Friday, January 16, 2009

Why some Doctors discriminate against patients?

He,let us call him Mr M, is 30 years old,single working in a Bank in one of India's big Cities.His native place is near my clinic and I know him for last 6 years. I know him because he is positive for Hepatitis B Virus.

I remember him coming to me in distress as the technician in the Blood Bank had rejected his donated blood and asked him to see a Physician.He was told he is having jaundice.
I understood what the technician meant.Such rejection meant the blood is positive for either Hepatitis B or Hepatitis C Virus.

I ordered a whole series of tests on his blood. Results showed he was harbouring Hepatitis B Virus in his blood,but all the other tests were negative.

Both Hepatitis B and C are transmitted by inoculation of infected blood and blood products or body fluids.Unprotected sex, unhygienic medical procedures and unsafe blood can cause transmission.Once the virus enters the body it lives and replicates in the Liver causing hepatitis which may or may not produce jaundice.In most patients the immune system kills the virus completely and the person becomes negative to the test for virus.
But in a minority of patients the virus persists in the Liver and blood in a dormant form.Such a person is called a carrier in whom the virus will not produce any problem but can potentially transmit it to others. Our Mr M was such a carrier.Later in life [may be after 10 or 20 years] in a small percentage of carriers,the virus may again become active producing severe permanent Liver damage and even Liver cancer.So Mr M will have to undergo periodic lab tests to assess the activity of the virus.

While I explained all this his face revealed a depressed mood.
'I never had any unprotected sex doctor.Also never received blood donation'.
Any major medical procedures or injections? I asked.
'I had a few shots for various reasons.Also few dental procedures'.

If he was speaking the truth, probably we the health care personnel might have carelessly passed the virus in to his blood.I stopped that discussion there.

From then on he had came to me every year doing a series of lab tests confirming that the virus is there but not doing any harm to him.

Today Mr M was before me again.After reviewing the lab tests I gave him a smile saying everything is all right except that he is continuing as a carrier. I asked him about plans for marriage.
'Family is after me, pushing for marriage',M said.'But I do not want to hide my carrier state'.

'You can immunise your future wife with vaccine.Then you need not worry about transmitting the virus', I reassured him.

'Will anybody willingly come for an arranged marriage with a Hep B carrier?' M asked.
'Then love somebody,that may solve your problem', I replied.He gave me a shy smile.

'I have another problem doctor',he hesitantly said.
'Tell me' I encouraged him.
'I need some dental procedure done.I went to 3 different dentists in the City where I work.When I revealed my Hep B positive status they became very hesitant in doing the procedure.They came with excuses like we do not have separate instruments,or we do not want to take a risk of transmission of virus to other patients etc..'M said.' I do not want anybody else to suffer like me,that's why I am revealing my Hep B positive status'he added.

I was ashamed but not shocked.
I have seen this behaviour many times in doctors[both dentists and other doctors] when confronted with Hep B or more often with HIV.These docs will do the procedure gleefully and pocket the fees if Mr M was not so truthful.And they are doing countless procedures on un tested or untruthful positive patients day in and day out.If the Universally accepted precautions are properly taken all procedures are safe.Why these doctors discriminate like this? Are they not confident about the safety measures they are taking in their clinics?
More over in case of M, he must have got the virus from an unsafe injection or procedure.So health professionals are even more to be held responsible.
I immediately send him to a Dentist friend, with a letter in such strong words that he will not even think about rejecting Mr M. I hope he will get the required treatment and will not ever be rejected again for being truthful.


CALpumper said...

I hope Mr. M gets what he needs from the dentist.
And maybe one day finds a partner that loves him for him.

It is unfortunate that Doctors do this. Instead of discriminating, how about the Doc be honest too???

It takes a lot for a patient to open up about some things. Then when they do, they are ostracized for it.

No patient got All the help they need by with-holding information.
Doctors need to remember that. And if they are uncomfortable with a procedure based on patient status, be kind and Human enough to suggest something else.

There is too much discrimination in this world. Too much. It really needs to be depleted when it comes to our own health and well-being.

Thanks for the post.

Anonymous said...

Great post Doctor..

Mr M is getting punished for being honest..No wonder majority of them are dishonest and lie about their health conditions,thereby making others prone to dangerous infections..Doctors are doing a great job,provided they are doing it with a humane heart..Those who don't do so,doesn't deserve to be called 'doctor'..

God bless your kindness of heart

Charakan said...

CalPumper, Hope Mr M gets everything that you wished for him. He is a fine person. Few docs do discriminate. Hope they will change for the better and no one will ever have to suffer this again

Charakan said...

nimis540, welcome to this blog. A leading Cardiologist of my Town once asked me "why these ppl always lie abt their positive status?"[Referring to HIV positive persons]. "They lie because if they tell the truth they know they will be referred elsewhere." I replied. "They never lie to me,” I added.
Stigma and discrimination drives the epidemic underground and thus chances of transmission increases

Solilo said...

Reached here through Nimmy's blog.

Actually this is scary. I mean if Dentists are rejecting his case then aren't they sterilizing the medical equipments? If they are then what are they worried about?

Here when I go for a dental procedure I confirm it that all equipments are sterilized. I know they do that still it helps to make sure of everything.

Charakan said...

Solilo,welcome to the blog.The fact I wanted to highlight is the irrational fear among the medical community itself.It is a crude form of selfishness.In most of the clinics atleast in Kerala the sterilisation procedures are done properly and there is no risk of transmission.May be 15 TO 20 years ago when awareness of HepB and HIV were less,this was not the case and Mr M might have got it then.
Still why the discrimination? Sad to say,but it comes from a very inhuman and unscientific attitude towards others.

Vally said...

I recently had a couple in my clinic, where the husband was hep B positive, wife was negative. They must have had a love marriage as their names indicated different religions. I felt good talking to them. She had been vaccinated and he was concerned about her health. Reminded me of another patient I had seen years ago in our Voluntary counselling centre. He had been referred by a local physician .The pre-test counselling went well. He tested positive for HIV. During the post test counselling, he started crying. I offered to talk to the physician but the patient was not ready to reveal his status to anybody. I counseled him for hours telling him that he had to bring his wife in . He promised but didnt bother to keep it. He was so scared that day. I dont know what happened to his wife but I feel bad I couldnt do anything for her...

kochuthresiamma p .j said...

a highly informative post. didnt know hiv had so many nuances. scary too. think the public should be enlightened about these facts.
to think that the dental chair can be a transmitter of hiv!
are our protective systems in the medical world so inadequate?
can a doc refuse to treat a patient and get away with it
is the hiv position in kerala alarming? you should know.
so many question, eh? sorry. am a little rattled.

Charakan said...

KPJ,Actually Hepatits B is much more easily transmitted than HIV. I am cofident about the sterilisation procedures in Dental clinics in Kerala at present.But in 1980s and early 1990s this was not the situation.The person in this post most probably got his Hepaptits B virus from a Dental procedure in his childhood.
A doctor cannot refuse treatment to a patient because he is HIV positive or Hepatits B positive. But many heartless and ethic less doctors try to refer the patient to some other doctor in some pretext.
Hiv position in Kerala is under control.Only among MSM[ male having sex with males]that Hiv incidence is still increasing.