Monday, March 20, 2006

So, what's changed?

This blog comes up more than a week after the famous resident doctors’ strike has been called off, and its crippling effect is becoming a mere tale we’ll tell at family gatherings. But one thought has been tickling my brain and refuses to die its natural death and must pour itself out on e-paper.

I had to do the night shift in the surgical emergency department one night after the strike was called off. Walking in for work that night, there was a marked change from the now usual sight of the large, empty emergency floor with a countable number of patients rattling between the pathology labs, x-ray sections and surgery/medicine sections. There was a respectable throng of patients everywhere and the incessant whisper was slowly growing into a loud buzz. On entering the Emergency Surgical Room (ESR) another new sight greets me… a registrar!

Immediately I’m pressed into action - “Intern, put IV lines into those two patients, fast.” Through the night the instructions flow thick and strong. The patients’ relatives, sick with worry themselves, entering in groups of twos and threes are loudly chided to not crowd up the ESR. “Sirf ek jan ruko andar.” People are sent all over the place without being given instructions clearly. Scolding a poor patient who kicks up a fuss about being pricked by a thick-bored needle, threatening another lady who finds it uncomfortable that a tube is being shoved down her nose… and so we go through the night. Through it all, not one expression on the face of the houseman; and worse, only a scowl on the registrar’s face.

You would think that people, who had returned to work because their demands had been met, would be a happy lot. You would think that they had missed their work, at least a little, and were glad to be ‘back in action’. Maybe I’m being too naïve… the changes that the government, promised won’t be here for a while and no one likes being dragged out of an impromptu vacation… but there can be at least one smile.

As doctors, we have a responsibility to communicate well. We see people at their most vulnerable moments and what we say and how we act is the sole determining factor for our patients’ sense of security. It doesn’t take a genius to know that every act of ours is being noted; every utterance weighed for its tone… anything to betray our true idea of the patients’ prognosis is being bleeped on the radar of their subconscious. These residents were, not too long ago, students who spoke nicely to the patient in the ward. Tomorrow they will be lecturers and will suddenly be comforting, patient and pleasant to patients again. So what happens to them in those three years? I can see that they are a frustrated lot; what with long hours, too little pay, shocking living conditions… but do they completely stop enjoying the high of accurate diagnosis, patient interaction and successful treatment? Why must the patient bear the brunt of their anger against the system just because he can’t afford a private doctor? Why will they smile and explain prognosis to the same guy tomorrow at their private consulting? The joy of interacting with people has got to be one of the reasons for taking up clinical fields; else they are in the wrong line. In fact, in a study done in the US they found that doctors who got sued most often weren’t making more mistakes than their colleagues; they were just arrogant. Does it take lure of money or the fear of a lawsuit to treat the ailing better? Isn’t it shameful to ask that question?

The hospital is, as such, a depressing place… no one wants to be here. To add to that, if sick people are treated like a nuisance, I don’t think that helps any. And the resident doctor, the one who is around most often, can make the difference between the negative vibes and the sunshine in the ward. I too know that many patients who throng a municipal hospital are not educated well enough to follow prognosis, many of them are stubborn about their idea of what ought to be done, many don’t follow rules. An occasional raise of the voice is not just a reaction, sometimes it is the only thing that works. But you can’t stay angry with all people at all times!

One incident comes to my mind when I think of rude doctors. A few years back my grandmother was admitted to Nanavati hospital for fractured vertebrae. Now, one day when I was sitting with her and she was complaining about exceptionally severe pain, a bunch of trainee doctors walked in. My grandmother almost begged them to do something to alleviate the ache. I don’t remember what they said; I only remember their arrogant, why-is-she-bothering-us attitude. I also remember being livid that evening and thinking to myself that when I become a doctor, I won’t treat any patient like that. Sometimes, watching my seniors shout at patients I find myself absorbing their unpleasantness. Being just a toddler intern, I still talk nicely to patients but I’m beginning to think its okay to be rude. God forbid, I don’t want to turn into a nasty snarling thing that people are too afraid to approach… I have to guard against that arrogant, dismissive, sharp tone that I think can pass off.

Well, let me come back to the strike which, let’s not forget, began because a doctor was struck by a patient’s relative. I’m not justifying the assault, but I can still feel anger at the way my grandmother was treated and I know that no reasonable person will hit someone who spoke to them decently. Somewhere, all the unpleasantness of the days spent in KEM got too much to bear and just boiled over in the form of a slap that resounded across Maharashtra in the form of a paralyzing strike. Well, but that’s over now, isn’t it? We’ve got our “written promise” for new hostels, our pay hike… we are back to yelling at patients and cribbing about ‘double emergency’… So, what has changed?


Dr.Dangayach said...

Hey Dr. Veena,
Well firstly I must say since we began our posting at Cooper, the whole feel was different, including the feel of the strike; no protest marches, no dharnas, no slogans. Perhaps the only thing which was serving us a reminder of the strike was the absence of the registrars and the house- officers.
I have a strong feeling that the way things turn out in the medical profession has a lot to do with hand-me-down-attitudes. Right since first year a lot of us 'consulted' our seniors regarding books and in the bargain also managed to imbibe their attitudes atleast in part-whether good or bad. The residency issue- hmm...have a lot to say and besides I think my comment is getting too long.So, I'll just blog that. Happy internship.

Sumedh said...

I think you have accurately pointed out the underlying attitude we tend to develop where we become too self-important. Doctors, so often, come across like they're doing the world a massive favour and, consequently, that reflects in their interactions with patients.

We tend to forget, while puffing our chests with pride for doing medicine, that the doctor comes after the patient (pun intended).

More on: (pun unintended)