The Patient as a Person

The bulk of medical care in India is given through public institutions, dispensaries and hospitals run by State and Central Government; Municipalities, Railways, Port Trusts, Armed Forces or Public Corporations (Steel, Coal, etc). The affluent top 10 per cent go to private hospitals which are equipped with the most modern and sophisticated high-tech medical facilities. Their ability to pay for the services puts them in the category of patronising five-star hotels where a client expects, demands and gets service for his money. The middle class patient is a trishanku, he cannot afford the private hospital and he cannot accept the public hospital. It is the poor indigent patient in the general ward or outpatient of a public hospital who is the typical Indian patient. Since he does not get his square meals every day, he is grateful for whatever treatment he gets in the hospital free of charge (the pilferage of milk and eggs and drugs not withstanding). Medical students who get their training and experience through these free ward patients owe them a debt of gratitude, which should be paid back by a compassionate and caring attitude. This cannot be taught by a lecture but by actual demonstration by the Physician in charge of the ward. The acid test of a doctor-patient relationship is how this poor patient is treated: as "Bed Number 23-a case of acute appendicitis", or "Forty five year old Nirmal Singh with two children". During a daily round, if the Chief greets each patient by his first name (which is possible by glancing at the temperature chart on the cot), the patient gets the feeling that he is recognised as an individual and not just as an exhibit for medical students. If the Physician enquires about the food he ate for the previous dinner and the medicines he received, it is a signal to the attending nurses and ward boys that any spittoon to offer to a coughing patient, or offers a urine pot to sick patient, he is giving a message to all around him that there is nothing below one's dignity so far as service to the patient is concerned. If the Chief has no hesitation in touching the bed pan, the ward boy and mehetar will not fight over whose duty it is to touch the bed pan!

If the Chief courteously takes the permission of the patient before exposing him for the palpation and auscultation by 30 medical and if, at the end of the teaching session, he takes care to put back the clothes on the patient, covers him with the blanket and says: "Thank you very much for letting the students examine you”, he is establishing the fact that the patient is an individual to be treated with respect and dignity. The values and attitudes learnt during the impressionable undergraduate medical student life will be lasting for the rest of the professional life. One can understand  shortage of drugs, equipment and manpower, but one can never understand shortage of compassion and sympathy. We owe it to the patient as his right.

It is the duty and responsibility of the senior staff in public hospitals to deliver this message - clearly and conspicuously - that the most important person in the hospital is the patient and every activity, medical, administrative or organisational, is to be measured in terms of its relevance to patient care. The missionary hospitals in India have created for themselves a special place in the hearts of people mainly because of their spirit of service and dedication. They are indoctrinated in the belief that caring for the sick is serving God. This attitude is reflected in their behaviour and actions. Mother Teresa is compassion incarnate.

Unfortunately, the currently prevailing attitude in contemporary society is not missionary but mercenary and this is reflected in the behaviour of the personnel at all levels. Those with power or money get the attention they demand, often out of proportion to their need, and the poor faceless patient tends to be neglected. The power of money seems to work at all levels. I see no qualitative difference between a ward boy asking for money to provide a service and a doctor asking for money to admit a patient to a 'free bed' in a public hospital. Both are equally despicable.