(Dis)trust your Doctor

 This morning, while on a phone call with my mother to check up on a family friend admitted in hospital with Covid-19, my mother happened to casually remark –“He is on ventilator since the past few days, you know how they simply keep patients on ventilators anyway for days on end…” I immediately retorted, “What do you mean, they keep patients on ventilators? You think they have any other choice when dealing with a critical patient?” This off the cuff remark, however casual, just reflected the deep mistrust most of people in this country have for doctors, especially the ones who practice allopathic medicine.

Following the surge of Covid cases in India this year, the ICUs filled up fast and quick, more rapidly than anyone was prepared for. What we witnessed was no less than a tragedy of epic proportions unfolding before our very eyes, on our TV screens- or as far as doctors are concerned- everyday at work. That we were unprepared is no secret, and amidst the cries calling for accountability from policy makers, another most frequent demand was for the call to install CCTVs in ICUs so that families can see for themselves whether their patients are treated “properly”. This demand is obviously coming from a place of distrust for the medical fraternity, and one really needs to look in to the reasons for this. Complaints flew in thick and fast, alleging patients who were elderly were not fed on time or  that the bed linen of some were not cleaned on time and that despite repeated calls for help by the patients, little or none was to be found.

Unfortunately, in most cases, majority of these complaints are true. But when hospitals are severely understaffed, with probably a single doctor and nurse and a cleaning staff on each shift wearing PPEs in sweltering summer heat, it simply becomes near impossible to take care of all the bases. Movement and visibility are hampered in PPEs, not to speak of the discomfort. The singular doctor on shift is tasked with the examination of the patients and giving orders, the nurse is busy administrating the drugs and the one single person on cleaning duty can only do so much. On top of stressing about the patients under their care, each of these people is worried about carrying the infection back to their homes, to their families. Also, nurses and cleaning staffs in most hospitals work mostly for peanuts, so is it a wonder that they do not find the motivation to be risking their and their families lives by doing what is mostly a thankless, unacknowledged job? Unless the policy makers invest more in public health, instead of blaming doctors, family members of patients in Covid ICUs should be allowed to accompany their patients and stay with them wearing PPEs for protection so that they can take care of the other needs of their patients other than treatment- because frankly, it sometimes becomes humanly impossible for the medical staff on duty to do so.

Even in pre-Covid times, terms like “medical negligence” and “wrong treatment” were crowd favorites. It is quite common for people to simply accuse their doctors of giving them or their family members “wrong treatment.” Firstly, if someone is accusing a doctor of giving “wrong treatment”, shouldn’t I automatically assume that the said person also happens to know the “right” treatment, then? If so, why call a doctor at all? They can go right ahead and treat their patients themselves, no?

On a calmer note, medical science unfortunately is not cut and dried into neat, precise treatment protocols. Had it been so, we would have found a precise cure for the common cold by now! It is a constantly evolving branch of science, with research throwing up new evidences every day.  As doctors, we look at the evidence at hand and choose among multiple options available when it comes to treatment. This choice, in turn depends on various parameters. Simply put, the antibiotic prescribed to you for your cough may be very different from the one prescribed to your friend depending on a plethora of factors like age, type of cough, duration of cough,  x-ray pictures, co morbidities, allergies etc. Hence, what is “right” treatment for you may just end up killing your friend, making the choice of treatment relative and in no way absolute. Thus, in medical science, just like life itself- “right" and “wrong” are not as absolute as one may perceive them to be.

If you are under the impression that this problem is nonexistent in families of doctors, let me tell you that even in our families, we still have many family members who will prefer alternative medicine (homeopathy/ayurveda/ or even quacks for that matter) as their first line of treatment before seeking legit medical help. Their point of view being that alternative medicine has less side effects and that allopathic medicine can be tried if and when the earlier treatment doesn’t work out. Which basically translates into the fact that it’s okay even if the alternative medicine treatments do not work, but they expect the allopathic treatment to work for their ailment (which by now may have transitioned into something far more serious than it originally was), irrespective of however late they go to the doctor. And of course, God forbid the allopathic treatment doesn’t work, one can always blame the doctor for giving them “wrong treatment”- a blame that ayurveda/homeopathy seem to be quite risk-free of.

Fresh out of medical school, I worked for a year in a Primary Health Centre (PHC) in a village in Assam, my home state. That village hadn’t seen a doctor in years, and their go-to person in all these years was an old pharmacist who used to go door to door giving people antibiotic and steroid injections for just about any ailment under the sun. I fought hard against the practice, but more often than not, the people remained unconvinced. For example, if I would prescribe only Paracetamol for simple viral fever and assure the patients that they would be fine in a couple of days and that they do not need antibiotics and that the weakness shall pass, they would in turn go to the pharmacist behind my back, pay him extra for the “injection that gives them strength” and he would go and administer the steroid at their house. I was told that there had been many cases  in the preceding years which had deteriorated or even died with his “treatment”, but that the villagers still didn’t hold a grudge against him or didn’t think it was his fault at all – “after all, there are no doctors here, he did his best, his treatment didn’t work but it’s okay…what more could he do?”

That was almost a decade ago. Cut to present day, in the middle of the pandemic, it is not uncommon for us doctors to be giving consults over the phone to friends and family. But even now, amongst family and friends, there is pressure on us to prescribe unnecessary drugs because of maybe something that was shown in the news or because of what they think is best for them or because some other friend had been prescribed a drug for the same symptom. Not to forget the background noise of how they are boosting up their immunities with all sorts of homeopathy and ayurveda drugs – ultimately ending up consuming a godforsaken cocktail of medicines, many of which may not even be needed in the first place.

A few days ago, on social media, I came across pictures of a politician who had gone to inspect the facilities in a government hospital and check on their preparedness in view of the surge in cases of Covid in the state. I simply opened the comment section on those pictures, although I knew fully well what to expect. The comment section was full of people lauding the efforts of the politician and egging him to “pull up the reins on these negligent doctors” and asking him to “scold and teach these doctors a lesson” and “suspend those who don’t do the job properly”. That we are seeing a surge in cases because of ill thought out political rallies with huge crowds, or politicians telling people (ridiculously) not to wear a mask is of course, irrelevant. It is only the doctors who aren’t doing their jobs properly and need to be taught a lesson, apparently.

I do not deny the fact that there are a few bad apples in every profession and the medical fraternity is no different. People choose to consult many doctors at once, going for second or third opinions. And I am fine with that- if it is the life of a loved one at stake, one has the full right to go about looking for that best possible option for them. But once you do find that option- please trust that doctor. Mistrusting , doubting and second guessing your doctor may have disastrous consequences, and accusing them of “wrong treatment” will only make matters worse by alienating your doctor further. Believe it or not, we are here to genuinely help you. Trust us on that, if nothing else.