I have been in and out of a number of military medical facilities in my career spanning 29 years. My experience can be summed up as follows:-
1. RMO and super specialists are by and large caring and dedicated.
2. Intermediatry medical system is not so patient freindly.
Before starting with the criticism let me put on record the fact I owe a lot to super-specialists in the Army. But to quote some examples of 2nd type conduct will only be in order.
(a) Recently I caught cold. First I went to an Army doctor, she listened to me (that is right - just listened) and prescribed medicine for five days. When there was no improvement I went to a civilian doctor, he listened, took my temperature, checked my chest and lungs with stethoscope, took my BP and perscribed medicine for three days and I was cured.
(b) Once my daughter was having fever and as is usual for a child, she was scared while the doctor was `listening' to her and us. Instead of putting her at ease the concerned lady doctor gave a lecture (in our presence) on good manners.
(c) At another time I went to a Duty MO with some complaint and he needed my BP reading. Instead of doing it himself, the doctor told me get my BP checked from the Nursing Assistant.
(d) In short. I find that army doctors display strong inhibition about making physical examination of the patient. They tend to be impersonal and standoffish. They display a total lack of concern. The subordinate staff is by and large rough and preemptory with patient because they are not checked by the doctors.
(d) I have also seen relatives of the in-patients (admitted) pushing the stretchers and wheel chairs in army hospitals. I have also seen in-patients being used as runners and orderlies by the doctors (apparently by keeping them in beyound necessary period). I have also seen hospital Ayahs and Class IV being employed in the houses of doctors and so on.
What could be the solution. first and foremost, there should be public notices about Doctor -patient relationship in all medical facilities. Second ther should be a fair mechanism to represent against the misbehaviour by the doctors and para-medic staff. Third there ought to be an efficiency audit by outside agency of doctor and facilities. These steps would go a long way in improving the quality of medical services in the Army and remove one fo the major casues of frustration.
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3 comments:
Good point of view!
Dear Yogi,
I am an 'intermediary' specialist in the AMC. I regret that your daughter had to go through an unpleasant experience in a service hospital.There are a few points to clarify,though.
(a) Any common cold runs a natural course of over 5-10 days. Usually needs only symptomatic treatment(an antihistamine+ analgesic for the runny nose & fever)You were already recovering when you visited the civil doctor! I expected our neonatologist friend to catch this point.
(b)The lady doctor could have been more empathetic. However 'listening' is a important part of treatment. Would you feel better if doctors didn't listen to you?!
(c)The Duty NA is trained to take your BP/Pulse/temp etc. With a shortage of doctors, more (& not less) delegation should be expected. Is it beneath your dignity as an officer to be checked up by an NA?!
(d) I agree that doctors & lower staff require to be more courteous . There is ample scope of improvement here. However,patients(esp middle level officers & their ladies)are 'impatient'(pun intended), like to pull rank on junior doctors('Doc,just sign the medical,yaar. I am fit & telling you & I am in a hurry')
(e) Relatives pushing strechers?! I have been in small & big hospitals. My patients always go out on strecher trolleys(I am an anaesthesiologist).Haven't seen this one yet!
Inpatients being used for ward work/upkeep of hospital- This one has been sanctioned by AHQ. Fit inpatients are supposed to be used for light work. Expect to see more of this.
Solutions-1.Training is the answer,not public notices 2. Please put up any details of misbehaviour to the Registrar,in writing if warranted. With a copy to higher HQ,if you feel so. 3. Medical facilities are already heavily audited, both in-house & by outside . What exactly do you want to audit?
I would be happy to join a discussion on this & more.
Finally,please add a name/URL option for identity.
@ Shri,
Thank you for sparing your time and effort to reply. My intention is not to rundown anybody/AMC. Rather I am solely concentrated on improving doctor-patient relationship within Army. As an esteemed professional an AMC doctor deserves faith and respect from patient and similalrly the patient deserves full care and attention from the doctors. Coming to specifics
(a) Relevant issue is not wether (when seen by civilian doctor) I was recovering rather it is about `attention' given by the AMC doctor to a patient in first instance. Here I would like to draw your kind attention to http://en.wikipedia.org/wiki/Doctor-patient_relationship which says `A patient typically presents a set of complaints (the symptoms) to the physician, who then obtains further information about the patient's symptoms, previous state of health, living conditions, and so forth. The physician then makes a review of systems (ROS) or systems inquiry, which is a set of ordered questions about each major body system in order: general (such as weight loss), endocrine, cardio-respiratory, etc. Next comes the actual physical examination and often laboratory tests.'
(b) Again issue is not wether she listened or not, it is about giving `attention' and showing concern.
(c) I do not doubt the capability of duty NA nor do I have an ego issue. The issue is about managing patinent flow. Why send back a patient to get his BP and Pulse reading and thereby create a bottleneck. It would have been better had the doctor done it himself and thereby saved time and effort. Some time it is better to leave bureaucartic issues aside.
(d) I think if the issue is turned into we (the AMC - vs- they (the Patient) then we will reach nowhere. If some middle (or for that matter junior or senior) level officer asks for shortcircuiting mandatory medical checkups, they are `begging' and not throwing rank. Such people have become officer by default and I am not one of them. On the otherhand I would like to put on record the fact that an officer deserves curtesy and priority from the doctor in a service hospital (naturally he must accept precedence being given to more serious/acute medical emergencies). But all ranks and more so the officer expect and deserve that doctors would honour their needs and value their time. There is nothing more disheartening and demeaning then to have a doctor indulge in long-winded chat on administrative matters with his staff or collegues or remain engaged on the telephone on domestic issues while the patient awaits medical attention.
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