Night Consultation

She registered with us for antenatal care today. She already had a pediatric surgical opinion on her unborn baby from our hospital. That was unusual, since the normal sequence is obstetric consultation followed by pediatric surgical referral if required. “How did you go to pediatric surgeons before registering with us?” I asked her. “We had come here before, and the doctor who examined me asked me to go to the pediatric surgeons” she answered. That sounded like prior registration with some other unit. “Show me the papers of your previous visit to the hospital” I said. She produced a casualty paper. It was indeed our previous emergency. The time of her examination in the emergency room was 1:30 A.M. “Why did you go to the emergency room at 1:30 A.M.” I asked. What complaints did you have?” “We had registered in KDMC hospital. They asked us to go to this hospital for neonatal care, because my baby has a malformation on ultrasonography.” “But were you having labor pains or vaginal bleeding or some such acute symptom?” I asked. “If not, you have to register in the antenatal clinic at 1:30 P.M. on any week day.” “No. I did not have any acute symptom” she said. “We have an acquaintance who works in this hospital. He said we should go there in the middle of the night, when there is no crowd and our work would be done well, the doctors being able to devote more time to us.” I was aghast. She was accompanied by her mother-in-law and husband both. I asked her to get them both. When all three of them came to me, I said, “Do you know that patients without acute symptoms have to come to the clinic in day time and not at night?” “We did not know that” the mother-in-law and husband said. “That is not believable. You are all adults and have visited KDMC hospital and private doctors before. You know the routine. Did KDMC doctor tell you to come to our hospital in the middle of the night?” “No.” “You came here in the middle of the night because there would be no crowd of patients and your work would be done quickly, and with greater attention of doctors who would have more time” I said. “That was not the reason” the mother-in-law said. “Your daughter-in-law told me that was the reason” I said. The mother-in-law and the husband kept quiet. “Do you know that the doctors working here work day and night on the emergency day, and they are very tired at night?” I asked. They kept quiet. “Do you know that they work at night to give healthcare to serious patients, and you deprived some serious patient of their attention, by drawing them away to examine you and perform your ultrasonography?” They kept quiet. “Do you realize this is abusing the system, which is meant for poor patients in need?” “We are sorry” the husband said. It was simple. One abuses the system to get what one wants, and if caught, just says ‘sorry’. “Saying sorry to me does not achieve anything” I said. “Will you go and say sorry to those serious patients who were deprived of the doctors’ care for the duration of your examination and ultrasonography?” They kept quiet because either they did not know how to do that, or did not want to do that. “Who was the person who gave you this advice?” I asked. “One Mr. Vinod” the husband said. “He is my friend. He knows someone who works in this hospital.” It identity of that fellow seemed to be covered by multiple proxies. I gave up. I directed the patient to an intern, and moved on to see another patient.