Doctors With Boarders
Altaf Patel ExCampionite class of ‘64
Ethical, cultural and social values vary from race to race, and in different countries. Recently, the Daily Mirror reported about two English pensioners - man and wife - living at Heathrow Airport after they lost their house due to financial distress. In a short time, the public donated 9,000 pounds for them. In a country like the United Kingdom, the proverbial basics of roti, kapda and makan are taken care of by the government.
The social system is such that people out of a job are even paid a living allowance and the National Health Service provides for all medical eventualities. If only these altruistic lot knew how many people live on the streets of Mumbai. Here's one question that comes up: If ethical and socio-cultural values vary from place to place, is the same true for the medical fraternity as well? There exist many studies which compare and contrast the views of American physicians with their European counterparts. (I found no such conclusive report on Indian doctors.) Certain interesting differences between American and European Physician exist. If the doctors are convinced that a procedure will help you, do they downplay the risks? In the US this is true, but not so in Europe. Doctor responses vary on the issue of life support. This is an issue which poses a natural dilemma for the treating physician. European physicians (25 per cent of them) feel that under the current system, life support must be withdrawn too soon. In India, many factors go into making this decision. Much of it revolves around financial constraints of the family of the un-revivable patient. At some point of time, the relatives ask if continuing with expensive life support might alter their loved one's condition. Such decisions are difficult, in a way only those who have to make them might understand. As for me, I ask two or three of my colleagues for their independent evaluations before taking a final call. The notion of physician-assisted suicide remains a hot topic of discussion. In India, physicians are not pro-assistance. Certain states in the United States have the legislation to assist patients if they are dying. Countries in Europe allow doctors to prescribe but not administer lethal drugs. Occasionally, an arguably harmless error in treatment may occur during therapy. European physicians tend to keep this to themselves but an American doctor tends to discuss it with the patient. I'd say their Indian counterparts tend not to discuss it unless confronted, often brushing it off as inconsequential. Almost 25 per cent of European doctors say that it causes the patient unnecessary anxiety - some even feel that they should discuss the situation with their insurance company before acting.
Another interesting area is the use of placebos. It is true that many Indian doctors prescribe such drugs, and that many patients are happy with the result. Doctors in the USA are more likely to administer placebos, as compared to the ones in UK. Now for the million dollar question: Do physicians hideaway discouraging details of a terminal illness to bolster the patient's confidence? It is important to realize that this is often a difficult stand to take. Obviously, the exact situation is explained to the relatives. But often, even the patient needs to be in the know so he can make a crucial financial decision. The wise way, in my opinion, is to gently remind the patient that life is full of uncertainties - even I, the doctor, in my state of fair health, have drawn up a will as there is always an off-hand chance of unpredictable death. The subject of health insurance is very delicate and many doctors believe that patients with unhealthy lifestyles involving smoking, excessive intake of food, should pay more for health insurance. Others feel that such payments are unnecessary and rightly point out that, by that logic, someone might have to pay for a poor genetic profile. And then there's the matter of making paid appearances. Many pharmaceutical companies routinely ask doctors to do so. In my opinion, this is necessary given the time and effort the doctor expends in researching the subject on which he is to deliver a lecture. Besides, most doctors are confident that their services would continue to be uninfluenced by the money or gifts received for agreeing to such speaking engagements. Physicians' attitudes do differ in various countries. What is considered crass in some cultures is acceptable in others. What is important is to deal with the situation on a case to case basis, mining for, and doling out exact information without undue anxiety.