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Working in a hospital where patients are dichotomised into “general” or non-paying and “private” or paying patients brings up some interesting questions and has stimulated my thoughts on this issue. Most hospitals in India belong exclusively to either the private or public sector. Such a stark contrast within one hospital is therefore unique.
Let me illustrate with a typical case history. X is a non-Bombayite, hailing from one of the Northern states, who has been referred to this large hospital in Mumbai. He walks into the hospital accompanied by two relatives from his home town, with a lot of hope, and becomes a general patient. He expresses a wish to meet the doctor whom he has been referred, and is informed by the junior doctor that consultants see private patients; the best way to get a consultant to see him is to become a private patient.
However, X has been told that the only hope of treating his disease is this hospital, so he holds every doctor he encounters in great awe. He is seen by a junior member of the staff (usually a resident doctor) in the outpatient department, and is asked to get a string of investigations done. So far so good. X’s morale is boosted; things are moving in the right direction for him at last.
The process of getting investigations continues much longer than he had expected. Finally he is told that it has been proven that he has a malignancy and need surgery. What a relief, he thinks to himself . At least he can have the surgery now — but will the senior doctors at least see him once before the surgery? He is once again reminded that they are being consulted, and that they do not have the time to see him as they are busy tending to more important matters.
By now he has a good taste of this discrimination, right from having his blood tested to having an endoscopy performed by the same junior doctor. He has had the privilege to catch a glimpse of the elusive consultant, who does not seem to register his presence at all. He visits the outpatient department once a week to get a date finalised for surgery — it has been three months now. He watches himself withering away; the weekly injections have hastened the worsening of his condition; they seem to be just eye-wash to buy some time for surgery.
The message to patients and all involved in their management: “wealth is health”
Along the way, the realisation slowly dawns upon him that if he were a private patient he would have been operated upon by now — and it would have been more economical to do so than to line in Bombay with two relatives for more than two months.
He goes to the outpatient department once more, now reduced to half the size of what he was when he first came to the hospital — and is asked to get the investigations repeated to monitor the disease’s progress, since it has been quite some time since he was first assessed. This report shows that the disease has advanced considerably. He is declared inoperable, given painkillers and sent home.
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