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.”