Gullible Patients

Over the last few days, it has been quite busy. The reason that my blog was silent was partly because of laziness and partly because of my not being on call during these days. Winter is yet to leave us and the number of patients at night are not that much. However, we’ve had our share of very very sick patients, most of whom found healing.

One of the common things we find here are patients who have been rather embezzled of their money by doctors who are a shame to the profession.

We had a typical one today.

The lady, MeD, a 28 year old who’s being married for about 10 years came in labour. Although this was her third pregnancy, she did not have any live issues. Both her previous pregnancies had died, the first one died within a day of the delivery which had taken place at home; the second one died within a week of delivery in a clinic.

Both deliveries had one thing in common – the labour was a long affair and the baby had not cried at birth.

Well, I was surprised to see quite a hugh file being brought in by the relatives. She had been on treatment from one of the posh hospitals in a faraway city to ensure that this baby survived.

As I went through the records, I was stunned to find out that MD had undergone all possible evaluation for infertility . . . her second delivery was not even one year back.

The list of investigations was huge . . . I saw one bill which totalled about 20,000 INR. Even after she had conceived, she underwent serial ultrasounds . . . I asked the husband if he had any information on why the previous two babies died.

She also received quite expensive medications which I thought was not at all needed. 

He told me that he was told that the VDRL was positive. However, all the records of both husband and wife showed that VDRL was never positive. And it was so surprising that the husband was all praises for the doctor who was rather looting them.

It is so so sad to see a young poor couple taken for a ride like this by a clinician who had multiple degrees printed after his name. 

By the way, MeD delivered within half an hour of her arrival into the labour room. The mother and the baby has been doing fine so far and we thank the Lord that we could be part of the joy of this couple. However, I’m horrified at how this poor couple has been fleeced off quite a lot of their money and they being of the impression that they’ve had the best treatment possible to ensure a live baby.

The couple was all praise for the big hospital in the city who gave them all the 'world class expensive treatment' that has ensured a healthy baby . . . of course, the joy was immense as it is a boy baby. The previous two who died were also male babies . . .

Unwanted Hysterectomies . . .

Over the last 4 days, our local newspapers are on a reporting spree on allegedly unwanted hysterectomies being done by couple of hospitals in our neighbouring district, Garhwa.

About couple of months back, we had a similar news in our own district. I don’t know about what was the outcome of the investigations and enquiries that came after that.

In fact, we at NJH receive quite a lot o patients who come to us after they had been advised to have a hysterectomy elsewhere. The reason would most of the time would be one irregular cycle or a vaginal infection. And in 80% of the cases, there would not be an indication or the surgery. The ultrasound reports it as 'edematous uterus' or 'enlarged uterus'. 

I remember a patient who was pestering me to get her uterus taken out. I could not find any reason to do the surgery. The family saw the uterus as a unwanted organ once the function of childbearing was done with.

It is not uncommon for requests for hysterectomies from patients when they are subject to abdominal surgeries which have no relation to the uterus. Appendicectomy . . . Cholecystectomy . . . Perforation peritonitis . . . there's always a query on whether the uterus can also be done away with. 

When the news about unwanted hysterectomies being done was first reported, I remember having a conversation with one of the local village leaders.

He wondered why the all fuss about the uteri being removed. He narrated to me how difficult and useless it was for a village woman to have a uterus once the function of child-birth was over. He was referring to the 'menstrual cycles which torment the lady' till she attains menopause.

And mind you, he knew the medical science. He told me how irregular and heavy bleeding during menstrual cycles could keep the lady anemic and malnourished.

He narrated, ‘First of all there is so much of poverty and malnourishment. To top that, there is the monthly loss of blood which is well averted if the uterus is taken out. Then, if she has a problem with her cycles, she’s too tired to work for almost a week. Therefore, why all the fuss about removal of few extra uteruses? And the treatment you people give for irregular bleeding is also quite expensive . . . he knew the costs that hormonal therapy involved . . . the drugs and multiple visits involved.’

A typical example of how developments in healthcare can be utilised in a twisted manner by people who are out for a profit and beneficiaries who assume that they have a good deal.

Then why the fuss .. .. .. my friend has the answer.

‘You cannot allow anybody to get their uterus out without a genuine reason. The reason why everybody joins the bandwagon of blaming the doctor and the hospital is because someone must have told them that there is the possibility of some sort of compensation involved. Nothing less, nothing more’

I could buy his reasoning . . . not about the reason for hysterectomies. The reason for the fuss being made after the surgery has been done. 

It was not difficult to imagine  . . . the hype after all the damage is done . . . nothing short of media sensationalism . . . the question on who got the scoop . . . and then, a glimmer of hope among the rural poor about getting some amount of 'compensation' for the 'wrong' done. 

Nothing concrete to change practice. That is what we learnt from similar 'revelations' elsewhere. 

I shall be much relieved to see some amount of responsible decisions being taken in the healthcare sector in this region after this incident. 

The Fourth Estate . . . Quo Vadis

It was quite surprising that Mr. Shashi Tharoor was again on centre-stage all over in almost all media circles yesterday night. The reason . . . he had posted something on Twitter regarding the Delhi rape victim. 

Yesterday night, the way the story was reported, showcased Mr. Tharoor as an uninformed ignorant person with ulterior motive. However today morning, with the family having obviously given it's consent for the same, most of the newspapers have backtracked and have been sort of commending the idea. This is a good article on how the media handled this. 

The whole incident shows how thoughtless are our media and politicians. We under-estimate the capability of a person who was an illustrious diplomat and was in the running for the UN Secretary General whereas we are ready to accept statements of people who end up apologising most of the time that they were misquoted. We would rather get along with people who would state what we want to hear rather than hear someone who talks from one's heart with conviction. 

And the media just waits to pounce on things. Everyone wants masala so that their viewers or readers would increase. The number of newspapers and news channels who publish real news are on the constant decline. 

Well, it's not in the national scenario that media does not behave with responsibility. 

In my routine clinical practice, it is quite often that I hear about patients threatening to call the 'patrakar' (the local journalist). I ask them to go ahead. During my first year here, there were few who tried to publish news against the hospital. However, when I convinced the local patrakars that they could end up in serious trouble if they published baseless news, they've left me alone. 

One of the common practices in this part of the country is 'paid-news'. If you run an NGO, it is very common for you to call the 'patrakar' and give him a 'baksheesh'. The prominence, the news about your program will command is directly proportional to how much you pay. 

I made a conscious effort to ensure that these guys are not called when we have big programs in the hospital. However, there is one problem. When we call some of the big shots in the government or administration, they usually ask where the patrakar is? I politely tell them that we usually don't invite the patrakar separately. However, they end up calling them up and they usually rush to cover the event. 

Even, with this Delhi rape case . . . although I'm quite encouraged by the protests it could muster and the awareness people got after the media coverage. I wonder .. .. .. is it that we never had molestation against women? In fact, 2 young men (Keenan Santos and Reuben Fernandes) were killed in Mumbai when they went to protest against a young lady being molested. To make matters worse, I read that there were about 25 cases of reported molestations against women since the Delhi rape all over the country. However, you were not interested in following them the same way you reported this particular incident. 

My dear friends . . . in the light of such incidents and experiences that we've had with the media, I propose that nobody of us believe much on what they say and publish. 

And my friends in the media . . . there is something called ethics which you need to follow. Please remember that you are not the rule enforcers or the judiciary. Your role is to report what happened . . . and not to report what you think should/would have happened . . . or not to report what you are paid to report. 

And please do remember . . . there is another India, news about which does not make find many takers. Hope you remember the Banwari Devi case. I wonder why much fuss was not made for that poor lady. There are many more which go unreported . . . 

Hope that you would be a voice for the voiceless rather than an amplifier which decides when to switch itself on or how loud and clear one should sound. 

Wish you'll report with sense and responsibility in 2013. Happy New Year . . .