Medical Ethics In Small Clinics

Indian Journal of Medical Ethics is an interesting read this time.

In her article titled “Waiting for the Doctor…”, Meenal Mamdani, a retired physician currently based in Illinois, USA, draws a big gun on the Indian small practice system.

Comparisons with western models of health care are usually dismissed in India with the argument that ours is a poor country without the resources to provide high quality treatment to every one. But providing a pleasant waiting area with comfortable seating and a salubrious environment does not require much money or technology. Nor does instituting an appointment schedule based on severity of illness and familiarity with the patient?s medical condition. These simply require the doctor to think of the patient as another human being and work according to the ?do unto others as you would have them do unto you? principle.

      She goes on to further lambaste the FIFO model of serving patients.

Some doctors do follow these patterns but the ?no appointment? system is more common. Patients simply form a queue in the waiting room hours before the doctor?s arrival, hoping that the doctor will see them according to the first-come first-served rule. It is pathetic to see patients, worry writ large on their faces, crammed into inadequate seating in the waiting room. Waiting times of three to four hours are not unusual and the patient is often so aware of the many others waiting to see the doctor that she/he does not grumble when dismissed with a brief, superficial exam and perfunctory advice.

 As a beautiful, almost choreographed counterpoint, Dr. B.C Rao, from Bangalore argues that things are possibly not as bad in an an article in the Indian Journal of Medical Ethics, aptly titled, “On the other Side of the Waiting Room”.

I have not seen any patient with ?worry writ large? on their faces, as the writer has described. The patients are sick and so, of course, they will not be in the best of spirits. Any worry they may feel is because of the sickness and not because of the prospect of confronting the doctor, who they usually know well.

Contrast this with what I know of practices in the West. It is almost impossible to get access to any doctor in a hurry. Even acute cases cannot get an appointment during the scheduled hours and have to seek help in the emergency room, where the patient is likely to be seen by a doctor who does not know her/ him. Unnecessary investigations and procedures become a distinct possibility in such cases. Avoidable interventions are not uncommon.

An interesting collection of worst-case and best-case experiences and as Dr. Rao himself puts it, “The truth perhaps lies somewhere in between.”


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