The value of 'free' in Indian medical practice (part 1)

THE VALUE OF FREE IN INDIAN MEDICAL PRACTICE

[PART 1]

To the people who don’t know me, I am a recently passed MBBS doctor from the very famous Bharati Vidyapeeth Medical College in Pune, India. To those who are reading this article being extremely skeptical, you are extremely right in being so. In this article I am going to try to present the reality based on my (not so good) experiences in an Urban Health Centre named ‘Shivshankar Pote Hospital’ in Padmavati, Pune.

To the people who are thinking that I am an extremely pessimistic person, I am not. Instead I like to call myself ‘Pragmatic’, although I am not even that, but definitely not pessimistic. During the time I spent in Pote Hospital, I met and spoke with many people. People of different age groups, different educational backgrounds, different religions, but mostly of the lower socio-economic strata. The next sentence written is very important. Almost 70% of the patients were cooperative, ready to listen to the advice I gave and overall behaved like patients. That doesn’t mean that the remaining 30% were bad! In fact 10% of that 30 were, I might say, ‘extremely good’, meaning they were really concerned about my opinion, the rationale for my treatment and more importantly- their own health. But this article is going to let all the good things aside and speak about the remaining 20% ,who you will get to know as you read!

But before that, let me tell you some things about Pote Hospital. Not to bore you, but to enlighten you. Pote Hospital is an excellent service provided for us by the government that comes under the category of 'Urban Health Centres'. It is a fully aided, corporation/government run facility made for public healthcare. An initial case paper over there barely costs 10 Indian Rupees. The remainder is free. Our consultation, examination and basic treatment, free. Bearing in mind that every human gets attracted to the word ‘free’, loads of patients come to the hospital for free treatment. And we, as recently passed doctors, go there for ‘free’ patients (I’m letting go the fact that we are sent there by the college, totally unpaid, for community services)! 

I spent almost 20 days in Pote Hospital in the month of May 2018. I saw many patients, so many that I have lost count. 6 hours daily, continuous patients back to back. But a few noteworthy cases come to mind. This  made me think about the cause of the problem- the attitude of the patients- ‘FREE’. I am going to tell you my story, my views and my opinions about such patients. Please bear in mind that opinions beg to differ from person to person and hence are completely subjective!

First to begin with was a middle aged male, well-built physique, apparently looking far too healthy to be in any hospital. He came with the chief complaints of general lassitude and fatigue since many months. I spoke with him about his complaints in detail, his previous visits to hospitals for similar complaints. He said that he had been visiting the same hospital since a long time. I examined him in detail, for the complaints had been chronic. I found out that there were no abnormalities. I counselled him about his diet, told him that his examination was normal and asked whether he was okay doing some blood investigations- which are not free- which he refused instantly. I prescribed him some multivitamins- because why not, they were free. I then looked at him and saw him grin, a kind of grin that mocked me. I asked him whether something was wrong. He said that his body lives on ‘alcohol’ (the critical history I missed) and added that every intern previously gave him the same medications and he was in the hospital seeking those medications from the start. I tried telling him that these were just multivitamins, but why take multivitamins for so long when there’s no absolute vitamin deficiency. He replied exactly what I had thought while prescribing those medicines- ‘why not, they are free!’ I saw him once every week, coming with same problems, refusing investigations, taking/ demanding same the medications and repeating this again. I tried to shake this incident off my mind since it was my first week in Pote Hospital, but never will I forget that one of my first patients was a malingerer, who wasted my own and every doctor’s time and skills, be it for any reason, but one of those was the fact that those multivitamins were free. We were there consulting for free, the chemist was dispensing medications for free and the multivitamins which were, free. And we did not, and could not refuse him for God knows how many reasons.

I will be writing this experience in two different parts, this being the first one. The other part will contain two more interesting stories of different sets of patients. Hope you had a good time reading through!