Patient care or compromised care.
Where should the poor patients go?
A news has been circulating on social media these days that two junior doctors, who were doing internship at a major tertiary care hospital in Multan, were terminated for prescribing medicines to patients that were not available in the hospital. I am sure they will get reinstated soon as protest has been announced by various doctor organizations. But this has exposed the attitude and policy of our health administrators and public officials. Instead of focusing on availability of all necessary medicines, they have chosen to victimize doctors to please higher authorities sitting in health secretariat. The aim is also to make public believe that they are getting everything free – no matter how much effective the medicines are. Doctors will stop prescribing these necessary medications at public hospitals out of fear of victimization, but who will suffer the most? The poor patients. And these poor patients have nowhere else to go unfortunately.
The other day while rounding on a patient, I was told by my house staff that ‘’sir we are giving ceftriaxone (an antibiotic) to this patient who has an infected bed sore. The culture from his wound has grown Acinetobacter (a highly resistant bacteria) which is resistant to most antibiotics, including ceftriaxone, and sensitive only to colistin (an expensive antibiotic). Sir, we have been trying to get colistin for this patient for the last many days, but hospital has not provided it so far. So, sir, what should we do? The patient is deteriorating day by day.’’ I had no answer to their question. I told them to speak with hospital administration again and escalate it further. From a layman perspective, patient was getting medicine (ceftriaxone), but was it effective and the right choice? The answer is no. The house staff were strictly prohibited by administration from asking the patient’s family if they can arrange it themselves. The family seemed reasonable to me, and they could have arranged it if requested given its necessity for the patient and non-availability inside the hospital. But doctors were not allowed to make any such request fearing blame and victimization. The ultimate sufferer was the patient.
On the other end of spectrum, I have observed that any medication – no matter how expensive it is – will be made available on a phone call from a politician or a bureaucrat. So, the real issue is not of funds, although I understand public hospitals are markedly underfunded. The real issue is lack of consciousness, fairness and self-accountability. If funds for some expensive medicine can be arranged for a patient of a politician, a bureaucrat or someone of considerable position, then they can be arranged for a poor patient too. No doctor wants to prescribe medicines for patients from outside the hospital if they are available inside. But are all necessary medicines available? The answer is no. If not available, then can those necessary medicines be arranged for all patients? The answer is yes for privileged and no for poor – most of the times. But the poor will be kept ignorant, and the doctor will be blamed for prescribing those necessary – but unavailable- medicines.
How have we arrived at this stage in our healthcare system where policies are made by the ignorant and implemented by the arrogant? The developed world has advanced and moved towards an era of digitalization and artificial intelligence in healthcare. But we are stuck here, still debating about who has the right to make medical decisions for the patient – the doctor or a clerk sitting in administration? The system is rotten from top to bottom and needs a major overhaul. We need a public healthcare system where everyone is accountable for their actions, where the center of attention is the patient and his/her health, where funds are available for all the patients equally irrespective of their social status or connections, and where healthcare workers are treated with dignity and respect instead of ridicule aimed at appeasing masses and bosses. Our patients, both poor and affording – need better care at our public hospitals.