should doctors take the unnecessary risk to their own life?



Raghuraj S. Hegde, I have been in the medical profession for many years

It would not be possible to put a statistic on this question because there’s no way to objectively analyze whether doctors refuse high-risk patients. No hospital would like to collect and publicize data about refusals of high risk cases.

But there are reasons why doctors and hospitals in general would be reluctant to take up high risk cases:

  1. In places like US, many hospitals’/departments’ funding are dependent on a non-representative statistic of mortality rates. The high mortality in a particular center may not mean poorer standard of care but that such centers take in more high riskpatients and hence have higher mortality. Those hospitals eyeing funding may want to steer clear of risks. This is not much of a problem in India. Even government hospitals don’t get enough funding for basic facilities so no mortality metric matters in India. All the complicated and high risk cases end up in the government hospital anyway, so mortality in government hospitals in India is always high.
  2. Litigation is a problem but in high risk cases usually a high risk consent is taken and a lot more documentation is done than the average case to avoid future problems. Unless gross negligence can be shown by the suing party, the case usually goes in favour of thedoctor on most cases in India. But this doesn’t meandoctors and hospitals cannot be harassed for the same. There have even beencases of patient’s relatives holding the hospitals for ransom. I was witness to one such incident in my internship when the the dead child’s relatives asked for Rs.25 Lakhs from the hospital management in lieu of not filing a negligence case and when that didn’t work, they threatened violence. Fortunately for us doctors serving in the ER, it was resolved with some police and political involvement.
  3. A celebrity or a VIP dying in a high risk surgery/treatment/hospital stay can cause bad PR and also sometimes invite hooliganism from their supporters.  Ambareesh, a famous Kannada film actor (and also an MP) got really sick in a Bangalore hospital in 2014. He was on the verge of dying there. The hospital management was worried that if he died in the hospital, his fans (and political supporters) would ransack the hospital and destroy it. This scare was legitimate since a few years earlier (in 2006) when another legendary film actor Rajkumar died of natural causes, his fans destroyed the whole city for 3 days. (Rajkumar buried; Bangalore burns). So to avoid all these unnecessary complications the hospital authorities made up a fake case of better treatment being available in Singapore. So he was shifted to one of Singapore’s most expensive private hospitals. Fortunately for Ambareesh he pulled through due to pure luck and not due to some extraordinary treatment. The same was observed during the infamous Nirbhaya rape case when the victim was shifted to Singapore for the government to avoid the consequences of the girl dying in New Delhi.
  4. High riskpatients undergoing surgery have high probability of dying on table. When it does happen, many times their relatives refuse to pay for expenses incurred. Doctors and hospitals cannot give guarantees for saving a life. By the act of consenting to a surgery, you accept the risks including sometimes dying on table. If patients’ relatives refuse to pay for the costs after death, hospitals will slowing be reluctant to take in high risk cases and may suggest they be taken elsewhere to avoid the costs as well as consequences. If a doctor performs a surgery on someone, but the person dies and he was unable to save him, does thepatient’s family still have to pay?
  5. Manypatients’ relatives don’t understand what high risk means. The risks can also include death sometimes. Doctors can’t do magic to save every patient who is on the verge of death. There are many instances of patient’s relatives using violence including beating up doctors. My father (a family physician) was an unfortunate victim of one such episode for no fault of his. I have detailed what happened in that case here- Why are doctors hit by the relatives of deadpatients?   Fortunately my father was not assaulted badly but he was quite close. These aren’t isolated cases and it is very common occurrence these days and can take on horrendous proportions in India. Recently a renowned Gastroenterologist in Allahabad, Dr. Rohit Gupta was assaulted without mercy for the death of a very sick patient. (Allahabad assaulted doctor in ICU, condition serious). The whole assault was recorded in the CCTV in the hospital. Please watch the video at your own discretion. After watching it any doctor in India would think twice before treating very sick patients. Why should doctors take the unnecessary risk to their own life?

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