Friday, 18 January 2013

Holding the healers to account

by 13

Mrs. N, a middle-aged, slightly overweight lady was operated at my ward for gallstones. Five minutes after she had been shifted to the ward, her breathing was labored, she was blue, her pulse was thready and cardiac arrest was imminent. The doctor on duty quickly moved towards her, tried to resuscitate her but after forty-five minutes of continuous CPR, she did not make it and passed away.
The doctor in his most professional manner explained to the family that sometimes – though – it is very rare, patients who get general anaesthesia are prone to sudden heart attacks during the recovery period. When they heard that she had been pronounced dead, there were loud cries at first followed by curses and swearing and then the male members of the family grabbed the doctor from the neck and hurled him on the wall. They broke windows and doors. Hospital security was called that showed up thirty minutes late. Another thirty minutes and many a threats later, they left the ward saying they will be back later.

Eight months after I have stepped into my professional life, this was the first instance where I saw aggressive relatives hurling abuse and threats to a doctor and the hospital staff. For ten odd minutes, I stood there shocked unable to move or comprehend the situation until a nurse grabbed me from the hand and took me to a safer room.

Mrs. N’s demise was unfortunate and going through her case, I found out that she was operated by a fine surgeon. There was nothing wrong with the procedure. She recovered from the anesthesia and then succumbed to a heart attack. There are still a hundred steps that the hospital could have taken to avoid a situation like that. One, Lady Reading Hospital, has yet to have proper patient charts and hence proper record (that if needed could be produced in a court). Second, ninety percent of the doctors here do not perform a proper CPR which is shocking and compounding that is the fact that there is no equipment for Advanced Cardiac Life Support in wards other than Cardiology. Third, regular “Mortality and Morbidity” meetings ensure that similar mistakes are not repeated – that in itself a rare occurrence at the hospital.

Our relationship with grief is complex and when it comes to the death of a loved one, one really cannot predict or expect a person to behave a certain way. “God’s will” happens to be one of the most common causes of death in our society but when a naturally irate and inconsolable family threatens a doctor when their patient dies, what are they supposed to do? Who should they blame? What will happen if the family decides to sue us? The obvious answer is “nothing”.

Most doctors suffer from the “god complex” partially because patients choose to trust them with their lives. In a society, where people are educated and literate enough to make their own decisions accountability takes a foremost preference before a doctor can attempt anything. Since the concept of holding a doctor or the hospital staff accountable for the death of a patient is still in its infancy in our country, ergo nobody suffers but the bereaved family.

-is a medical doctor working at a major teaching hospital in Peshawar. 

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