Inappropriate referrals at the end of life
A patient enduring terrible pain travels by train from Guwahati to New Delhi, 1800 kms away, only to be told that there was no treatment for him. “Why did they send me here when they knew there is nothing more to be done?” he asks. Dr Savita Butola adds, “Doctors, more than anyone else, should realize how precious each minute is for someone who is dying!”
In her article “Inappropriate referrals at the end of life – the existing Indian scenario” published in the Official Journal of the Multinational Association of Supportive Care in Cancer, Dr Savita Butola writes about cancer patients who have been unnecessarily referred to higher hospitals instead of someone explaining to them how supportive care can be provided at home. These patients spend the last days of their life wandering from hospital to hospital, getting little attention, wasting a lot of money and time, whereas they should have been with their loved ones in familiar surroundings.
“It is indeed a pity to see how lack of communication skills awareness and clear legal guidelines all result in so many inappropriate and avoidable last-minute referrals just because as doctors we refuse to accept death – the only thing in life that is sure.” she says. “Terminal patients are routinely referred to higher centres even though very often it means that they are declared dead on arrival”. In her opinion, doctors in India are trained to think of death as the enemy to be battled till the end and not as the inevitable consequence of life.
“Poor communication prevents patients and their families from coming to terms with reality, resulting in unrealistic hopes, affecting their ability to make rational choices and prepare for death. Of the estimated seven million deaths each year, almost four million need palliative care, but the majority do not have access to it”.
Dr Savita stresses the importance of palliative care education that would limit inappropriate treatment and the need for communication with the patient and families so as to prepare them for the inevitable.
A very serious issue must be addressed properly.
I agree with Dr. Savita, there is a tendency for doctor shopping by patients & inappropriate referrals by doctors to a higher centre.
But on the deeper aspect, its doctors tendency to save his skin & patients relative trying to prove their love for his patient.This is the scenario In north india.