23/12/2021
Cause of Death: Relatives
© Dr. Rajas Deshpande
The panic was audible on the other end of the line: “Doc, he is becoming unconscious again and again. Please come immediately”. Sundays are sometimes really cruel upon doctors.
I had explained them the situation, the 22 year old boy was most likely faking unconsciousness because he was stressed and scared of parents. He had recently told his parents about his girlfriend and they had declined to accept her as she was from a different community. Parents refused to talk any further about her, and he was too scared to tell in front of his parents that he still loved her, and this was stressing him.
I went to the hospital. The cardiologist had already investigated the case, and we had discussed at length. There was no neurological abnormality either on physical exam or on tests. They refused to see a counsellor or psychiatrist, a common medical sin in India due to the unfair stigma associated. A massive number in our society would really benefit by seeing a counsellor or a psychiatrist, but refuse to do so. People are okay with breaking relationships at the drop of a hat and giving away great careers rather than someone correcting faults in their thinking and attitude.
Even now, as the patient pretended to be unconscious, all parameters were normal. There is no proof for real unconsciousness - if someone is faking, there are only a few clues with which doctors can understand. I explained the relatives again that he was stressed. They wanted injections and aggressive treatment that could make him smile and talk to them “like before”. Now the tone of relatives was becoming threatening. Affluence and connections give Indian patients a birthright to be arrogant and insulting to doctors or polite others.
I told them they could have a second opinion. My colleague neurologist saw the patient and suggested a psychiatrist opinion. They refused again. They requested discharge and went on to some sweet talking doctor who guaranteed them a cure. Another menace in our profession.
After two months, a colleague from another hospital told me that the patient had tried to hang himself at home, failed, and passed away later in a hospital because he had developed a ventilator related infection.
A highly educated and well placed officer lady recently brought her elderly husband in a wheelchair and complained that he wasn’t breathing well. He was found to have pneumonia. Earlier, doctors had put in a feeding tube and told her to feed him only through that tube. However after watching some Babaji on TV the lady had taken the patient home, removed the feeding tube and forcibly fed him food, which had gone to his lungs. He is now critical.
Many relatives are so adamant and impolite that it is impossible for doctors to spend time to convince them what is right. Sometimes relatives expect doctors to explain everything including complicated medical decision making (compare asking a Supreme Court judge to explain every decision to every plaintiff while resolving over fifty to hundred cases a day). Many busy doctors are now refusing to take cases with highly demanding and impolite relatives who interfere with treatments of other patients by being a nuisance, repeatedly demanding same explanations. A doctor is human too, and the frustration of dealing with such relatives while a medico legal sword hangs above one’s head is causing huge stress to many.
Many complicated patients actually suffer or even die because their relatives make demands which interfere with proper treatment. Many patients are not taken to hospital or specialist till last moment when nothing works. Many are discharged from ICUs as relatives do not want to spend for their treatment. Delays in treatment of heart, brain, kidney, liver and orthopaedic conditions, infections, cancers and psychological issues resulting in death has created a new ‘cause of death’ in our society: careless relatives.
Doctors by default want every patient to improve. When relatives fail to understand that medical decisions are complicated and cannot all be explained to one’s satisfaction, the havoc begins. The best way we doctors have learnt to deal with this situation is to avoid it, because other patients need us, and there’s no one to protect a doctor’s life or reputation.
We hope that this situation changes and interference with medical treatment is declared illegal. The freedom to make healthcare decisions about a family member should be used only with complete documentation so we know who is responsible for wrong decisions and also ensure that every patient receives the best care.
© Dr. Rajas Deshpande
Please share unedited
