Life is a management of sorts. Life of a doctor is no different. We had a patient in the outpatient clinic, who had undergone a uterine sling operation for a nulliparous type of uterine prolapse at the hands of a gynecologist who was in a peripheral non-teaching civic hospital. He used to do a hybrid operation, which was a combination of two operations described by two eminent gynecologists – one on the right side and the other on the left side. He called it by his own name. Nothing wrong with that from his point of view, I suppose. But it failed and the uterus popped out postoperatively. So he proposed to do it again. There was a senior resident doctor working in his unit, who decided to save the patient and verbally advised her to go to a government hospital. That didi not save the patient. She underwent a sling operation described by a third eminent gynecologist, but that failed too. She finally came to us. We had the option of performing an operation described by a fourth eminent gynecologist. But I advised her to try and have a baby first, using a ring pessary until she got pregnant and during pregnancy too if required. The prolapse was likely to recur after a childbirth, and I did not want a third failure for her.
“Sir, that fellow who referred her to the government hospital was with us for six months in past” my Assistant Professor said.
“I know” I said. “He was trained in a government hospital and must have faith in the government rather than the civic body.”
“Does it not sound a little funny that he should advise the patient against undergoing treatment at the hands of his own boss?”
“He must think he knows better” I said. “In our own hospital, resident doctors of a particular unit used to scare away patients of cervical carcinoma after their boss ligated both ureters of a patient during radical hysterectomy, which was diagnosed only at autopsy.”
There was stunned silence.
“I recall one of my own subordinate sending away without treatment a patient who was referred to that person by someone. That patient had a massive lymphangiocele of the genital tract I had diagnosed correctly and asked for referral to a surgeon for excision of the lymphangiocele and its drainage tracts. The patient came back without treatment when it grew until it ruptured and spilled milky fluid everywhere. Now the patient will develop it again and the cycle will repeat itself.”
“Sir, perhaps that person did not trust any surgeon.”
“That person did not trust even me thoughI had been saving patients from dangerous decisions of that same person for a long time. I have a reputation for playing everything safe, avoiding trouble for patients at all costs. I have always said one should know what not to do more than what to do. But still this person would wash up with me whenever I was operating on a patient who had any condition out of the ordinary, and try to do something before I did it. This person would try to sweet talk me into changing my decisions, and if I did not relent, change them in my absence, even after being given fully scientific and logical explanations for whatever I had advised.”
There was another silence.
"Sir, that person must have meant well" he said.
"I agree" I said. "But good intentions without wisdom or expertise are not worth much. Mistrust for a more knowledgeable and experienced person is dangerous."
“That does not sound like team work and trust in the team leader, Sir” he said.
“It doesn't and it isn’t” I said sadly. “But as our psychiatry department head says, there is no medicine for attitudes, including this one.”
