Thread by @docbhooshan

This thread is about -
1. harm caused to doctor-patient relationship due to corporatisation of healthcare
2. corruption in govt machinary and
3. laws that govern practice of medicine.

It is about my father who passed away few days ago.

Few months ago when my father was diagnosed with autoimmune vasculitis on top of his chronic kidney disease secondary to lifelong diabetes, we knew his days are numbered. He knew it too.

Doctors gave us a very clear idea about seriousness, complexity and prognosis of it all.

So when he stopped eating solid food in adequate quantity and remained in his bed all through the day, we knew where this was headed.

Two months in and out of ICU, alternate day dialysis and high level of care given to him by family, nurses and doctors wasn't going to make

him independent again.

So two weeks ago when he went to ICU again, we had little hope. We wanted him to be comfortable and pain free.

He developed severe infection in his gut, that spread to his blood and even developed a bed sore.

His fistula used for dialysis closed down and a central line was needed for dialysis.

He knew and we knew.

My mother, I, my sister, our spouses all agreed that further intervention is a terrible idea. I gathered courage and discussed this with my father.

He was drifting in and out of his coma and after multiple attempts to talk to him, in few lucid moments, he nodded yes.

I again asked him if he wanted to go home. He uttered a clear "yes". Knowing well what it meant.

Here my battle with current healthcare system started.

His doctor consented to our course of action of moving my father from ICU to a private room where we could be with him all the time without time restrictions that apply to ICU.

But hospital management said it is against their policy to keep patient in ward with only minimal medical care.

I was in no position to fight.

I searched for a nursing home that could help us. Found one within an hour. (Such nursing homes are closing fast due to govt policies)

There are serious advantages of being medical consultant for 20 years. It helped.

We met the doctor and explained our predicament. He agreed to help and after signing all disclaimers (fair enough) , we moved my father to his new temporary home.

Now the medicolegal problems -
What if he passes away within 24 hours of admission to this new hospital?
Who signs his death certificate?
Death within 24 hours of admission is a medico-legal matter and police must be informed.

Fortunately, my father's new doctor and I consulted medico-legal experts and they assured us that it is a hospital to hospital transfer of a patient who is investigated and diagnosed well. So signing death certificate is legal. But...

But final word remains with govt authority and we know what that means in India.

Fortunately, my father pulled it through the night.

Pain relief that he needed is a schedule X drug. Due to paperwork and vigilance needed for that medicine, hospital didn't stock it.

Same issue - vigilance officers making life difficult for even legal activity. We all know how honest doctors are harassed by PCPNDTA act meant to prevent sex selective abortions. Same stuff with schedule X medicines.

So a run in the middle of night to ONLY medical store in the city that has licence to sell that painkiller.

Fortunately, my father pulled it beyond 24 hours and spared all of his family and doctors of legal trouble. I am indebted to his doctor who took the risk of admitting him.

If we had taken him home and he passed away at home, another complication would arise -

His doctor at corporate hospital was not allowed to certify death at home due to "hospital policy" but we had to carry the deceased back to hospital emergency for certification!

Hence the decision to opt for a nursing home.

Later my father passed away peacefully, while I was with him. He was without pain and distress.

If corporate hospital with its lawyer informed policies, had behaved a bit more humanely, a lot of distress would be saved.

Treating doctors have no say in these "policies".

With my medical background, I could take decisions, foresee complications of certifying death, find helpful doctors, hospital and medicines so that my father could have a dignified exit.

Plight of families without such resources and priviledges can only be imagined.

This is real face of corporatisation of healthcare where doctors can not make patient centred decisions if it has even a tiny chance of conflict with aims of management and investors.

Implementation of good intentioned laws with huge discritionary power to municipal officers ..

is the worst nightmare of patients, families and treating doctors.

I am lucky to have supportive family, resources and medical background to make sure that my father did not suffer in his last days.

This is not default option for most. Their loved ones spend last hours alone in ICU sometimes in intense pain.

And I haven't even talked of financial cost. My father, with his frugal lifestyle and prudent investments, made sure that ₹50,000 per day cost was out of his own money

He paid for his own treatment all the way. That's his way of doing things.

I hope you all realise where we all are headed with our healthcare.

I hope my disclosure of my deeply personal experience and that of my family makes you think and act.

May Shiva free us from suffering and let our lives be zestful and we be released from ties of life like a ripe fruit separating from tree. 🙏 Om Shanti