The spectre of death in hospitals

The spectre of death in hospitals

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• 3Dr Shrijana Shrestha

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JUL 15 -

The hospital is a place for people with health issues, many of them terminally ill and some acutely sick with low survival chances. This makes hospitals a place where people can die.  Medical professionals do their best, as per their knowledge and skills, to bring about complete recovery in all the people they treat. But the medical sciences have their own limitations—it is not like, say, mathematics, where two plus two is always four. Predictions in medicine, based on information from books and evidence-based practices, might not always work for all patients, as each individual’s genetic makeup, background health , organ functions and immune system is different from that of another. This means that not only can the same disease manifest itself in varying ways for different people, but the outcome of the disease and the response to treatment can also differ from one individual to the next.

There are, therefore, no hundred percent predictions in the medical world, and doctors, however skilled, should not be considered guarantors of health , life or death. Unexpected events occur all the time; someone with no known health problems could suddenly die of a heart attack. If this happened outside the hospital, people would accept it as an unfortunate case, but were it to happen in a hospital, the doctor would be blamed for negligence. Similarly, if a patient does not respond to a given treatment, people deem it the doctor’s mistake. Or if the disease continues along its natural course and worsens after being admitted to the hospital, the doctor is once again blamed. And when it has to do with death within the hospital, the blame is multiplied many times over.

No one can stop death; the most we can do is postpone it, and this is a result of the collective efforts of patients, families and medical professionals. But frequently, patients are brought in already at a terminal stage, having been neglected by families in terms of their nutrition and other vital aspects. So when these patients pass away while in hospital, the families kick up a fuss, demanding compensation. In such cases, a social security system should be in place to question families for their negligence and delay in seeking medical help for the patient. The lack of a social security system, proper health insurance and free health services in the country are some of the factors impeding this.

Medical practice does incorporate a system wherein immediate family members are counselled about the condition of any sick patient—but of course we don’t discuss the issues with all the patient’s friends and relatives because we have to maintain the patient’s confidentiality. If something goes wrong, people complain that they were told nothing about the patient’s condition, and that the doctors are trying to hide their mistakes. The immediate family, who were counseled about the patient’s conditions, however, are preoccupied with mourning and so rarely on the scene.

The loss of a near and dear one is something no amount of money can compensate for, but there is proper legal system in place, in which people can lodge a complaint, and if a mistake or negligence on the part of the medical professionals or the hospital at large is found, legal action will be taken. But Nepalis don’t appear to have the patience for this, and prefer to bring in a crowd, make a scene, and get the money through aggressive tactics. This is a dangerous path, because it could lead to hospitals and medical professionals backing off from taking care of sick and terminal patients for fear that they might die on their watch; instead referring them to other centres in or outside the country, creating unnecessary delays in treatment and reducing survival chances. Ultimately, it will be all of us, including our near and dear ones, who will suffer the consequences.

Medical sciences have their limitations, and these are even more pronounced in resource-poor countries like ours where modern diagnostic facilities are not available, and medication and treatment is often unaffordable. We must accept the fact that not everyone coming into a hospital can be saved. Together, families, patients and medical professionals must put in their best to ensure that the patients are comfortable and peaceful—in life and in death.

Dr Shrestha is the Chair of the Department of Paediatrics at Patan Hospital and Professor of Paediatrics at the Patan Academy of Health Sciences