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Oct-Dec2002-10(4)
LETTER FROM BANGALORE
Peculiar
gifts
Sanjay A
Pai
Elsewhere in this issue is a review of
Complications by Atul Gawande. As the author and the reviewer emphasise, some
people have to be at the receiving end, so to say, of tyros in surgery and other
medical fields. This is unfortunate; however, it is the only way medicine can be
learnt or taught. That this teaching can only happen in a teaching/university or
a government hospital is a given fact.
However, because it is the poor who usually
frequent such hospitals, I find that many Indian medical students are rude to
their patients. I recently had the opportunity of visiting a teaching hospital.
It would be an understatement to say that I was horrified at the shoddy,
sub-human treatment - be it language, behaviour or attitude - meted out to the
poor, often ignorant patients. These same doctors, though, are honey tongued,
when in their private practices, some months later.
Physicians must also remember to respect their
older patients. It is all too common to see young medical students address
elderly patients by first name. (I am certain I did the same not so long ago. I
regret it now.) They would do well to put themselves in the senior citizen's
shoes and consider how they would feel if someone 40 years younger called them
by their first name. Familiarity breeds contempt.
The reference to medical education brings me to
another point. There must be very few, if any, specialised geriatricians or
departments of geriatrics in India. This is something, which the health
authorities and policy makers must address soon. Currently, five per cent of
India is over 65 years old. This is projected to increase to 15 per cent by
2051. (1) It is unreasonable and unscientific to expect an adult physician to
have the same competence in treating a senior citizen as for a 35-year-old
patient. By extension, anything unscientific would be unethical.
Patient's rights are fairly new concepts to
Indians. My hospital, I am happy to say, has just started working on such a
charter. It will, I imagine, be quite some time before we come out with a final
draft. The initial draft is being worked on and there are many un-addressed
issues.
It was, therefore, an unpleasant surprise to learn
of an e-mail message created by a disgruntled patient in a particular hospital
and sent to many people advising them to forward it to as many people as
possible. Thousands must have read the message before the hospital stepped in to
do 'damage control'. It turns out that the patient was mistaken in his
understanding and belief about a doctor employed by the hospital. A correction
e-mail was then sent, but doubtless, it was not forwarded with the same frenzy
as the earlier one.
This is one more use of the internet. An
unscrupulous competitor - in health care or elsewhere - can run down somebody's
hard earned reputation with relative ease. And it brings up another point - what
about doctor's rights ?
We are, of course, aware that doctors are not
expected to accept gifts that have no bearing on their education or on patient
management. This means that while textbooks, journals, free drug samples, etc,
can be accepted, one has to turn down cakes (and ale), air tickets and other
freebies. The idea is that the doctor not be enticed into prescribing an
unnecessary or useless drug for pecuniary or related reasons.
At least one drug company in Bangalore seems to
have accepted this - well, in part, at least.
They have gifted a colleague - and I am not making
this up - a small pouch filled with glass marbles. I am unclear about how this
can be interpreted as an aid to treating the patient (unless the physician keeps
herself busy in her spare time by playing marbles). The possibilities in humour
are endless. Patients - and other doctors, doubtless - can say, "This doctor has
lost her marbles." The good doctor can then present evidence to the contrary.
But one thing is for sure - not even the most unethical of doctors will be
influenced or 'bought' by such a gift. Can you imagine a scene where one doctor
says to another, "I recommend this drug over its better competitors because I
simply cannot resist those marbles. I'll do anything to get another
pouch."
Reference:
Srivatsav R. The flip side of FP: India greys
early. The Times of India, July 3, 2000.
Dr Sanjay A Pai, Consultant Pathologist, Manipal Hospital, Bangalore 560017. Email:s_pai@vsnl.com