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OPINION

Unsympathetic doctors!

With experience I realised it''s not jealousy but ignorance of people about our healthcare system
Dr. Zahid Qayoom
Srinagar | Posted : Mar 14 2018 1:18AM | Updated: Mar 13 2018 11:55PM
Unsympathetic doctors!
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Ever since our childhood, we have been working hard day and night with just one dream that our hands join those hands who relieve people of their sufferings, without worrying about our own sufferings, our own health and everything related to our own well-being. There have been times when our eyes have not witnessed the sunlight for weeks together! we would not care whether we ate anything or not. we would not care about what we wore. Whether it was our school life or college life, all we knew and did was, work hard and hard and hard!

Then came the time when our dream finally became reality. That beautiful feeling can't be expressed in words. We were very excited to work day and night in the hospital and save lives! Nothing gave us more happiness than seeing a person smiling after being successfully saved from a potentially fatal condition. Sometimes we saw our seniors scolding patients or, more commonly, their attendants and we would curse them for doing that even though the patient or attendant was at fault. We had so much sympathy for patients that we would sometimes weep or even faint upon seeing a patient in severe distress. When sometimes our seniors asked us as to why we chose medical field and strived very hard to get into it and through it, we would quickly answer, "we want to serve our community". They would laugh at us!

As time passed by and we were gradually integrated into the field of healthcare completely, we understood how thankless people are and instead we found many people having anti-doctor sentiments. We failed to understand why that anti-doctor trend was spreading like fire, not only in our state but all over India. We then started believing that people are jealous of us because we have outshined them! We lost sympathy for people and we would no longer be affected by cries and screams! We were so much affected by the anti-doctor propagandas that we would hesitate to offer help if we saw someone bleeding on road after being hit by a vehicle! Our subconscious mind believed that people who don't appreciate our hardwork and rather selectively highlight our flaws or even spread false propagandas, don't deserve our help even if they are dyeing!

As I gained more and more experience, I started realising that the reason for this feeling is not jealousy but unawareness of people about the structure of the healthcare system. Even our "educated people" are not aware. That is the reason we sometimes hear people complaining as to why a consultant is not available at the hospital during night! or why a doctor is not available to check a patient's blood pressure at night just because his attendant "thinks" that his blood pressure needs to be checked! People have misconceptions and wrong expectations and obviously their expectations are not met.

Throughout the world, healthcare system has been designed in such a way that every individual person gets healthcare as per his/her requirement. Like a person having common cold requires the most basic form of healthcare as compared to a person having asthma. So, the former doesn't need to be seen by a chest specialist. So, keeping in mind the healthcare requirements of people, three levels of healthcare have been setup:

 

1. Primary healthcare: It is the most basic form of healthcare and majority of people require this form of healthcare only. e.g. person having common cold, diarrhoea, simple non-specific headache, backache, minor trauma, common infections, basic mother and child care, etc.. This form of healthcare is delivered via Primary health centres and sub centres and we have hundreds of those in our state.

 

2. Secondary healthcare: It is more advanced form of healthcare and is the most important level of healthcare as per my experience because majority of those patients who can't be managed by primary care can be managed at this level. e.g., patient having severe undiagnosed headache, severe undiagnosed abdominal pain, seizures, chest pain, loss of consciousness, etc. This form of healthcare is delivered through Community health centres, district and subdistrict hospitals and we have many of those also in our state.

 

3. Tertiary healthcare: It is the most advanced form of healthcare which is provided by state hospitals like our SKIMS and GMCs.

 

The hierarchy of healthcare that I just mentioned is the "ideal healthcare system" that should be in place, but in reality, it is not. Unfortunately. The reason is that either people do not believe on the peripheral healthcare system or the latter lacks proper facilities for delivering the appropriate level of healthcare, especially secondary healthcare level. So, the result is that our tertiary care hospitals are overburdened with those patients who do not require tertiary healthcare at all. Even patients who do not require any instant treatment, and can be easily managed in OPD's, come to emergency departments. We have to provide all the three types of healthcare facilities in our tertiary care hospitals and at the same time we have to take care that those brought with potentially fatal conditions are provided appropriate tertiary care facilities. Since thousands of patients visit our tertiary care emergencies daily, it is humanely not possible to give like half an hour to each individual patient. So, we apply a modified form of a method called "triage" (for God's sake don't google this term and feed your mind with crap!). Triage is ideally used in disasters to save maximum lives but our tertiary care hospitals have disaster like situation everyday!

Now, triage is a vast concept and describing it fully is beyond the scope of this article. In simplest way, triage refers to prioritization. I will explain with three examples:

 

1. A young person comes with severe abdominal pain and is tossing on bed because of pain. After examining him, we found that his pain is due to a small stone trapped in his ureter. He will just be given appropriate "pain relievers" and kept aside till his pain is relieved, without wasting time and energy on him, because we know with 99% certainty that he is not going to die because of this pain and the pain is going to be relieved within an hour or so. His definitive treatment for ureteric stone will be done on OPD basis. Similarly, patients having acute gastritis, non-serious headache, nonspecific abdominal pain, etc will be dealt with in the same way.

 

2. An old person is brought in an unconscious state and, after examination, is found to have "massive" haemorrhagic stroke with majority of his brain already dead (mind it, i said "massive"). This person will be admitted, prescribed required medications but he will not be in the priority list because he is not expected to survive!

 

3. A person has met with an accident and the primary impact is over his abdomen. He is conscious and apparently looks normal to the common people. After evaluation, he is found to have a breech in one of his blood vessels in the abdomen and he is bleeding inside. This is the person who will get maximum attention because we know with 99% certainty that he is going to die if not operated soon, even though he looks apparently alright to common people. Similarly, cases like acute appendicitis, acute gut obstruction, gut perforation, active seizures, acute severe  asthma, heart attack, stroke, diabetic ketoacidosis, shock, etc will be dealt with in the same way.

Now, imagine that all the three types of patients are brought at the same time and we apply the method of triage to save the third patient. The attendants of the first two patients expect doctors to be around their patients all the time and many times there is exchange of words between doctors and the attendants. This is exactly what happens in our tertiary care hospitals every single day! Infact, majority of the patients visiting our emergency departments belong to the first category and are typically given one or two injections, after excluding any serious cause for their sufferings, and sent back home. They are advised to get definitive treatment by concerned specialists on OPD basis. This is the reason we often see patients complaining in the emergency departments that doctors are just giving injections and not treating the cause, again they are having wrong expectations.

 

So, the doctors sitting in tertiary care emergencies have only one aim that is to find whose life is in danger and save his/her life, without giving much attention to others except for relieving their pain and distress after excluding any serious cause. This approach is very important to save lives and i feel proud that i am part of the team which saves lives every single day even if it takes hours together to save a single life, ignoring all other stable patients. We have been working hard and will continue to work hard day and night even if people speak against us and defame us in all possible ways without knowing the ground realities. We set ourselves on fire to keep others warm and in return, the "others" pour more petrol over us and enjoy watching us burn, without realizing that they are actually burning themselves! We do have flaws as, after all, we are humans too, but selectively highlighting those flaws and even spreading false propagandas, especially on social media, without appreciating our sacrifices, is very disappointing for us and it affects our approach towards all patients and we become less caring and unsympathetic! >90%, if not all, of doctors are hardworking and dedicated towards healthcare and that is how they have become what they are.

"I act like I don't care, but deep inside, it hurts"

Dr. Zahid Qayoom is Postgraduate resident doctor in the department of Radiodiagnosis at SKIMS