Tuesday, October 09, 2012

Why don't patients complain if they are unhappy ?

I just saw a patient who had failed IVF treatment at another clinic. The husband was an ophthalmologist and the wife was a dermatologist and they had done 2 IVF cycles in a leading hospital in Mumbai. I asked him for notes of the previous IVF treatments, including photos of their embryos . He said - we don't have any . I was upset, because if I do not know what the earlier doctor had done , it’s hard for me to formulate a treatment plan . I can use documentation of the earlier cycle to intelligently tweak the treatment protocol and customize it for the individual patient, so I could help the patient to grow better quality eggs and improve her chances of getting pregnant. However, if patients don't have this documentation , this valuable information is lost, and I need to indulge in guesswork . This is a shame , because I have to start from scratch all over again.

When I asked the patient ( who was a doctor himself !) for these details he became defensive. This particular hospital doesn't provide this documentation . I said that as a doctor you know that every time you do a medical procedure, you always provide a discharge summary , an operative note and photographs , if relevant . When you did an IVF treatment for yourself, why didn’t you insist on this basis paperwork ? They both looked a little embarrassed and said – We thought this is the way things are done in Mumbai ! In fact , this particular hospital and doctor did not even provide a receipt for any of the payments we made – and they insisted  that all payments be made in cash ! We thought this was the accepted practice in Bombay, which is why we did not ask any questions.

This is major bad news. When articulate sophisticated patients like doctors ( who are insiders in the medical system ) get this kind of medical care , what is the fate of ordinary patients going to be ? How do they deal with these roadblocks ?

Patients feel intimidated and are reluctant to ask the doctor too many questions, because they do not want to upset him. They are pretty much resigned to accepting what the doctor dishes out – and if everyone else seems to be doing exactly the same thing , you assume that this is the accepted norm and don’t want to rock the boat. You don’t want to ask too many difficult questions, because you do not want the doctor to think of you as a troublemaker.  It’s easy for hospitals to intimidate patients and get them to shut up. Sadly, patients are still uncertain about what their rights are . The tragedy is that if doctors ( who I would consider to be extremely well informed expert patients ) have to put up with this kind of malpractice , what is the fate of the average patient ?

I wish patients would be a little more articulate and would complain when they see that the quality of care which they receive is not acceptable . It might not help them too much , but hopefully will help the hospital to get its act together and prevent these problems from occurring again ! By keeping quiet, patients are entering the conspiracy of silence and ensuring that the rot continues to grow.

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