligence and demanded a compensation of Rs 37 lakh. When the matter reached the national commission, it found that the hospital was guilty of medical negligence. It said ‘ideally, a cardiac patient in the throes of a heart attack should receive thrombocytic medication within first 30 minutes of his arrival in the hospital which helps him survive the attack’. The commission found that the patient was not given this treatment. Worse, he was ordered to be shifted out on the ground that there was no hospital bed available. “We have no hesitation in arriving at the conclusion that referring the patient, who was in a grave condition, to another hospital was sheer negligence, and the time spent in his shifting undoubtedly proved fatal”. On the non-provision of ambulance, the bench said, “No reason is forthcoming as to why this life saving facility was not made available and the patient, admittedly under Inferior Wall Myocardial Infarction, was tossed from one hospital to another like a chattel.” It ordered the compensation to be paid with interest. The total amount with interest will now be over Rs 50 lakh. The bench thought it necessary to remind the hospital that failure on its part, like any other hospital, to provide timely medical treatment to a person resulted in violation of right to life guaranteed under Article 21 of the Constitution.

Most Indian hospitals today claim that they put patients first. However, this is usually far from truth. Most patients are treated shabbily – and their family members are treated much worse, especially in public hospitals. Why? That they can get away with it. The number of hospital beds is fewer than the number of patients, and since they have enough bed-occupancy, they see no need to change what they’re doing.  On the other hand, corporate hospitals’ primary focus is in incentivizing doctors to make sure that their beds are full, rather than cure the patients. The hospitals have invested a lot of money. So they need to be profitable and to achieve this they pressurize the medical faculty to achieve their targets, which is to offer the investigations available in the hospital to the patients. It is immaterial whether or not they are required. Recently 3 doctors were suspended from practice due to unethical practices. While one doctor was suspended for taking benefits of foreign jaunt sponsored by a pharmaceutical company, the other two faced action for violating the self-advertising code of Medical Council of India. Pharmaceutical companies bestowing gifts to doctors, sometimes even money or sponsored trips, in return to prescribing a particular brand of medicine is a disgrace to the integrity of medical profession. Even the commissions that pathology laboratories, scan centres or hospitals give to doctors for referrals is unethical. While such unethical practices need to be curbed, too much policing of doctors can be counter-productive. It is not right to subject a medical doctor to investigation and harassment simultaneously by the police, consumer court, NHRC court and the ethics committee of medical council.

Why patients go to quacks?
While big hospitals in the cities are inaccessible to rural patients, they don’t know what to do in case of any minor or major ailment. The quacks may come handy. Patients prefer quacks for different reasons. They mix with the public very easily, they are from the same community, they establish strong rapport with the people, their behavior and manners towards the patients are excellent, they communicate with them very easily and with utmost patience, there is no need for waiting or seeking appointment from them to avail their services, they have sympathy and understanding  for them, they deliver the services at their door steps,they are available for emergency services at any point of time, their financial expectations are not high, not fixed, no need to pay on the spot, can be paid in cash or kind at any time. They even give some medicines from their side for the time being so that the patient need not rush to a pharmacy to get them on the spot and they are culturally and status wise compatible and mix with the patients. Under these circumstances and with so many advantages, which patient will opt to forego such facilities and opportunities?

Patients want to be heard and cared for. They appreciate courtesy, attention and sincere interest in them with a chance to be heard. Treating patients with care and compassion makes a lot of difference. The patient does not care about medical science. What he wants to know is can you help him?  Growing research evidence points out the importance of compassion and communication. ‘Non-clinical elements such as convenience, customer service, staff attitude, communication, accessibility matter much to the patient.

Each hospital should have a chief patient officer, whose job is to make sure that everyone in the hospital remembers that the only reason the hospital exists is to help patients to get better. He needs to champion the cause of the patient and emphasize on ethical and affordable health care.

 

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