Tuesday, November 25, 2008

Non-Medical reasons for referring a Patient-Part 1

You may think that if a patient is referred to a higher medical centre[with better facilities] from a smaller hospital it is purely due to medical reasons. Many a time it is not.
Today I was confronted with such a referral.

It was near the end of my working day. Four men came in to my consultation room wanting some advice regarding a patient admitted under another Physician in a small hospital nearby. She was diagnosed to have Dengue fever and had been referred to higher centre.

They had brought all the patients records.I went through the clinical notes and lab charts.She was not in a critical condition.But the doctor treating her had asked them to take her to Hi-tech hospital in the nearest City.
One of the men,whom I know before asked, 'Is there a hospital in this town which can manage such cases?'
'Yes, even the Hospital in which the patient is currently admitted may be able to take care of such cases. Dengue fever patients need constant monitoring,that is all.If there is a fall in blood pressure or bleeding they may need blood transfusions'.I said.
'Then why the referral?' He asked.
I asked them what the treating doctor told them about patient's condition.They revealed that the doctor had told them that the patient has a serious life threatening infection. The patient can be said to be out of danger only after 3-5 days.
'Would you have accepted death of the patient if it had happened in that hospital?'
I asked. 'If patient died there in spite of all the recommended treatment methods you would definitely would not accept it and will raise voices against the doctor and the hospital.You would have asked the doc why he did not refer the patient to better centre'.

[Most probably stones will be thrown and the doc manhandled, which is now the fashionable thing in Kerala.I did not say that aloud.Did not want to give them ideas]

'On the other hand if the patient died in the big hi-tech City hospital you will accept it as your fate and will be satisfied with yourself that you have done enough.That is the reason for the referral.So it will better for you to take the patient to the City',I concluded.

Their faces showed indecision.They went out of my room to discuss among themselves as I saw my last patient for the day.I thought they will not come back again.But they trooped in to my room once more. I did not expect what they asked.

'Can you treat the patient in your hospital?

I did not know what to say.My hospital was slightly better equipped than the hospital in which the patient is admitted currently.I wanted to take up the challenge.10 years ago I might have jumped at the opportunity. But age and bitter experiences have changed me a lot..[as explained in my earlier posts 30vs40 part 1]. I wanted time to decide.
'Let me see the patient and decide.Bring her to the hospital tomorrow morning'.I replied

Tomorrow they may or may not come.If they come I may take up the challenge.
To know what happened to that patient click here.

1 comment:

deepz said...

Good one Doctor...