Spectrum of doctors and healthcare facilities 2

While undergoing treatment in a hospital, if things are not improving or worsening, it is always a dilemma for people whether to stay put in that hospital or move to a higher centre with better facilities. This can be a big problem for people who are getting treated in hospitals outside of major cities.

Close family members are generally distraught as the patient is not responding to treatment. They want some “knowledgeable” person to guide them. Best person who can advise whether to shift to a higher centre or not, is the patient’s treating doctor or the team. Ideally the treating doctors should guide the patient’s family whether shifting to a higher centre is needed, whether the patient is stable enough to be shifted, which hospital to be shifted to, talk to the team at the receiving hospital and co-ordinate a smooth transfer.

Patient’s family members are usually unhappy with the treating doctor or the team as the patient is not improving despite their treatment. Most intense feeling in their mind is “Why is my relative not improving despite your treatment?” Generally, they are skeptical to follow their local doctor’s advice.

Local doctors are usually feeling bad that they are not able to make the patient better and it is sort of, loss of face for them. Most doctors feel like they are the best doctor, and their hospital is the best. Yet another factor is which hospital to shift to. This is too much to ask for in our mostly disjointed system. Doctors may be accused of forming nexus and guiding patients with some motive. Sometimes the doctor may indeed have an ulterior motive in referring patient to a particular higher centre, which again is the reason for skepticism on the part of patient’s family.

An important factor to consider in shifting a critically ill patient is the additional risk associated while shifting. An air ambulance is ideal, but it is rather expensive and beyond the means of most people.

It is common sense and general belief that better treatment results in better outcome. But it is not always so. Some patients may recover with treatment in the peripheral centre, whereas some patients may not recover in the hands of best doctors and hospitals that money can buy. It again boils down to the three cardinal factors mentioned previously: patient factors, disease factors and treatment factors.

Doctors and healthcare facilities also come in wide spectrum; from an MBBS doctor practicing in a small peripheral area to a transplant surgeon in a tertiary care hospital in a city. Not every patient requires the ultramodern services in a tertiary care hospital. The highly specialized doctor cannot provide the basic health requirements.

What is needed is a stepwise approach to the problems and smooth transition from primary care to secondary to tertiary care depending on the clinical condition of the patient. As mentioned before, there is enough time in most patients for this to happen. But due to the anxiety, coupled with misguidance (by themselves, media or healthcare providers), people want everything done quickly.

Unfortunately, there is a lot of blame culture in our society. People usually want to blame someone or something when things go bad. Due to all these issues doctors in peripheral area hospitals may not entertain the discussion about shifting to a higher centre, leave alone guide the relatives, for the fear of getting blamed if things do not work out during transport or in the higher centre.