The value of 'free' in Indian medical practice (part 2)

THE VALUE OF FREE IN INDIAN MEDICAL PRACTICE

[PART 2]

The second thing which I cannot ignore to mention is the addiction of many patients towards cough syrup. Yes, you read it correctly, ‘Addiction’ to ‘cough syrup’! At Pote hospital, we give this cough syrup for free. And being free comes with its obvious implications. People absolutely abuse this medication. It is dispensed in the patient’s plastic bottles from the huge cans the hospital receives. During the beginning of my posting at Pote hospital, I used to examine the respiratory system of all the patients with respiratory complaints in great detail. I used to see the same patients coming again and again, with the same complaints, with their chest absolutely clear, taking/demanding the same medication, cough syrup. I knew what I had to prescribe, even before taking the history and doing the examination, just by looking at the empty plastic bottle with the patient. During the end of the posting, I tried to change a few things by prescribing tablets with a similar compound. And the result was not surprising at all. The demand for cough syrup increased, with increased refusal for tablets and a lot of unhappy faces. Actually, I was told about this cough syrup overuse by my seniors, which I chose to ignore initially, just to realize later that people were indeed addicted to this medicine! Scientifically, maybe, it must be called a habit rather than addiction (but lets just stick with ‘addiction’ to live in a fool’s paradise). It is so prevalent that I even saw a man who had got an empty whiskey bottle to be filled with the cough syrup! Another patient directly drank it from the bottle, not even measuring the quantity she’s taking!  And not to forget most of the patients, with any complaint, demanded cough syrup to be written at the end of the prescription!

And then comes a really special group of patients. They were not really patients, they were more like ‘ramblers’ coming in the hospital. They belonged to a health scheme called ‘CGHS’. This CGHS scheme is provided to the people working in the Pune municipal corporation which allows them to get ‘any’ medication for free in any PHC. The way they talked, the way they behaved and their demands were literally agonizing. Not all, but most were extremely rude, filled with disdain, and not only me but also my colleagues felt their hateful attitude towards us. Most of the patients used to be there to get free medications. Most of the medications were for the chronic diseases like diabetes or hypertension. As they entered the consultation room, we used to identify them with their scheme number mentioned on their case sheet. And as soon as we asked them what their complaints were, they used to take out a lengthy prescription to give it to us to copy it on our case sheet (which was mandatory for dispensing the medicines). Although the prescription was outdated or needed review for dose titration, we were told or rather instructed by the patients to write the prescription on the case sheet. The CGHS scheme which is excellent for the patients, became a thorn in my side, just because of the attitude of a few. Once, I even ended up in an altercation with one of the CGHS person. That person ‘instructed’ me to prescribe a medication whose empty vial he had provided me with. The drug he wanted was injectable methotrexate, an immunosuppressant and potentially a fatal drug. He was not the patient. The patient was his relative who was also in CGHS. So the patient was unavailable, patient’s prescription- unavailable, the name of the treating physician and the diagnosis- unavailable. Patient thinks his demand- reasonable and his expectation- unyielding. And there was no chance in hell of giving him that drug, by me, just like that, just because he was from CGHS! And that didn’t end quite well and my colleague had to order him to go to the medical officer to get what he wanted.

There were many more incidents which made me write this blog.  But at the end of my posting at Pote hospital, I pondered upon what was wrong and what made me ‘not’ like my posting. Pote hospital itself was a decent place to work, the medical officer was very good and sound in her practice, and the paramedical staff was also very responsible and skilled. The problem I found was the attitude of a few patients, the niche 20% patients I tried describing in the blog. Government has done an excellent job setting up public health care centres such as Pote hospital. In fact, we are in need of many such institutions. The CGHS scheme is good scheme. I think that everyone should have something like that! But at the end of the day I asked myself, will I work in such a place where many people don’t value what government is giving and the services which the doctors give? And the answer is pretty obvious.

I end this blog with an ambiguous question. A question because of which I thought of writing this blog. Is this the value of something which is free? And in my case, would that figure of 20% patients whom I felt oddly different, had been much less if it was rather inexpensive than free?