The Problem With Some Schools of Manners!

"Primum non nocere", First do no harm.

This is the premise upon which the whole noble profession of medicine is built. The Hippocratic Oath that graduating clinicians take is a solemn vow that affirms a commitment to this philosophy of only making well again and causing absolutely no harm. This is the whole essence of the Oath. The practice of medicine just like the practice of other professions has its toll on the practitioners.  But whatever the case this is the holy ground whose desecration has to be watched against. Do no harm is thus loosely the first law of medicine. In medicine however so much to the contrary has been observed. Left right center you hear of and experience treatment that is quite the opposite of this noble practice. Why? There is a whole load of reasons..

My interactions with both younger and older colleagues has made me appreciate that indeed old is gold. Nearly all of the elder practitioners strictly adhere to the code of ethics of practice. So do a significant number of the millennials. Every generation has its stock of bad eggs though! But we have so many cases of professional malpractice observed in the younger pool. Why? A whole lot of reasons. For instance it is a silent unwritten expectation that colleagues will not charge you for consultation. You observe this more in the older group. This has not prevented them from having brilliant, profitable and fulfilling practices. But now you have recent graduates who are so aloof, arrogant, petty, commercial and strikingly under-read waddling along hospital corridors with a feeling of self importance...one can only observe them as a scientist would observe a recently discovered specimen of existence.
It has to be noted that many do not really grasp what they are signing up for. This coupled with the very persistent hiccups in the health care delivery system can only worsen an already bad situation.

Some day in December I get this call. That one of my uncles is admitted in hospital, gravely ill. Well I know this hospital well and so my anxiety is sort of relieved. It is not that I have a few people over there but that I am in position to go there myself. And so the next day me and two of my cousins jump in a van and when we arrive at the facility I find out that true to what I heard he is in a pretty bad way. But what strikes me as odd is why despite being evidently dyspnoeic he is on no respiratory support. I inquire from the nurses and they direct me to the doctor on call. It happens that I had called a doctor acquaintance of mine who referred me to this very doc.
He comes after  a short wait and goes to the bedside. He requests for space and time to review the patient. We politely give him time to do his work and so wait outside. One hour later we come back. I request him for a little conference. He tells me what they are doing which is alright. However something is bothering me; the lack of oxygen support. When I point this out he tells me they will do something about it. But that is not even my biggest concern. What is causing the breathlessness? I ask him what he thinks and he tells me the patient is on antibiotic cover for what he believes is a bacterial chest infection. In reality this is ducking the question. "Your uncle is very sick", he bluntly tells me that and I try to shut out what this is supposed to mean.
"I can see that doc, I know you have covered him for bacterial pneumonia but don't you think it could be pneumocystic pneumonia or even tuberculosis?" I ask him having absorbed everything.
"I do not think so!".he responds in apparent agitation. But I press further, "You know PCP is a diagnosis by exclusion".
"I know what I am doing my friend and if you think otherwise then you are at liberty to take your patient elsewhere". He snaps and this surprises me. "But I was only trying to point out something doc, I have not come here to discredit you or any one else for that matter, it was just a polite observation".
Then he does two things; requests for a piece of paper to write the transfer letter and then engages my acquaintance in a long phone conversation, proceeding to tell him how he won't be taught biochemistry and pathology again, he already had enough of that in cold, hostile campus lecture halls!
We step outside for a little deliberation with my cousins and they really cannot start to fathom the perils and trouble of a referal to a public facility nearly one hour away. But it is very clear that our patient is far from getting the optimal care and so this little discussion is of mighty weighty significance. I am seething with internal rage but I try to keep my cool lest I jeopardise things. But I am enraged at this treatment and many things are going on in my mind.
When did doctors begin to be so aloof and distant from the people they should be serving? Of course this is not a new observation. People have always been aloof and distant since time immemorial and some are not even improved with time, privilege and education. But when did doctors and other health care workers start to actually believe they are the only people who matter in patient care? And how on earth are they able to get stingy with information about their patients? (this is not a breach in confidentiality) But just how did HCWs start to treat fellow colleagues thus?
We go over the merits of each course of action and we agree to let him stay here because of the nightmarish scenario that relocating a gravely ill patient will present and by this time the patient has been put on respiratory support and this is perhaps the only reason that sways my opinion.
I seek the doctor and try to speak with him.
"Doc I hope you are not offended by my persistent intrusion."
"No, I am not." he responds.
"Well, you must realise that mine and everybody elses' aspirations are the same; we all want the best outcomes for patients who happen to be relatives." I quip.
"But you must give us time to do our work, you know we get overwhelmed with work!" he retorts. I am in no moods to pursue this conversation further and so tell him to consider my opinion on the patient.

My uncle passed on in the night...and the grieving was not only for his passing on but for this disturbing occurence I seen happen pretty often.