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Table of Contents
COMMENTARY
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 235-237

When care kills!


Department of Neurosurgery, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India

Date of Web Publication02-Nov-2021

Correspondence Address:
Dr. Lokendra Singh
Department of Neurosurgery, Central India Institute of Medical Sciences, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJNO.IJNO_433_21

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How to cite this article:
Singh L. When care kills!. Int J Neurooncol 2021;4, Suppl S1:235-7

How to cite this URL:
Singh L. When care kills!. Int J Neurooncol [serial online] 2021 [cited 2021 Nov 27];4, Suppl S1:235-7. Available from: https://www.Internationaljneurooncology.com/text.asp?2021/4/3/235/329827





How absurd! How can care kill? Perhaps medicine is the only field in the whole world where in spite of best efforts, best intentions and honest commitment, a patient, who is cared for, can die, be maimed, incapacitated or disfigured for life!

Is there any doctor with sound mental faculties in the whole world who would like to harm a patient? Actually none. Errors and complications are inherent in the practice of medicine, and more so, in the surgical branches. 'To err is human'. A human life is marred by an unending string of miscalculations and misjudgements. Practitioners of all other professions, that is, academics, law, engineering, etc, commit many mistakes but get away with those with impunity. It is not so with medicine. In medicine, complications are unacceptable, rather unpardonable. 'The doctor is either a deity or a demon but not human' is the public's unexpressed perception. The sudden and humiliating fall of a doctor in the face of a mistake from the 'pedestal of being a deity' to a 'demon's dark alley' can be baffling! People forget to differentiate between an adverse event and a complication. 'Adverse events' are mainly caused by the treatment processes and are comparatively small in number; 'complications', however, are the unfavourable outcomes of the disease process itself. The body that the patient brings to doctor is in itself, often, full of problems, and many-a-times, beyond the scope of satisfactory repair. The patients and their relatives, however, have selective amnesia for the counselling performed prior to the procedure, forewarning them about these adverse events. Medical practice can be very taxing for any human being, as here, one uses oneself and one's thoughts extensively as the most important “instrument for providing treatment and management”! Wear-and-tear of this instrument are inevitable. This leads to emotional exhaustion and depersonalisation. The phenomenon of burnout is probably one of the highest among medicos. This burnout further enhances the problem of mistakes and complications.

The results of these adverse events and complications are devastating for both the patient and the treating physician! Certainly, the patient is severely affected, along with the simultaneous occurrence of adverse cascading effects for the family; the physician, too, is in no better position after an unexpected and devastating complication that hits him out-of-the-blue! We all know too well the reactions of many patients and their family members (although not in all cases) in the form of lawsuits, mental harassment and physical violence against hospitals and health care providers. What is not known is the other side of the story! Till very recently, the general public did not know how a doctor feels, reacts and behaves, once something has gone terribly wrong, inadvertently, through his hands. This anguish and plight of doctors was brought to light by many doctor-writers, who wrote about their failures, woes and psychological trauma. It was only then realized by the general public that the infallible, unemotional and unaffected appearing doctors are as human as their clients and go through tremendous pain and self-inflicted torture after any mishap that occur to their patients consequent to a procedure that has been performed by them. The Hippocratic oath that the doctor takes, 'First do no harm' feels grossly violated every time the complications occurs, and he/she tries to crucify himself/herself for that.

The initial reaction of a doctor is usually of shock and denial and then he/she is filled with fear, frustration, guilt, shame, remorse and anger. It has been found that in many instances, the doctor, particularly a surgeon, goes though many detrimental changes in his/her psyche and personality. As a consequence, the decision making is impaired, the difficult cases start getting referred to other centres, the clinical judgement gets affected and there is loss of confidence. It may go to the extent of making them insomniac, even affecting their marital life and forcing them to go into a self-imposed isolation. Many doctors develop features of anxiety, stress and clinical depression! Ideally, a doctor should honestly accept his mistakes and be open about them to the relatives of that particular patient; but, being an ordinary human being, deep-within, he gets worried about his reputation, loss of face, future compromise of practice, ridicule from colleagues, and unexpected reactions from patients and their relatives. Particularly, when he reads about the violent physical attack upon doctors, sometimes even leading to murder, he is badly shaken-up internally!

Unfortunately the 'culture of medicine' is very dry, non-soothing and ruthless. It is surprising that the ethos of medicine is all about kindness, empathy and compassion towards patients but at the same time these are totally non-existent when a practitioner of medicine is in focus, especially when the latter has reached a severe psychological ebb and is desperate to get support! Unfortunately, it has been proven time-and-again that doctors are the worst enemies of doctors, indulging in frequent backbiting, ridicule, accusations and abuse towards their own colleagues, conveniently forgetting that the next time, they themselves may be on the 'hot seat'! The so-called morbidity and mortality meetings are mostly about fixing blame, as well as admonishing or dressing-down (even if in polished way) colleagues, rather than serving as analysing and learning processes. These are totally patient-focused, conveniently forgetting that there is one more human-being under distress and duress who needs solace, sympathy and support. Till the medical field is existing, mistakes and complications are bound to happen, in spite of the all-encompassing utopian dream that every patient and relative has, of there being a zero-complication rate related to the procedures and treatment given. This feature is an inescapable part of providing treatment, whether or not one accepts this fact.

Gradually, the medical fraternity is acknowledging the severe internal struggle and external problems a physician faces after a complication and this has brought out the concept of 'second victim', a term coined by Dr Albert Wu in an editorial published in 2000. Obviously, the 'first victim' remains the unfortunate patient.

These problems are significantly increasing with the shift of medical practice from being a spiritual branch dealing with body, mind and soul to a cut-and-dry technical branch. The gadgetry, technicality, harsh objectivity and the treating of 'soma without psyche' has its own significant drawbacks. The doctor who was once revered as 'God on earth' is reduced merely to being a technician, who can be easily accused, abused and harmed. Unfortunately, the human body still remains an enigma and one does not know how it will react sometimes. The predictions of doctors may sometimes proceed towards a miserably wrong direction.

All said-and-done, the doctors and the society still need each other. If there are no healers, who will help human beings in the time of crisis? The society needs to learn to accept the good and bad features of medical science in its contemporary state in their geographical region. One cannot expect the care administered in the most advanced and affluent countries, to be equivalent in all its aspects in the progressing and often, less-endowed countries. One shouldn't expect 'Mumbai or Delhi standard care' in Jhumri-Talaiyya! The progress of medical science is so rapid that it is very difficult to keep pace with it. Hence, the fields of 'specialisation, super-specialisation and micro-super-specialization' are emerging to cope with this frantic demand. The inevitable drawback of this development in medical science is getting focused on only targeted human body parts and organs but distancing oneself significantly from the patients as human beings.

The culture of medicine needs to change to provide for a more humane approach towards the mistakes committed by a medico, or of the complications that ensued as a sequel. Doctors must be taught in their curriculum about the complications and how to cope with them. We always talk and teach about successes but not failures! So, when the unexpected occurs, the poor physician does not know how to deal with it. He does not feel like revealing, sharing or discussing it with colleagues. Doctors keep suffering deep-within in isolation but still do not seek professional help as they find the latter process both humiliating and insulting. They need to be taught to change this attitude.

Many doctors commit suicide as they are not able to withstand such a volcanic turbulence deep within. The rate of suicide in doctors, especially amongst lady doctors and more-so during their training, is much more than seen in the general population. Many doctors start indulging in alcohol or drug abuse, and many others leave their job and shift to doing something less stressful. A doctor who has been a brilliant student and who has trained rigorously for very long years to heal the wounded and the sick, perhaps pursuing a rigorous training curriculum that has the longest period amongst all professional careers, gets destroyed in a ruthless system. The society loses one excellent physician or surgeon just due to a few mistakes that have occurred, or complications that have inevitably arisen during his/her service imparted selflessly to the society. The person is often in a position to be easily saved from this predicament and has the potential, in turn, to saving the lives of thousands of his/her patients in the future!

Who's loss is this anyway? Obviously, the loss is that of the patient and the society

Let us think about this issue seriously and take appropriate steps to rectify this problem.






 

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