Higher Institute

It is a matter of pride for me that I work in the institute I work in (bad grammar, probably). I know it is one of the best. There are other hospitals run by the corporation in the city, also with attached medical colleges. But not as good as mine, I feel. When I talk to some others working in those institutes, I gather they feel the same about their institutes as I do about mine. In fact, one of the heads of departments keeps saying every time how superior they are to all others. If I say we are overcrowded, she says so are her wards. If we discharge thirty patients a day, so do they. The story told by people who are transferred to our institute from there is at odds with this story. The hospital looks like one in the developed countries, with large wards and long corridors, all almost empty. The doctor patient ratio is probably better than in the developed countries, not because there are a lot of doctors. Still I don’t grudge that Head of department her feelings about her institute. We met at a selection process recently, and I received a booster of her usual claims. What came as a surprise after the booster was the referral of a patient with genital prolapse from her institute to ours. Genital prolapse is a condition that any gynecologist can handle well. This one was special. She had a rheumatic heart disease with multiple valve involvement, and was on multiple drugs. Obviously she was at a great risk of anesthesia and would require intensive intraoperative and postoperative management. The referral note from that institute said “Refer to a higher center for management”. Such a reference from a poorly equipped and manned peripheral hospital is not unusual. But it was a surprise coming from a tertiary level care center, especially one whose doctors had such an attitude of superiority. I refrained from ringing her up, because she goes on defensive and then offensive when I tell about the transfers to our center from her center. Perhaps they have a phobia of difficult cases, like hepatitis E cases (three cases in last month), rheumatic heart disease (two cases in the last month), severe preeclampsia (three cases in the last month), and some more critical illnesses which involve a lot of work and stress. I had told her to hold on to all transfers until our building was repaired and we had all of our space available to us. I told her we would then take her entire workload. That perhaps was not appreciated very well by her. They continue to send the ‘bad’ cases on a regular basis. What I fail to understand is that if they send their ‘bad’ cases to us, when and how will her residents learn management of such patients and be capable of treating them when they qualify and go into practice.