Plight of West Bengal and India Doctors

It is with deep anguish that we as the Organisation of the Paediatricians of West Bengal on behalf of the entire medical community at large are writing to you being concerned at the way in which a section of the media, supported by vested political interests, is destroying the holy relationship of trust that has always prevailed between a patient and his doctor through the ages, in our society. A patient trusts his doctor literally with his life and a doctor in return always tries to keep that trust and do everything with the best interest of his patient in mind. No doctor in sound mind ever causes deliberate harm to his patient. As the Hon’ble Supreme Court of India has observed in Jacob Mathew’s case, “No sensible professional would intentionally commit an act or omission which would result in loss or injury to the patient as the professional reputation of the person is at stake. He does not gain anything by acting with negligence or by omitting to do an act”. It must be remembered that it is not possible to guarantee an outcome in the healthcare sector anywhere in the world. Man is mortal, and therefore there would be times when in-spite of the best efforts of the doctors, the patient will die. Every doctor wants that his patient to get well and go home and bring him good reputation. Only a psychopath can ever wish to deliberately cause harm to his patient, and only very few doctors can ever be such psychopath. Every medicine that has effect also have side-effects, some of them can be life threatening. Every medical condition can have complications which are inherent to that condition, similarly every surgery can have complications and failures which are not under human control.

Anger and Grief Response

Every death and every loss are disturbing and devastating not only to the immediate family but also to all the people around, and more so when such losses happen in an untimely manner and unexpectedly. As the family moves through the five stages of grief viz 1. Denial, 2. Anger, 3. Bargaining, 4. Depression and 5. Acceptance, it is natural that everybody will try to seek out what could have caused the mishap. Next of kin will be angry as part of their natural grief reaction, and may accuse doctors of causing death by negligence; it is acceptable thus far. Any aggrieved party can lodge a complaint with statutory bodies following established procedures, and the law of the land has the capability to investigate and deliver justice. But what is not acceptable is people taking law into their own hands and mounting attacks on the healthcare professionals and facilities, assaulting doctors and nurses, destroying expensive life saving equipments that cannot be easily replaced, thus jeopardising the treatment of other critical patients admitted in that hospital. This gets even more serious in the private sector where people have to pay for his treatment and there sets in an expectation among many that if they are paying, nothing short of a complete cure can be acceptable. The natural anger of a grief-striken family gets further aggravated when they get the hospital bill, which in many cases may be over-inflated, and as the doctors are the only people freely accessible to the patient family, they start assaulting these healthcare staff even though the doctor usually do not get anything more than what is charged as his consultation fees in the bill, which is seldom more than 5% of the total hospital bill. Most of the money charged by private hospitals go into paying indecently fat salaries to their CEOs, Zonal Directors, etc., something the government needs to cap if it really wishes to keep hospital bills in check; just capping doctors’ fees will not help.

Vested Criminal Interests

It is now well known and already in the records of the Hon’ble Calcutta High Court that there are rackets around private hospitals that take money from patient families to foment trouble in the hospital premises to force hospitals to reduce or waive their bill. This encourages more and more patient families to tread this path, even if they did not have any genuine grievance about treatment at first.

Role of Police

The police, the keepers of law and order of the state, remain mute spectators when healthcare staff are assaulted and hospitals are ransacked; but this same police become hyperactive when patient family lodges a complaint, and slap charges on doctors under sections which the Hon’ble Supreme Court has repeatedly said doctors cannot be charged with; including in many cases non-bailable sections, often under intense pressure from vested political interests as well as their irresistible temptation to play into the hands of the media.

Role of Media

And fuelling the fire is the media - both print and electronic, who distort facts, misrepresent circumstances and quotes people out of context to sensationalise such human tragedies only to boost their Television Rating Points (TRP) and thus their profitability. “Tragedy sells”; and no wonder these media houses barge into the houses of the deceased to film a spectacle of a mother grieving over the dead body of her little child, with complete disregard to their bereavement, just to get some business out of her tears. They tend to form an opinion based on a mere allegation without waiting for the charges to be verified and publish unsubstantiated allegations as facts which is nothing short of rumour-mongering with an intention to foment further trouble. And this rumour-mongering of the media has been instrumental in gradually and consistently undermining the trust a patient wants to place in his doctor. They initiate a media trial mobilising public opinion in a direction that they want, based on mere speculations, without any verification of facts and without concrete proof, thus making it virtually impossible to ensure a fair trial even in the courts of law.

Points to understand

The relationship between a doctor and a patient is essentially one of mutual trust and respect. An ailing person has nobody else to go to if he cannot trust the medical community. Ideally every patient should go only to the doctor he trusts, but if situation compels him to go to a new healthcare facility, he better trust his new doctor. Medical treatment of an illness is not merely writing up a few medications, or doing something to suffice in the court of law. It involves a care component which cannot be extracted at gun-point. It is the trust of the patient that makes his doctor care for him to an extent that if his condition is complicated, he keeps thinking about it even in his sleep and writes to colleagues across the world, - something they are not required by law to do. They do all these to save his patients to repay their trust.

But the irresponsible and aggressive media propaganda against the medical community and their rumour-mongering even over natural deaths, have eroded people’s confidence in their doctors. Consequently even doctors are becoming more and more apprehensive of their patients and both the patient and the doctor looks suspiciously at each other, with the family looking at the doctor as the potential killer of their patient, and the doctor looking at them as a potential trouble-maker and litigant. This is a very unhealthy relationship and is not sustainable for very long.

Excellence in clinical care cannot flourish in this kind of an environment of suspicion, apprehension and insecurity. As the Hon’ble Supreme Court has very thoughtfully observed: “If the hands be trembling with the dangling fear of facing a criminal prosecution in the event of failure for whatever reason — whether attributable to himself or not, neither can a surgeon successfully wield his life-saving scalpel to perform an essential surgery, nor can a physician successfully administer the life-saving dose of medicine. Discretion being the better part of valour, a medical professional would feel better advised to leave a terminal patient to his own fate in the case of emergency where the chance of success may be 10% (or so), rather than taking the risk of making a last ditch effort towards saving the subject and facing a criminal prosecution if his effort fails. Such timidity forced upon a doctor would be a disservice to society. ... The purpose of holding a professional liable for his act or omission, if negligent, is to make life safer and to eliminate the possibility of recurrence of negligence in future. The human body and medical science, both are too complex to be easily understood. To hold in favour of existence of negligence, associated with the action or inaction of a medical professional, requires an in-depth understanding of the working of a professional as also the nature of the job and of errors committed by chance, which do not necessarily involve the element of culpability.”

We, the paediatricians of the State of West Bengal, therefore, desperately call upon the executive to intervene and re-establish the rule of law and instil trust and confidence in the minds of both the doctors and the larger society by bringing an end to these misadventurous media trials, making the press, the police, the judicial commissions and the West Bengal Medical Council more accountable and impartial, and ensuring speedy delivery of justice to the aggrieved parties. The media should be encouraged to present true and verified facts only and not unsubstantiated speculations, and essentially in a bipartisan way, so as to give a balanced and true account of any incident, and not to cook up stories to make a mountain out of an ant-hill to increase TRP. Media should not be allowed to sensationalise for profit any human tragedies, through their savage coverage of dead bodies and tears of their near and dear ones.

The very first and the very last professional a man meets in his life is his doctor. Every small child likes to have a stethoscope and a doctor’s kit and play a doctor. Such has been the relationship of the doctors with the society. We earnestly request you to please help restore this ultimate relationship of trust. more