Cause of Death; Dr K Ramprakash MBBS

Today If Governments, Press , Society in general and Courts are to be believed, doctors are the only cause of death in this country. They cause death by operating or deliberately not operating, by doing unnecessary money making tests or by not doing the appropriate test, by giving branded useless medications, and even by not working whether by going on strike or taking leave. This dichotomy where on one hand their presence and their work allegedly kills and so also their non working is difficult to understand but universally accepted.

ICD codes in India become redundant since there is only one cause of death or disability in India and that is the doctors inability to treat. That the accident happened because of drunk driving and stray cattle on pot holed unlit roads causing polytrauma is incidental. Why the doctor did not treat immediately and referred patient to a different hospital, or why the doctor did not refer to higher centre one of the two would be reasons to blame the doctor. This is taking into consideration that he is the only doctor posted at the PHC with broken doors, intermittent electricity and no gloves which caters to about 20 sq km area and hence is 24 hr, 365 days on call for all emergencies and despite this had been present to attend to the patient brought to his PHC. That no ambulance is available is again a moot point.

Joining a Government service these days is being gradually made impossible for doctors who are made subservient to multiple masters. They are paid poorly, do not get any of the perks like housing, transport, security provided to the judiciary or the executive and even the salaries are at times delayed or unpaid for months. Despite this they cannot go on strike or protest or even resign as seen in the recent Rajasthan incident and HC judgment (Dr Kusum Sanghi vs State of Rajasthan & Ors). We fight against ignorance, misconceptions, misdirected faith, and various taboos to inculcate scientific knowledge and impart health literacy among the public only to be targeted for doing our job.

Switch on the TV and you will learn that The Cancers, the Dengues, The Tuberculosis, the Diabetes and Heart Diseases do not cause death unless intervened by these meddling doctors of modern scientific medicine. Divya Kit (or its equivalents) which is provided as a service to the nation for only Rs 5000 for a month’s supply can prevent all of them and even cure the most devastating of stages. The Baba Ramdev’s prescriptions opens arteries without stents and paralysis of any kind is treated by giving a purple coloured injection by an illiterate lady in Boonga Tibbi near Ambala. The Gall stones are removed without any surgery by giving medications and this is advertised openly in news papers and TV , the Drugs and Magic Remedies Act not withstanding. I have often wondered why India does not get the Nobel prize of medicine for so many inventions and new discoveries which guarantee cure of diseases on which the world uselessly spends trillions of dollars.

The knowledge and the scientific reasoning taught during MBBS trains us to practice evidence based medicine but does not teach us how to compete with advertorials and anecdotal stories which are projected as proofs of irrational therapy. Coil placement in an aneurysm for an intracranial bleed is a highly technical and skilled procedure requiring excellent state of the art infrastructure but would still not benefit 100 % patients. Despite that it would still be recommended due to its potential to prevent disastrous outcome of the disease. This would be a costly procedure irrespective of whether the patient or the taxpayer paid for it. To compare this with the self proclaimed healers’ theatrics is worse than comparing chalk with cheese. However being a costly procedure it is very likely to unleash the ubiquitous violence in case the patient does not survive.

Yes if the doctor responded to the screaming patients relatives faster or if oxygen was available, the cardiac arrest may have been reverted, but then if the person was one peg less drunk or one second slower the accident in first place would not have happened and neither would have the cardiac arrest. There is no grudge for this misdirected anger because doctors since time immemorial have faced it. The problem is the calculated promotion and deliberate igniting of passions by local politicians and yellow press for petty gains which results in flaring up of situations. We can deal with our patients and their relatives if only the local wannabe politicians and press are kept out of bounds.

Dr Neeraj Nagpal
Medicos Legal Action Group

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