Lately, there’s been a lot of heat in discussions about the doctor-patient relationship. Many views from both sides – ranging from sympathetic to vindictive – have surfaced on several media platforms. The integrity and ethics of the treatment provided by doctors have been questioned; the behavior of the aggrieved has been scorned. The remarks of the judiciary and the legislature have been ‘interesting’ (to say the least) and have only added fuel to the fire. In the aftermath, questions have been raised about the hypocrisy of the judiciary over various past rulings. Several videos have gone viral with the media proving fundamental in shaping the perception of the masses to the same.
I often sit back and wonder what provokes such actions and what has led to this loss of trust of both the care-giver and care-seeker. Unless we diagnose where this malice stems from, we won’t really be able to fix it. All knee-jerk actions will only offer ‘band-aid’ solutions.
Being a resident doctor in a busy trauma centre at a government hospital for the past three years, I have had the unenviable opportunity to see a lot of grief. Along with my colleagues, I have managed huge numbers of patients – battling through the insane work-hours, often without basic amenities. We have saved numerous lives – but we have also occasionally failed. We see a lot of pain and hurt and the occasional loss of life despite the best of our efforts.
It affects us all very deeply – but as the saying goes, ‘the show must go on’. And so, as a defense mechanism we develop an unavoidable perceived detachment towards human suffering – something we are infamous for. It is this detachment that enables us to not be preoccupied with the grief of a previous loss. It also helps us discharge our duties consistently, unflinchingly and save lives. This is an intangible feeling that can’t really be expressed in words.
But when I put myself in a patient’s or their attendant’s position, I feel the immense pain and despair they do. I have tended to my ailing mother for a year at a stretch – so I would know about this. The loss is irreplaceable and the situation hopeless. It’s a natural tendency for one to find someone or something to lay the blame on. It’s not done actively – but it’s happened to all of us and probably will continue to do so. This grief cannot be put into words.
The point that I want to stress here is the word ‘grief’. Grief is said to have five stages – denial, anger, bargaining, depression, and lastly, acceptance – all in that order. We all go through these stages when we experience any form of grief. The only difference is the pace at which one progresses through the various stages and deals with each of them.
Denial is probably the most profound period, when the news hits or the realisation dawns. It’s the time when the mind goes numb and one can feel the cold sweat as the veil of grief engulfs them. Then comes the stage of anger. This is where an already-bad situation goes south, rapidly. It’s at this point that the mind becomes deaf to the sound of reason and impulse takes over. The response at this point is purely instinctive, regardless of the consequences. How one reacts here depends mostly on how they have learnt to function in life.
As clinicians, we are sometimes so focused and preoccupied with our work that we neglect handling the patient’s/relative’s emotions at this crucial juncture. It is at this point that communication becomes key – and it is at this point that we clinicians probably lack the most. It’s imperative to take a few moments to convey to the patient and their attendants that we do care and understand – and that whatever we are doing is to the best of our ability and available resources. This point has to be effectively conveyed, period! If done properly, most people do understand and see the logic and reasoning.
But then, there are few people who have a rather abrasive way of handling this stage. They tend to look to shift the blame elsewhere. Since it’s the doctor who’s the most gullible and at hand, they become the recipient of the consequences of this blame game. This is probably not done with intent, but rather, out of pure, raw instinct. What follows is a distasteful altercation which often leads to violence with a mob mentality. The several videos and clips are perhaps proof enough. The instinct may be without malice and intent – but the actions are not. They are just not acceptable. Violence, in words or actions, should not be the chosen vessel of expression.
So, how do we find a middle path? Do we enforce stringent laws to act as a deterrent? Do we tackle this show of force with force, or do we stop offering treatment altogether? What can be done to address the insecurities of the care-giver that they feel at being so vulnerably exposed at such precarious moments? What can be done to appease the aggrieved and to prevent the violent outbursts that have become the norm? At this point, your guess is as good as mine.
Featured image used for representative purposes only.