‘Doctors in government hospitals are par excellence … a skewed doctor-patient ratio is the major cause of trouble’

India’s public healthcare system has been in the spotlight following an assault on a junior doctor in West Bengal. Tatyarao P Lahane, an ophthalmologist by training, who is director of Maharashtra’s Directorate of Medical Education and Research (DMER) and was dean of Grant Medical College and JJ Hospital, Mumbai, spoke to Sugandha Indulkar about the issue:

Why is there so much discord in the public healthcare system?

Patient-doctor relationship has to strengthen; patients should trust doctors. One can also say that doctors need to instil faith in their patients. Doctors in government hospitals are par excellence, so is the support staff. Their skills are exemplary, especially when you look at the number of patients they attend to on any single day. Medical staff, including doctors, are extremely overworked. In such situations, paying attention to enhancing doctor-patient trust sometimes takes a backseat.

What are the solutions to improve trust?

A skewed doctor-patient ratio in our country is the major cause of trouble. In almost all leading countries of the world a doctor in a government hospital checks a maximum of 30 patients a day. In India, any doctor on an average checks at least 150 patients a day. Number of relatives exceed the number of patients, leading to more crowds and ruining hygiene standards.

Immediate steps to be taken are an increase in the number of seats in government medical colleges and medical faculty, and strengthening primary and secondary healthcare facilities.

There is no differentiation of patients. We get primary, secondary and tertiary patients even from remote areas in the state. Government healthcare facilities in villages and taluka level or small towns need to be improved to correct this situation. It is important that the government makes concerted efforts in improving primary and secondary healthcare facilities.

Recently an intern was beaten up in Bengal. How can such incidents be avoided?

What happened is extremely saddening – it should not have happened. Trust between doctor and patient has to be there. Doctors get scared because of such incidents. Thereby, the trust between the doctor and patient is destroyed. Once doctors realise that a patient is in critical condition they simply try to shift the patient to another hospital. Instead they can use the time to save the patient’s life. We call it the ‘golden hour’, the time when doctors put in their best efforts to save the life of a patient. In some cases they succeed, in some they don’t. It doesn’t mean that they haven’t tried their best. If doctors suspect there will be violent reaction from some patient’s relatives they will immediately shift the patient and the ‘golden hour’ is lost.

What should a doctor do in such a situation?

Doctors can tell the patient’s relatives the exact condition of the patient. They can always tell them that the patient is really critical and despite their best efforts anything can happen. A positive and compassionate attitude of a doctor conveying this message to the patient’s relatives will help them come to terms with reality. Counselling of patients’ relatives should be done at least by a lecturer and not an intern. Patient’s relatives must sign a statement saying that they were made aware of the health condition of the patient and will not hold the doctor accountable for the death of a patient.

Doctors treat patients with the help of medical science, which clearly states that signs and symptoms of a disease can be treated. Instead of vandalising the hospital and beating up the doctor, patient’s relatives can go to the consumer court and take legal recourse. They should not take the law in their hands.

Ragging has been a serious problem in medical colleges. Why is there no deterrent action in place despite so many cases?

Registration of doctors, found guilty of ragging, gets cancelled with immediate effect. What can be more of a deterrent than that? Till now, ragging was observed on a minimal scale in first year of MBBS. We never found instances at PG level. Now that we have found this serious case (Payal Tadvi’s suicide), we will appoint counsellors and form an anti-ragging cell even at PG level.

Isn’t it important for government hospitals and colleges to take some responsibility and take corrective measures?

Government medical colleges are taking several steps to ensure such incidents do not occur. Counselling and orientation of students entering MBBS is already in place. We will make it mandatory for PG level also. The academic stress and work load is higher in PG courses, especially in government medical colleges. That is why some students are unable to cope with the stress. They need to be taught certain soft skills from the beginning and some techniques to boost their emotional quotient as well. This training will surely help them. Life is tough, more so for a doctor. A good doctor has to learn to cope with the challenges of this profession efficiently.

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