Doctor-patient relationship in Manipur

“All the world’s a stage. All the men and women merely players” – wrote Shakespeare. Here in Manipur also, there are other actors apart from those playing in the ILPS drama. Let’s turn our attention to some of them.

Trying to understand the nature of human commonsense reasoning has been one of the most complex subjects in non-classical logics such as the intuitional logic of doctor-patient relationship. Like in love, there is no logic in it. It’s all intuition – the sixth sense.

The dwindling doctor-patient relationship in Manipur is primarily by physicians’ behaviour and lack of interpersonal skills. Patient trust is a complicated construct. Patients who trust their doctors feel better already when the doctors walk in to see them before any medications. The doctor–patient relationship is based on trust.

To this end, doctors in Manipur have to work towards rekindling of the trust between them and patients with a greater understanding of their socio-cultural norms.

Patients and relatives also should understand doctors are humans and are liable to error and negligence. Death of a patient in the care of a doctor is not due to God. Here in the UK, death of patients admitted to hospital at weekends (Saturday to Sunday) when there are no consultants working, are ten times more than during working days of the week.

To err is human but negligence is a crime for a doctor. Negligence of a doctor can occur in the diagnosis, assessment and treatment of patients. For a patient on the operating table, it may be during the pre-operative assessment, failing to see if the patient is fit for surgery and whether the patient’s benefit will outweigh the risks of the operation. Or, it may be during the surgery itself and in the post-operative care.

To protect patients against doctors’ negligence there are state laws. Only when a doctor is proved to be negligent, then he/she is charged with a crime and punished according to the law of the land. A crime is an act that is against the behavioural laws of a society.

The vast majority of doctors in Manipur take patient-care with professional integrity. Still, accidental deaths do occur as they do elsewhere. But deaths due to doctor’s negligence may also happen. Therefore, it is essential that patients’ relatives should first find the truth before they let go off their fury. To make my point clear let me cite a few instances:

A vascular (arteries) surgeon Mr Woodburn at a Hospital in Cornwall, was alleged to have caused the death of a 16 year old girl Kelly Kent on the operating table, beside losing his temper and swearing – f…ing this and that. He was charged of manslaughter. She was suffering from acute myeloid leukaemia (bone cancer) and would have died in due course anyway, but that was not the issue.

In February 1999, the surgeon had some difficulty in inserting a catheter into her chest to deliver the medication for her leukaemia. During the process he punctured her heart and she died on the table.

Following a complaint by the parents of the deceased, he was charged for gross criminal negligence. He was suspended and tried in the Crown Court on December 11 2001 but was acquitted on

December 22 2001. He was reinstated to his job.

A verdict of accidental death was recorded by Mr Justice Toulson, as the Crown (Prosecution Service) could not prove to the Jury that Mr Woodburn did an act or acts that were a significant cause of Kelly’s death, and amounted to a breach of the duty of skill and care he owed to his patient and his conduct was of such a nature and quality as to amount to criminal negligence. But the hospital had to admit liability and offered the mother Mrs Dent £7,500 compensation.

Another case cites the magnanimity of the patient’s relatives. On January 12 2012 a widow Amy Francis (77) died on the operating table with internal bleeding when an experienced surgeon tried to pull a liver out instead of a cancerous kidney, in a keyhole surgery at a hospital in Wales.

At the inquest, the consultant urologist Dr Adam Carter explained and admitted his mistake. The son of the deceased, Alan (52), praised Dr Carter for his honesty and the hospital for ‘owning up’ early. He said – “I think that it was the honesty that saved the hospital. If we thought that they had not answered our questions it would have been different. This was an honest mistake.” That was the end of it.

But there is always a rogue doctor anywhere in the world. In the UK, the laws have been further tightened since January 31 2000 when a GP Dr Harold Shipman (56) was found guilty of 15 murders of his old and lonely patients in their homes in Manchester. He killed them by giving lethal injections of heroine, signing patients’ certificates as death from natural causes, and then falsifying medical records to indicate that they have been in poor health. He was the worst murderer ever.

He was sentenced to life imprisonment for each of the murders. Subsequently, he was charged for killing at least 215 patients. However, he cheated the relatives of the deceased victims. He killed himself on January 13 2004 by hanging from the window bar of his cell in jail. He was crafty. His suicide occurred one day before his 60th birthday, so that his widow wife could receive a full National Health Service pension, which she could not have been entitled to if he died after the age of 60.

Brute force by dead patient’s relatives in Manipur as well other places in India, Pakistan and China against allegedly negligent doctors has been reprehensible. It’s a manifestation of generalised lack of trust in the doctor-patient relationship. It’s a break in the age-old Asian culture. Even in the UK, odd Indian doctors are sometimes beaten up, mostly by second generation Pakistani boys.

Years ago. I had an Indian doctor colleague (Dr M) who was very lazy and rude. He treated South Asian patients as he did in India. He was beaten four times by patients. Three times by Pakistanis and one time by an English man.

One morning, during surgery hours I heard a commotion. I went out to see. Dr M’S clinic door was open as a woman patient rushed out, asking staff to call police. I saw the Englishman who barged into his room, holding him by the neck with his left hand against the wall while his right fist was landing on his face. Apparently he was rude to his child and wife an hour earlier.

I came back to my room as Dr M was an obnoxious fellow, whom I myself wanted to beat a couple of times. Only the fear of being locked up, stopped me. The staff called police but they would not take action saying that it was a common assault, despite the woman offering to be a witness.

Since then, to protect myself, especially in relation to young Pakistani boys, I kept a bodyguard (a Pakistani wrestler) at my beck and call during my surgery hours.

The public need to understand that more patients die in hospitals in India than in the West. It’s partly because of lesser training and inadequate experience of specialists, partly because of poor modern diagnostic and treatment facilities, and less rigorous pre & post-operative care.

In the UK, a trainee specialist in any field, after his postgraduate qualification takes a minimum of 5 years’ practical training under an experienced consultant before he/she is appointed as consultant. For General Practitioners (GPs) ie primary care doctors, it also takes 5 years in this field after his/her MBBS degree, before they can practice without supervision.

Manipur has now many well-trained specialists but their expertise could not have been of much use because of lack of modern hospital facilities. It is partly because of this and partly because of lack of patients’ trust in their doctors that many patients who can afford, go out of Manipur to other cities even to Guwahati for treatment.

Time has changed a lot. When I took my father to AIIMS in Delhi for enlarged prostate (TURP) operation in 1978, the facility was unheard of in Imphal. There was not even an experienced surgeon for open radical prostatectomy, from which my uncle died because of internal bleeding.

The surgeon was a bit like me. With only the experience of a House Surgeon in Gynaecology, I was compelled to do Caesarean sections on patients who were brought down in stretchers from up the hills with one or two days march, to the old Churachandpur hospital. I was lucky with a very smart and charming Paite nurse Chingnu, trained in a Mission hospital as the anaesthetist (chloroform). Nobody died but babies could not be saved due to lack of neonatal care that was unheard of.

Doctoring in Manipur has come a long way since the days of indigenous Meitei doctors and midwives, for whom I have the greatest respect. We need to go much further with modernisation and concordant doctor-patient relationship.

The writer is based in the UK