Matter of life and death

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Matter of life and death Shailaja Chandra Hospitals need to be made legally responsible for collecting and collating data on all treatments. Only then can research unravel outcomes and let people know that ‘more’ does not necessarily mean ‘better’. Or else unnecessary check-ups on the unfailing advice of ‘life and death’ will be a routine affair It was Sunday afternoon. It was the first emergency I had faced in our new home in a private colony where we had moved after my retirement. Shorn of Government props of 40 years standing, I felt fearful as I touched my mother’s burning forehead again and again. Afternoon would soon become evening and then night. Things would get increasingly difficult as time passed. I desperately thumbed through the colony directory and located a physician. I begged him to come over and see my mother. He came soon enough, checked the BP, ran the stethoscope, looked for pain, murmurings, nausea and concluded that the lungs had some liquid. Since my mother was over 100, he advised me to take her to a hospital immediately. “But which one?” I asked helplessly. “Since she is a Government pensioner you can take her anywhere you want”, and “the nearest to you are Rockland, Max, Fortis and a little further away, Apollo. CGHS will pick up the costs. Don’t worry.” “But doctor,” I pleaded, “They will put her through a battery of needless procedures and tests. I cannot bear to see her being tormented like that.” “That is bound to happen,” he replied. “Once you get into the hospital you will have no say and I would not be surprised if they put her through a CT scan, and the full cardiac drill.” “Can’t I just get her treated without any invasion … just drugs or antibiotics or something? Don’t I have an option?” “I’m afraid you have none,” said the doctor as he wrote out a prescription, folded his stethoscope and banged his briefcase shut. At your mother’s age you should not take chances,” he added. As I saw him to the door, I suggested hesitantly, “Doctor, can I not take her to the RML hospital instead?” He turned on his heel and unexpectedly said what I longed to hear. “You would be 100 times better off in RML hospital if you know someone there,” he added for good measure. “They will have no interest in plugging her into the ICU or ordering a battery of procedures and tests. They will do the minimum and, god willing, she will be fine.” My situation was something that all of us face these days. Medical malpractice is entirely different from medical negligence. A conscious decision to force medical procedures and tests for monetary gain (all in the name of medical ethics) is malpractice, but we can’t measure its prevalence or contain its practice. We all know that in urban hospitals the caesarian rate is 80 per cent when it should not exceed 10 to 15 per cent. We also know that angioplasties invariably lead to the implantation of stents, procured or ordered to be purchased from a particular source. We also know that people who go to certain hospitals with chest pain invariably have to undergo by-pass surgery, on the unfailing advice that it was a matter of life and death. We also know that the MRIs and endoscopies that hospitals and doctors order almost routinely, were unnecessary but who can question a busy specialist or an impersonal monolithic hospital? One would not even have the vocabulary to start inquiring. The costs of health care in the US are spiralling but out there full information on procedures, tests and investigations has to be collected and published, making it possible for researchers to unravel the data and relate it to outcomes. The New Yorker recently published a piece called the ‘Cost Conundrum’ in which real-life medical care costs are juxtaposed with health outcomes, on the basis of research conducted at the Dartmouth Institute for Health. The research shows that in the US the more money Medicare spent per person in a state, the lower was that state’s ranking in quality health outcomes. Treatment records of one million elderly Americans diagnosed with colon or rectal cancer, hip fracture, or heart attacks were examined. They found that patients in higher spending regions got more frequent tests and procedures, more visits by specialists, more frequent admission to hospitals but they did no better than other patients whether measured by survival, ability to function or satisfaction with the care received. “If anything, they seemed to do worse.” That brings me to the conclusion. In India, the Supreme Court has brought medical negligence under the Consumer Protection Act (subject to some needed safeguards) but negligence does not encompass the wide range of costly procedures, tests and investigations that are ordered by hospitals and doctors, devoid of explanation, alternatives, leave alone obtaining informed consent. In the name of medical ethics, how can hospitals and doctors do what they like, regardless of a patient’s age, symptoms or prognosis? Hospitals need to be made legally responsible for collecting and collating data on all such procedures and investigations. Only then can research unravel outcomes and let people know that ‘more’ does not necessarily mean ‘better’. Hospitals with higher costs and poorer outcomes might just discontinue indiscriminate procedures to pad hospital and consultant’s fees — regardless of the quality of outcomes. At least we would know. ——————————————————————————–

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