In this week's Doctor Diaries entry, we feature Dr. Rajas Deshpande's story which touches upon a very relevant topic of "patient threats" for today's doctors. 

Long day, came home, had a ritual steamy hot bath to wash away the hospital smell, followed by a steaming hot dinner. Played jazz, and picked up the pasta. As heaven descended upon my tongue, I thought, "how perfect this moment is!” That’s where I was wrong.

The phone rang.

“Sir, 18-year old boy- has fever since a day, took some tablets, became unconscious, then comatose. Vitals are stable, although he is coughing occasionally. No significant past history. Poor family; cannot afford treatment. Father is a labourer. What should I do?”

“Get him into the ICU, intubate if required and stabilise. Arrange for an MRI,” I said.

“OK Sir, but Sir they don’t even have a deposit. They had first gone to the government hospital, but as they were not happy there, they have come here."

“We will work something out; I am on my way,” I replied.

In an hour, after examining the boy and seeing his MRI and other tests, we concluded that he had viral encephalitis. The standard medicines were started.

The boy’s father, an obvious poor slum dweller, was in a state of shock. The mother, sobbing, told me the history. I reassured them. When I explained the diagnosis and treatment they asked some questions.

“We don’t understand anything, we are illiterate and poor. Do anything Sir, Just save my son, Sir!" said the father as he folded his hands.

Private hospitals have a quota for free patients, but, it is always overloaded. I requested the hospital management to please make this a free case and they accepted.

The next day, the boy opened his eyes. On the third day, he started responding. I was quite elated to have his mother speak with him. However, his respiration was still shallow, and blood pressure very low. His heart rate was fluctuating due to the effect of viral infection. He was still critical.

I spoke to his parents twice every day, specifically reassuring them. Poor patients must never feel that they are not equally cared for.

That evening, as I attended to my patients in the OPD, the patient’s father came in and requested that he wanted to have a word. He came in with six other people. None of them could possibly be poor, given the way they looked.

“Yes?" I asked.

The patient’s father looked at the giant next to him. “You ask,”  he said to the giant.

The giant, chewing his gutkha, asked me, “What’s wrong with his son?”

“I have explained it to them thrice,” I replied. “He has a viral infection of the brain. There’s a lot of swelling in his brain.”

“How come he is not improving? His BP was normal when he came. He did not have any heart problems. Now you tell us his heart is not functioning well,” asked another medical superstar wearing white linen and sporting gold teeth. 

“Yes, this happens commonly with viral infections,” I replied, feeling hopeless. How does one teach complicated medicine to this pure, muscular class? I wondered.

“But you said he had an infection in the brain. How come now he has it in the heart? Is the treatment wrong?” This was asked by someone similar looking, among them, in a nasty tone.

I looked at the patient’s father. He was looking at the ceiling, deliberately avoiding eye contact with me.

“Listen, Sir.” I told them, “Your patient has a viral infection, it has primarily affected the brain, but involvement or dysfunction of other organs is well known with such infections, and this is not something new to us. We are on guard, dealing with the situation. Nothing is wrong about the treatment, in fact, his brain swelling has improved, and he is conscious now. Ask his mother.” I looked at her.

“I don’t know,” she said, “We don’t find any improvement in my child. Nobody tells us anything."

“Haven’t I explained about the patient's condition to you and his father every day?” I asked. They did not reply.

The white linen-gold teeth man spoke again: “We want a report. We want to show the case to another doctor.”

That was a relief. I gladly wrote them a report. They went doctor-shopping all day and returned the next day. Almost everyone had asked them to continue the same treatment that we had advised, except some desperate non-specialist telling them to shift the patient immediately for surgery to his hospital. Even our gold-toothed medical superstar understood that it was wrong! 

“We will continue treatment here only. But our patient must survive.” This came as an open threat.

”I will do my best, but I cannot guarantee you anything. You may please transfer the patient under the care of any doctor of your choice,” I told them.

“No no, you continue to treat him. But if anything goes wrong, we will file a police complaint. We will ruin this hospital,” said one of them.

I am allergic to threats. I don’t allow them twice from the same source in my life. How could any doctor guarantee that there could be no complications? How could I say that the patient could not react to any medicine in such a critical condition? If every patient could have guaranteed improvement, what’s the need for a doctor?

“I am sorry, I will be on leave the next few days. I won’t be able to see your patient. I have requested our management to transfer your case to another doctor,” I told them.

There was a movie “Teesri Kasam” in which the lead character, at the end of the movie, vows never to help the character of the lead actress in the movie, because the very wish and effort to help her has shattered his life, caused him regret.

Most Doctors are now being forced to take such a vow. Urban poverty is not so simple and innocent in a hospital as it is made out to be by the media and society. Whether it is the roadside rowdiness of slum dwellers who roam around with weapons or a maid’s drunkard husband, in a civilised society, we all understand the misuse of poverty status anywhere outside the hospital, but somehow when this happens in a hospital, the blame is automatically pinned upon the hospital or the doctor.

But who among the vote-mongers will speak against the majority voting bank?

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