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Humane, effective medical care beyond intensive care

I was at an important meeting in Bangalore. While most members in that group had their individual projects to be considered for funding, the one taken up by the chairman first was a project submitted by a very busy and highly rated doctor. He wanted funds to start a project to train future emergency room nurses on mannequins.

His introduction, something on these lines, startled me: “Future hospitals will only be intensive care units, and out-patients will all die a natural death. We need thousands of ICU [intensive care unit] nurses. They cannot be trained in a nursing school as there are no patients for them to train on. I have this project to train them on mannequins instead of on patients. We have a group to manufacture these, and then we can sell them for a relatively cheap price in India. Let this body have the pleasure of associating itself with this laudable project for the future of mankind.”

The wise chairman and vice-chairman agreed with him totally, and without any further discussion the required funds were granted as the doctor had to leave quickly. He had got what he wanted.

We were three other senior doctors in the group, and none of us was even asked what we thought of the project. In fact, two of us had spent more than half a century studying patients and teaching students. In fact, the busy doctor was one of my old students! The third one was a serving Vice-Chancellor and another a student of mine.

A young American patient had been in and out of many hospitals in the United States for 15 years without a diagnosis — her condition was labelled idiopathic disease — until one humane doctor diagnosed Lyme disease. She later commented on how the medical system had become technologically proficient but emotionally deficient and inconsistent. While describing her sorry hospital experience, this intelligent young lady had so many things to teach us doctors. She wrote: “The system is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. The system that invokes “patient-centred care” as a mantra, modern medicine is startlingly inattentive — at times, actively indifferent — to patients’ needs.”

Modern western medicine does not even have a correct scientific base. Now to say that every patient in the next 10 years will have to go to the ICU is a very dangerous statement. The rate of happy outcomes from terminal ICU care is abysmally low; a majority of the patients go to meet their maker through the ICU route. Death loses its dignity; the near and the dear ones are left with a permanent feeling of guilt if they miss being near the person as he or she departs, as many ICUs do not let relatives in.

ICU treatment is indicated only for a small fraction of the acutely ill. The population of such acutely ill patients is about 2 per cent to 5 per cent of the patient load on a given day. Are we converting our hospitals into ICUs for all patients? It might be a very good business proposition but a bad move for the sick.

Be that as it may, our ICU management is also far from satisfactory. Usual causes of death in ICUs are nosocomial infections with superbugs, which love ICU settings, and depressed immune systems that decrease the chances of survival. The latter is caused by starving the patient and parenteral feeding, and loading patients with all sorts of drugs and antibiotics which sap the immune guard further. The gut environment is a major part of the human immune system. If you do not feed patients by mouth the gut environment gets totally changed, depressing the immune guard.

In short, all that we do in the ICU is anti-patient, philosophically. The Lyme disease patient drove the point home effectively on the medical industry’s record when she wrote: “Spend a day in an emergency room, and chances are you’ll be struck by two things: the organisational chaos and the emotional detachment as nurses, doctors, and administrators bustle in and out, barely registering the human distress it is their job to address.”

Lately some voices from among the profession itself are trying to express the internal turmoil. If a doctor is conscientious, he should feel it sooner than later.

It is more than 45 years that I have been raising my voice against this malady without being able to stir the conscience of too many of my colleagues. Rather, they were under the wrong impression that I am against their business. I tell them that healing is not a business; it is a calling, a great opportunity to serve human beings in distress.

When it comes from the U.S. and the U.K., people here open their eyes and listen. The American scenario today is pathetic. Doctors are frustrated, patients angry, hospitals are going broke, insurance companies are closing down almost daily with chaos everywhere. In the present corporate hospital setting, doctors spend most of their time doing things other than being with patients — they spend just 12 to 17 per cent of their day with patients. Filling forms in the euboxic system of medicine that the U.S. practises, reviewing laboratory results, maintaining electronic medical records and dealing with staff members take the rest of their working hours.

Arise, healers. Awake, and sleep not till the system gets rectified to the benefit of the suffering humanity as that is where as doctors our training has prepared us for.

Being a doctor is a blessing and a rare opportunity to fulfil our societal obligations. Money will follow and no doctor will starve, for sure. Remember, medicine is an “art” based on science. Art is that which makes another’s day. Medicine must try and make the patient’s day.

(The author is a senior doctor and a former Vice-Chancellor of Manipal University. He won the Padma Bhushan in 2010. Email: hegdebm@gmail.com)

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Printable version | May 10, 2021 7:00:48 AM | https://www.thehindu.com/opinion/open-page/humane-effective-medical-care-beyond-intensive-care/article6819434.ece

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