AND a few stray thoughts for yet another Saturday. For a Saturday following the week when the issue of the quality of patient care in the GMC and government hospitals was highlighted. For a Saturday following the week when the focus was on criminal negligence by doctors both in government and private hospitals. For a Saturday following the week when doctors’ mistakes can be injurious to the life of patients. For a Saturday following the week when I recalled my experiences with private hospitals, not only on Mumbai but even in London. For a Saturday following the week when the most prestigious hospital in the country is the All India Institute of Medical Sciences in New Delhi.

QUALITY OF PATIENT CARE
AND a few stray thoughts on the issue of the quality of patient care in the Goa Medical College & Hospital which is a government hospital was highlighted. When doctors are attacked, it makes headline news. When doctors are humiliated, there is a national approach. But nothing happens if patients are badly treated in public hospitals. There are no protests if doctors make a mistake. When doctors make mistakes, it can be fatal for the patients. Doctors are united.
Unfortunately, patients are not. Every patient is only concerned about his or her own treatment. The so-called VIP culture is rampant in Goa because every Goan thinks he is a VIP. Goa being a small place, every Goan and every migrant has access to the MLA or the minister. So much so, it is routine for the relatives of patients to pressurize doctors not only in the casualty but even in the OPDs and in the wards.
The biggest threat to doctors comes not from politicians but relatives of patients. On the very same day, Vishawajit Rane humiliated Dr Rudresh Kuttikar, as many as four residents and the nursing staff were abused by the relatives of a patient in the Medicine ward later in the day, around 4 pm. There were only two lady doctors on duty in one of the Medicine wards. A male relative of one of the patients barged into the duty room and started abusing the female resident doctor.
The resident asked one of the Public Relations Officers (PROs), all of whom appointed by Health Minister Vishwajit Rane, to lodge a complaint against the abusive relative. The PRO refused to call the constables on duty at the Casualty. He told the residents to approach the Aggasaim police station.
This is not an isolated incident. The junior residence and the bond doctors have to put up with abuse by the relatives of the patients on a routine basis.
THE VIP culture is all about jumping the queue. The relatives of every patient want attention for their patient on a priority basis. The protocol in Casualty is that the most serious accident and trauma patients are treated first. If a patient comes with a head injury, he or she will get priority over a patient whose blood sugar has shot up.
However, a major cause for irritation is the delay in admitting patients in Casualty to the designated wards. When a patient is in Casualty, besides the routine investigations, very often an X-ray or a scan is required. There is also a blood test. It takes time for the results to come. It’s only after the results are in that the duty doctor in charge in Casualty takes a decision on admission to a ward for observation and further treatment or to discharge the patient after treatment. Consultants take time to check on patients in Casualty to decide whether the patients need to be admitted.
As Health Minister for many years Vishwajit Rane has hired hundreds of so-called public relations officers. In theory, it is the responsibility of a PRO to explain delays to relatives of the patients. None of them are qualified to do so, and in any case, doctors do not listen to the PROs. Even while drawing up Standard Operating Procedures (SOPs) for VIPs, the GMC should also prepare SOPs for doctors dealing with patients.

CRIMINAL NEGLIGENCE
AND a few stray thoughts on when criminal negligence by doctors occurs, both in the government and private hospitals. Like politicians and journalists, there will be a few doctors who think they are superior doctors. Many of today’s doctors without exception think that they know everything and patients may be idiots. Unlike in the United Kingdom or the United States, doctors do not believe in the patient’s right to know the details of the treatment prescribed to them. Patients must be informed of side effects of drugs to be administered to them. Patients must know what is radiation from MRIs and CT Scans, or even humble X-rays.
Have you ever wondered why an X-ray is taken and the operator hides behind the screen? When a CT scan or an MRI is being done on a patient, no doctor or nurse is in the room and everything is done from outside the room by remote control. All this is because the doctors are very careful to protect themselves from radiation.
Doctors can be very impatient with patients who ask questions. They expect patients to be quiet and compliant. Which means that the patients must accept conclusions on treatment by the doctors without question, even if they know they may have a few doubts about the treatment. In government hospitals, patients have no rights.

DOCTORS CAN BE WRONG!
AND a few stray thoughts on when and how mistakes of doctors can be injurious to the life of patients. I will not talk about myself as I have written about the experiments of doctors with me as a long-suffering patient in detail before. But I would like to narrate only two instances to show how mistakes of doctors can cause death or seriously affect patients.
A very close friend of mine Ashraf Hassanwale, used to manage the milk booth in Dona Paula, besides his full-time job with the National Institute of Oceanography. While on his rounds on his cycle, he was bitten by a dog. A few hours later, he started exhibiting all the symptoms of rabies. One of the most common symptoms of rabies is that the patient feels very thirsty. However, he was not able to drink any water.
I first took Ashraf to Manipal Hospital. The then director of Manipal Dr Ulhas Nachinolkar, refused to treat him and send him to the GMC in the Manipal ambulance. At the GMC Dr Edwin Gomes admitted him to an isolation room in the Medicine ward. I left for work in the belief that he was in safe hands and that he would be treated for rabies. If treated on time rabies is not fatal.
When I went back to the GMC around 4pm I could not find Ashraf in his room. I learnt from the staff on duty that Dr Edwin Gomes had shifted him to the Institute of Psychiatry deciding that he was a nut case and not a victim of rabies. By that time Ashraf’s condition had become much worse. I took him out of the Institute of Psychiatry and rushed him to the Campal Clinic. Several doctors tried to save his life. It was too late because he started bleeding heavily. He was declared dead at the Campal Clinic late in the evening.
I called up Dr Edwin and told him that I was bringing his body for the post-mortem in GMC. I requested Dr Edwin Gomes to be present at the GMC but Dr Gomes of course denied that it was a case of rabies. I insisted that the relevant tissues be sent to the National Institute of Mental Health and Neuro-Sciences, Bengaluru. NIMHANS confirmed that it was a case of rabies. But for the criminal negligence by Dr Edwin Gomes, 40-year-old Ashraf may not have died.
I was personally involved in another “mistake” by a very famous ophthalmologist. A friend of ours, Jaichand Motwane was a very good singer who sang Saigal songs and played the sarod which is a very difficult musical instrument to play. He had gone to an ophthalmologist for a cataract operation. The ophthalmologist bungled the operation.
Subsequently, Jaichand went to the GMC for treatment under Dr Pradeep Naik. Dr Naik discovered the mess created by the private ophthalmologist he had gone to earlier. Fortunately, dr Pradeep was able to save the eyes of my friend Jaichand. I invited both the private ophthalmologist and Dr Pradeep Naik who was the HOD in the GMC. The arbitrator was the then dean Dr VN Jindal. The private eye doctor was forced to admit his mistake and magnanimous enough to compensate Jaichand.

LONDON EXPERIENCE
AND a few stray thoughts on my experience with private hospitals not only in Mumbai but even in London. A good friend of mine underwent open heart surgery at the Asian Heart Hospital in Mumbai. The Asian Heart Hospital, headed by Dr Ramakanta Panda, claims to be the best cardiac care hospital in the country. Dr Panda owes his reputation to the fact that he had operated on former prime minister Dr Manmohan Singh. Dr Manmohan Singh was operated on by Dr Panda, not in his own hospital but at the All India Institute of Medical Sciences in Delhi.
This did not prevent Dr Panda from putting up huge posters at the Asian Heart Hospital claiming that Prime Minister Manmohan Singh came to the Asian Heart Hospital in Mumbai to be treated. On could not enter a lift at the Asian Heart Hospital without coming across a giant photograph of Dr Panda with Prime Minister Manmohan Singh. Never mind that Dr Panda refuses to even to see a patient unless all payments are cash transactions.
Coming to my friend the open heart surgery went off smoothly, but the patient developed an infection. While no doubt Dr Panda is an excellent surgeon his support staff of resident doctors and nurses is pathetic. Due to this the patient almost lost his life. Even though Asian Heart Hospital is the most expensive cardiac hospital in Mumbai, it has poor infrastructure in terms of ill-trained support staff.
When I was in London for treatment for my Addison’s disease (steroid addiction), I went to Harley Street where the best British clinics of the best doctors in the UK are located. They all operate out of private villas with elaborate reception areas and piped music. The doctors there prescribed a narcotic called Temzipan to me, this is a depressant to counter the highs of taking steroids. This resulted in very wild mood swings.
This is when I discovered that one should not take any medication or drug without checking on its notified side effects. Fortunately, now, thanks to Uncle Google, everyone routinely checks the side effects of drugs prescribed by doctors.

AIIMS IN NEW DELHI
AND a last stray thought on the most prestigious hospital in the country, the All India Institute of Medical Sciences in New Delhi. It is the hospital that caters to VVIPs like the president of India, the prime minister and all the cabinet ministers and their families. The hospital also caters to all the top officials of the country not to mention the chief justice and the judges of the Supreme Court. There is no other hospital which has to deal with the VIP syndrome or culture as this hospital.
AIIMS has put into place standard operating procedure to deal with VIPs and VVIPs. The Goa Medical College & Hospital cannot do better than adopt the SOPs followed by the AIIMS .