The Telegraph
Since 1st March, 1999
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Gangrene is in focus, not the diabetes that may lie beneath

Doctors are generally good and generous hosts. Many of them are also excellent raconteurs. It is always a pleasure, therefore, to call on doctor friends. That is, when they have the time. Many of them are also extremely dedicated, so much so that one of them religiously goes on his round every day, even on holidays or ‘off-days’. “My patients,” he explains, “wait for 23 hours and 50 minutes every day to chat with me for 10 minutes. What right do I have to deny them'”

He, a surgeon, owes it to a professor of his. When his daughter was a toddler, he once took the evening off because it happened to be her birthday. The next day, he was summoned and roundly reprimanded by the senior, who pointed out that one of his patients had a critical time the previous evening. “Doctor, always remember that your daughter’s birthday will come again but your patient’s life may be lost for ever.” That is when the doctor decided to keep a special watch over his patients, rain or shine, holiday or no holiday.

Of late, however, one can sense a little uneasiness among doctor friends, sensitive to criticism in the media. They do try to crack a joke or two. “You guys report that government hospitals are visited by cats and rats,” one of them once quipped feebly. “Patients in these hospitals pay nothing. So they can’t possibly expect leopards or lions to visit them, can they'” But most of them are cut up with what they call ill-informed criticism and resent what they see as their ‘trial in the media’.

This writer was, therefore, instantly on the defensive when he dropped in at the house of a doctor friend and found, not one, but three of them waiting for him! But they appeared relaxed and intent on discussing everything except government hospitals and doctors. It is, perhaps, a case of overkill, with the media having exhausted the fusillades, one thought. It was necessary to test the water, though, and so this writer tentatively asked what they thought of the campaign in the media about medical malpractice in government hospitals. The reply came as a surprise and led to a rather lively and useful discussion.

“Newspaper and television reports are largely correct,” they said. “So what is there to be upset about'” “ It is a different matter,” added one of them, “that you are reporting the gangrene that you see and not the diabetes which may have caused and compounded it. But then, that’s your problem.” All three of them felt that while the media have fuelled a blame-game and knee-jerk reactions from the government, what is needed is, perhaps, a more dispassionate and constructive discourse.

“Most government hospitals are actually madhouses,” confessed one of the trio. “Wherever you look, you find lungi-clad people; you can’t make out who are the staff, who the patients and who are the attendants; even doctors no longer don white aprons; other employees get uniform allowance but do not get uniforms stitched. With the pressure of patients, politicians and relatives, even basic discipline has gone for a toss. If the government succeeds in persuading hospital staff to put on their uniform and name badges, it will make a difference.”

His colleague demurred. “One of the key problems in government hospitals is that they do not have a demarcated reception area, where visitors will be screened, registered and cards issued to give them access into the hospital.” The third doctor suggested that the government issue pagers to everyone in the hospital, down to ward masters. A lot of time, he said, is wasted in tracking the right people.

“The ward master may have to shift a patient for his discharge and change the linen, etc, so that another patient can be put there; but he could be having tea outside and return half an hour later, and there is nothing anyone can do about it now,” he offered, by way of explanation. Many of the paramedics, he claimed, had been assigned to work in two different wards and the arrangement allows them to shirk responsibility.

Patient relations officers to counsel attendants and relatives, besides suggestion and complaint boxes in the wards, they felt, could also help. Citing the example of Susmita Biswas, who died without being admitted to SSKM Hospital, one of them claimed that what she needed was immediate blood transfusion and ought to have been referred to the haematology department. SSKM, he suggested, was the wrong hospital and the patient should have been referred to NRS. On-the- spot counselling could have helped save time and, possibly, her life.

There are more serious issues involved. The pressure on the house staff, need for computerisation, quality of interns, allowing hospitals to arrange for their own security agency and providing adequate incentives to doctors and para-medics are other areas that require attention. But even seemingly minor administrative steps could make a significant difference.

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