SRINAGAR: “It was 11 in the evening; I was dealing with a trauma patient. He had multiple bullet injuries. It was a complicated case which needed the intervention of a senior doctor,” says Farman (name changed) a registrar at SMHS hospital: “I rang the doctor on call, he didn’t answer. I was doing the best I could, but I needed guidance; it was, simply, a matter of life and death. I called him 20 times, I remember clearly.”
On the 21st call, the doctor picked up the phone, Farman says, and told the latter that he busy with the operation on a patient in a private clinic: “I told him to immediately come here, as the patient was critical. But he categorically said ‘no’, and gave some suggestions on the phone, which I couldn’t really comprehend. The patient died.”
This case is just once instance of the effect senior doctors more engaged in private practice can have on the lives of people. “As usual,” continues Farman, “Everyone was okay with it. Because we are not accountable. The senior doctors are more concerned about the patients they seen in private clinics, here they treat them like dirt,” he says, bitterly.
What makes matters worse is the fact that private practice of senior doctors (Head of Departments) was banned by the government in 2013. The High Court also dismissed a petition by virtue of which private practice of HODs in the government medical college and its associate hospitals and dental colleges of the state was banned in 2014. Yet, the practice continues.
A senior doctor actually revealed that many of his peers, holding faculty positions, leave the hospital before 4pm and head to their private clinics: “Many doctors also go for private practice in the morning and by the time they reach the hospital they are too exhausted. So, they basically come to the hospital to rest! And, as I said, others leave the hospital in the afternoon.”
A junior doctor shares another incident of what this can lead to: “I and another doctor were operating on a patient’s heart. It was a major surgery; and we juniors couldn’t have handled it alone. We called our consultant, as the case demanded him to be here. But he didn’t come, and after some time the patient collapsed. And when we informed him, he put the onus on us.”
Apart from the ‘burden’ on junior doctors, patients also have their own tales of suffering to narrate given the absence of senior doctors. Zubaida, who has come from Tangdar, after being referred to SMHS, hopes a senior doctor will attend to her.
“Here, it seems like kids attend to a patient,” she says. A day before, a junior doctor asked her to go home, saying she ‘was fine’; and she was only admitted when she starting complaining of severe pain.
In the casualty ward, patients are seen by interns and junior doctors. “We are juniors; ideally our senior doctors should be with us. Because a patient first comes to casualty and we have decide what treatment the patient deserves; whether he or she should be admitted or not. Often, we get confused about what to do with the patient,” says a post-graduate doctor. “The health care system has deteriorated in hospitals because of private practice. The doctors are just not available for patients,” he adds.
Senior doctors are primarily in the hospital to treat patients, teach students, and do their research and get that published. But they compromise on these things, and rush to their private clinics. “Our academics is badly hit by private practice. The faculty doesn’t take MBBS and post-graduate theory and clinical classes regularly. There is hardly any research going on in the GMC except PG thesis work, for which these ‘so-called guides’ take credit,” said a faculty member. “Our mortality rate is high because patients are seen by post-graduate doctors, who are at a learning stage,” he adds.
“Either doctors should give their full time to private clinics, or not do that at all,” says Nisar-ul-Hassan, President Doctors’ Association Kashmir, “because this way, neither do they treat patients properly in clinics nor in government hospitals. For example, if a patient is admitted in a private clinic in the afternoon and the doctor is in hospital, how will he manage? Either he has to leave the patient untreated in the government hospital or not attend to the one in the clinic. So, neither our private hospitals nor government hospitals are able to provide proper treatment to patients.”
“Ideally, private practice should be utterly banned,” says Principal GMC Rafique Pampori, “but let the government give good incentives to doctors so that they shun private practice.”