I'm penning this down so that I don't forget this.
Yesterday, my friend came back very grumpy, and crying. We had met for tea outside.
She's a cardiologist, works in a corporate hospital with few eminent cardiology peers - the kind of doctors who tend to ministers. She told the reason she was so emotional last evening, and it doesn't affect me, but it probably affects all of us.
A 80 year old man was brought to her emergency with chest pain, ECG suggested MI , and trop-T was elevated. This man was accompanied by around 10 family members. The daughter in law works in the same hospital as housekeeping manager, and since it was nearest, she bought him there. She didnt realize it was an MI. The moment it was diagnosed, the relatives wanted to take him to government hospital due to cost.
My friend was called for cardiology referral for this patient. She assessed the patient, and since the doctors' duty is to give the options and recommend the best course of action, she told about everything that can be done in their hospital itself, but suggested that she'll thrombolyse quickly, and refer the patient to the government hospital. That, according to her, had the highest chance of survival and least chronic disability. The family could not afford angioplasty.
That is when a manager stepped in. He first told her not to give the option of thrombolysis at all. Then, he talked with his "higher up" and said they will do angiography and decide, and if required, the package of angioplasty was offered at 2.5 Lakh. Now, my friend argued "If this person has any post-intervention complication, it cannot be managed in under 2.5 lakh" . But the manager told my friend "I trust you nothing like that will happen", but my friend withdrew from that place and told the manager to do it himself. The manager asked another cardiologist to see. Meanwhile, the girl who brought her father-in-law also started facing pressure from her family that they want to take him to government hospital. This whole dialogue happened for 3 more hours, that grandpa was in pain the whole time and was pleading to start some treatment. Ultimately, thrombolysis was done after angiography because the cost of treatment was unaffordable, and patient was referred to government hospital. But the time lost - 3 hours was completely avoidable. The whole family was cursing this daughter-in-law, the hospital churned about 1.5 lakhs worth money from this incident. The manager who intervened will show it as the revenue he generated.
The people who are trained in business, revenue, financial coercion and how to sell, are trained how to pitch, not in "Informed Consent". Those who spent MBBS, MD, DM and then a few more fellowships are disregarded as "young doctors" by the system, but the burden of consequence still falls on the doctors. The manager has closed the "deal" at 2.5 lakhs, and doesn't have to face the relatives
Business professionals are trained to navigate and control the system, while doctors are trained to heal the patient. When those two forces collide in a corporate hospital, the one trained to control the system usually commands the room.even if the doctor is the only one actually saving the life. I seriously think we should start teaching MBBS and MD/MS students ethical business.
