About two decades ago, when I was new to practice, a family brought a newborn child for a surgical problem after having first consulted a senior surgeon. The surgeon had bluntly told them that the child would die without an operation; surgery was the only hope, but with just a 1% survival chance. They could go to a higher centre if they wished. I was aghast at the counselling of the surgeon. “Not true,” I told the family. “The survival chance is about 80%.”
The surgery was successful, and I shook my head in utter disgust at the attitude of the senior surgeon.
Recently, I was talking to a family and caught myself saying, “Your child is serious and will die without an operation; an operation would mean maybe a 1% chance of survival. If you take the risk, I will operate; otherwise you can go to a higher centre.”
Only this time around, I had cameras recording the conversation and it would stay in my “system” for a month. I also had a consent form in duplicate, listing all the possible complications, with even the mention of death in bold letters, a couple of times. The family would need to sign the consent form. A second copy would go to the family to mainly prevent them later from saying, “Nothing was told to us.” I shook my head in utter disgust at myself.
Why has this happened? No arguing that patients have an extreme scare of many things in the medical profession. But it is also a fact that doctors have an equal fear of the patients. There is mutual distrust and suspicion as the patient stands facing the doctor. “Oh, a lot of tests; surely a commission racket; the medicines are unnecessary; these medicines are powerful; these medicines make a lot of money for the doctor; the surgery is not required; need to check with Google; need to check with another doctor” and so on.
Each party carefully hangs on to each word coming from the other side. The consultation table almost becomes a battle line. The doctor would think, “What village does he belong to? What community does he or she belong to? Would there be trouble if things go wrong? What political backing does this patient hint of? Are there any hints of pressure from politicians, press, lawyers or the police?”
Why is a doctor concerned with the village and community of the patient? Why is the fear of physical violence against the doctors so agonisingly palpable among the doctors? The questions we ask today when the hospital informs us of a death are, “Is there going to be trouble? Is there a mob? How has the family taken it?”
It is strange that not only the populace but the doctor also holds himself guilty of any death at a subconscious level automatically, whatever be the condition of the patient and whatever be the efforts of the doctor.
There was a golden past when the doctor could say, “I am going to cut your head tomorrow and replace it with a cauliflower,” and the patient would say, “When do I get admitted?” Also, there was a time when the doctor would say, “Don’t worry about the payments. Whenever you have the money or whatever you want to pay, that is fine; but let me sort you out first.”
Today, even when the doctor prescribes paracetamol, the sharp patient would receive the prescription with suspicion and scepticism. He would surely check the brand name on the readily available apps. Today, even when a patient and the family agree to a surgery clearly required, as when the bowels hang out from the abdomen, the surgeon would want consent forms in duplicate with lots of signatures and take time for video counselling. The consent forms seem to be getting bigger, better and scarier, similar to those in some western countries.
My sister-in-law was due for delivery in the U.S., and was screaming in pain. The doctors decided for a Caesarian section. It was a consent “book” rather than a “form”, my cousin tells me. As my cousin and his wife were signing each of the pages after careful reading, she gave birth in the room itself!
I get scared by my own consent forms and my own video counselling when I rewind them to see. How can the family even agree for me to be near their child? These are all signs of difficult times and certainly does not augur well for the future of the profession. Things only seem to be spiralling downwards as doctors and patients fly farther away in matters of trust and faith and yet depend on each other for their survival.
