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Tuesday, June 19, 2018

Doctor Shaming at It's Best!

This past week I read a post on facebook by a woman who had lost her mother and she vented out on social media against the hospital and Doctors that were in charge of her mother's care. It took all of my restraint to not post on her wall as a reply, because I knew it would do no good and it wasn't the right time to justify things to someone hurting. Also, I didn't really think it was worth it as I thought people would be more intelligent than to accept everything written on face value. Unfortunately, the link came up on my high school group with some questions being asked and instead of just replying to them, I thought I'd write about it.

Before you read any further, I would suggest you to visit this page and read the article or even better, keep it open side by side and read through.

The headline itself is inflammatory and sets the bias for the article which I think is grossly unfair. 

Girl's FB Post Tells How Doctors Cheated Her Family & Charged Rs 1 Crore But Couldn't Save Her Mom

This implies that she was cheated for sure and the Doctors charged her the amount and there was some guarantee of saving. Now, I'm not going to nit pick and argue fine details and take sides here but read the article and the title starts to stink right from the third paragraph.

"Doctors are considered as God on Earth as they have the capability of not only curing a person but also saving his/her life. However in the present times, as many doctors have been found guilty of illegal activities such as organ trafficking, gender determination, etc., the faith on doctors has decreased to some extent."

We aren't considered as God and never asked to be. We have the capability of treating someone but that treatment will not always result in a cure or life being saved and we're only too well aware of this. Unfortunately, it seems that the general public is not. It has become some kind of inane expectation that if you pay a certain amount of money, the life that was handed to us must be saved irrespective of the disease or condition.

"it won’t be wrong to say that the big hospitals are no less than 5-star hotels and they charge exorbitantly from the patients and doctors play an important part in milking the patients for cash."

Big hospitals are like five starts because the people demand a certain level of service and they have to be satisfied for the hospitals to run. Last I checked, most of the so called 5 star hospitals were not charitable, neither were they forcing people to come in and get admitted, nor were they set up using public funds. They have a right to charge an arm and a leg for them to survive because of the level of expectation set up. This may sound horrifying to all of you but let's put it into perspective. I know of hundreds of people who won't watch a movie in any other theatre than an Inox because of the quality or whatever. I know people who wouldn't touch tea cup from a road side tea stall for fear of leprosy or some other disease being contracted. I know people who refuse to travel in buses for all the above reasons. When these people require healthcare, most of them have accepted the fact that quality healthcare is expensive and sterility costs a bomb. They understand the reasons for the high costs of healthcare, which by the way, compared to the rest of the world, is still dirt cheap here in India. The problem is with the other end of the spectrum where you have people who save their life savings going to these big hospitals. There is a clear reason for this. THERE ARE NO GOOD ALTERNATIVES THAT ARE ACCEPTABLE.
I don't even need to ask you, I will tell you that it is the role of the government to provide quality healthcare at affordable costs, not the role of Doctors or Private Establishments. At the same time, I will also tell you this, there are enough and more Doctors who will go to no ends to push the limits of how much money they can squeeze out of you. This is sad, but very true. The choice, however, still lies with you. Pick the correct one who you can trust. Find one out there, because there are more than enough of us around/

"Parul’s mother fell sick due to ammonia attack and it was later found that she was suffering from Liver Cirrhosis which is the last stage of liver disease"

Factually incorrect and inept journalism. There is no such thing as an Ammonia attack that I have encountered, in my medical training, as far as I remember.

"they tried out to churn out money from them without providing proper treatment and how they harassed them for paying the bills and purchasing medicines from their dispensary at high prices rather than buying it from outside at low cost."

I wonder how she decided it was not proper treatment and when she would think was the right time to harrass someone to pay a bill. It is standard practice in a corporate hospital to send out daily bills to patients in the ICU with a three day period to clear those dues because even hospitals realise that costs add up and if they don't do this, there will come a time towards the end of a long hospitalisation that the bill suddenly sky rockets and causes severe mental trauma to the relatives. This was actually an order passed by the government towards the same. It allows the relatives to think of alternatives when the costs seem to be going above their heads.
Again, unfortunately, I agree about the point of overcharging by the hospitals for medicines that are available cheaper at regular chemists outside the premises. This is something we really need to look into. It is the same as going to a movie and being forced to pay more than double for pop corn and water bottles.

"have spent nearly Rs 1.2 crores on her mother’s treatment who took her last breath on May 7, 2018, due to multiple organ failure despite successful liver transplant. Parul also told that her mother was kept in ICU for nearly 100 days by these hospitals and they charged them Rs. 1 lakh per day for this purpose"

Well, if you want to stay admitted in a 5 star hospital for over 100 days with Intensive Care support which is required after liver transplants, just what would you expect the bill to be? ICU is extremely expensive and I would invite any of you to take up a job running an ICU to try and bring down the costs and offer that model to any hospital. We would gladly pay you for your service! Also, I wonder what Parul's idea of a successful liver transplant was?

At this point I have reached out to several news channels like Aaj Tak, Zee News, News 24 and the honorable CM and Health Minister of Delhi and the Indian PM, but I have not received any help or support in the matter. I have no other option now but to go public with this information so that appropriate action can be taken against these so called hospitals, established to help the ailing members of our society

Maybe there is a reason none of them are ready to help. Possibly, there is nothing to help about. I would love to know what is the appropriate action she would like to be taken against these hospitals? Also, just to make it perfectly clear, no corporate privately owned hospital exists to help ailing members of society. That is an illusion that defeated people hold on to. They are a business here to make a profit and provide a living to thousands who are employed there. To help ailing members of society, we are supposed to have a robust health budget from the central and state governments who are supposed to provide world class care in their state and municipal run hospitals. The BMC is supposed to be the richest civic body ever, how about asking them to spend more on their hospitals and provide basic care, forget world class facilities.

"January 04, 2018: Doctors at BL Kapoor Hospital advised her to undergo a liver transplant. Total cost mentioned: Rs 18-19 lakh."

Sounds like a reasonable budget to me for a liver transplant with private hospital care and post operative medications and ICU care.

"January 12-13, 2018: a lady named Jyotsna Verma (link to her website:…/jyotsna-verma-liver-t…), claimed to make a liver available to us in a very short time. Total cost estimated: Rs 23 lakh.

January 16, 2018: Ms. Jyotsna called us to inform about a liver from deceased patient being available at Yashoda hospital, Secunderabad. She charged us Rs. 1 lakh for the information shared."

These two lines perhaps are the only reason I am reacting to this. What remarkably poor judgement to trust a lady who claims to make a liver available rather than Doctor's at the hospital in Delhi. As far as I can see, her costs are also higher, this again leads us to the point of a choice being made. Parul chose to trust someone who wasn't a doctor over the doctors at Delhi. Moreover, she had no problems paying 1 lac for information about a liver but has a problem paying one lac for intensive care for failing organs. Something to ponder over, I think!

"January 16, 2018: My parents flew to Hyderabad and were given a cost estimate of Rs. 27 lakh. The doctors at Yashoda Hospital would quote a fee from Rs. 24-29 lakh to the different patients for a liver transplant."

Looks like she chose to go with the 27 lac quote rather than the 18-19 at Delhi. Furthermore, different patients have different conditions to be dealt with and will accordingly be quoted different costs for the transplant depending on how much pre and after care would be required. This is, however, something I don't expect her to understand but perhaps she could appreciate it after some research.

"February 05, 2018: My mother underwent a successful liver transplant.

February 08, 2018: She was put on ventilator because of a lung infection."

Lung infections are extremely common in hospitals and are one of the reasons for maintaining the 5 star cleanliness and sterility that make up much of the costs of the admission process. Unfortunately, with the number of germs in the hospital and the immunosuppression involved in liver transplants so that the transplant doesn't get rejected (thereby a successful transplant) the patient is always at a high risk to contract infection.

This is followed by how her mother was in the ICU on the ventilator and how the costs escalated. I've already touched on those points and again reiterate that healthcare is bloody expensive.

"My mother developed Jaundice on a Friday evening and doctors from Yashoda Hospital in Hyderabad recommended the doctors in Delhi to immediately install a stent in her liver to prevent the spread of jaundice in her body as she had a similar problem while she was in Hyderabad"

The story is far from simple as there are multiple episodes of health issues and infections coming and going. No one is going to assume that this was easy for the family but mostly all would agree that this doesn't sound like a routine patient with a successful liver transplant. The costs were to be expected and there is nothing the hospitals or the Doctors could do about it. Yes, they could have been more polite, yes there could have been more empathy but who is to say there wasn't. It's just one word against the other. I will not defend the Doctor here though because I've seen some really rude ones in my life and I agree that most have a superiority complex and an ego the size of a football field.

"for the doctors in Delhi, their weekend was more important and they delayed the installation of the stent to Monday afternoon (April 23)"

I don't know the circumstances as to why the stent was delayed but perhaps, just maybe, the patient wasn't fit for the procedure yet or there were some complications due to which the stent could not be placed. I've never known a Doctor to enjoy a weekend when they have a serious patient in their care. It just doesn't happen. Ask my wife!

"They kept on performing kidney dialysis almost every day on a person who was practically dead, in an attempt to make more money."

Would you believe that perhaps it was to try and keep her alive? Perhaps, it is the only thing they could do to stop her from dying there itself? Or would you have preferred that, because that then is an argument for euthanasia which is anyway a topic I can discuss with you for days! Besides, no one makes money with dialysis, it's more lucrative to not offer dialysis and give more medication and treatment. Dialysis is now so cheap that it would cost less than the room rent for a 5 star hospital!

The bottom line is that the poor woman died. Parul is clearly going through the 5 stages of acceptance and needed to vent. It was unfortunate, but certainly not negligence nor was it a money game or an incidence of cheating.

There are a lot of you that will be on her side of the fence. Reach out to me, come live a doctors life for a month and see how much we care for our patients. See how we lose sleep just so that patients get theirs. Watch how we crumble under the pressure in the privacy of our own lives just so that we can put on a strong face in front of you. Feel the pain we feel when we miss important events in our families lives just so we can put in a stent on time.

Anyone who would like to take this further can reach out to me at any time. Leave your comments if nothing else. Share this so more people are aware of the lack of affordable healthcare which our government should have provided us years ago. 


Unknown said...

Smart systematic synopsis Doc ... my points below in random order .
1) ability to say no ( not possible / not curable ) is lacking in many doctors in fear of loosing a patient . Doctors who say it bluntly are more credible for me.
2) there is huge prevalence of ABILENE PARADOX in all big hospitals these days . Independent thought is lost in corporate management . Puts lives at risk.
3) where are the doctors who did not need 1000 tests to come to a diagnosis or a prognosis
4) sure there is a litigator malpractice risk now but no amount of tests can protect any doc or hospital . Consumers are venting in public , see case in point .
5 ) there should be zero charges if patient dies in hospital . It should be covered by some national insurance fund where hospital will get only cost no profit after full investigation.
6) hospitals should have statistical date of births , deaths , operations done major minor , length of stay etc innreception and provide bench mark stats along with it across India .

Deepak said...

Absolutely spot on.

Prof. Dr. Kumaraswamy said...

Dear Dr Dheeraj Mulchandani, I completely agree with your response, people expect miracles once the patient is in the doctors hands, as doctors we can only treat and expect the patient to respond to our treatment and definitely medicines costs money, procedures costs money, keeping the hospitals as sterile as possible costs money but patients and their parties cannot understand this and hence the atrocities against the doctors. Many doctors might be money oriented they might take more money from you but no doctor wants harm to their patient, they take pride when their patients are cured or improve.
It is extremely sad and derogatory that so many physical attacks are happening on doctors in India, I am just worried that no good doctors would like to work in India in future, they will go and work in other countries where they get much more respect and also money.
I am a Indian doctor now working in Malaysia

As rightly mentioned by you people put all their life's savings for treating their loved one's and bring them to corporate hospitals and when things do not work in their way they loose their patience and blame the doctors

Unknown said...

My comment is not getting published :(

Kapil said...

All valid points doc, except for the movie hall analogy. One can go to the multiplex, watch a movie or two and choose not to munch on popcorn, thereby saving themselves from getting fleeced. Hospitals doing the same is a serious issue.

Shagufta said...

Superb! I hope it clears most of the doubts of common people about the so called "scams" doctors are involved in.

Shagufta said...

Superb! I hope it clears most of the doubts of common people about the so called "scams" doctors are involved in.

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