Dying from denial:

'Youth dies due to medical negligence'- cried the local headlines in the newspaper this morning. In recent days, infamy has become the doctors' friend , while death is befriending the lesser mortals. And the lower in the SEC-pyramid one is, the lesser are the odds that he or she will cross the average life expectancy of an Indian. The unfortunate death of Shivaraj (Read the story here.) is just another example of how much the socio-economic system is lacking in accountability (what is that!) and social responsibility (ouch, not that nerve again!).

Either some of us keep running into the wrong set of people or it has now become a habit for doctors to act pricey-and-stately for no reason. A smaller example of this- minor in significance but chafing none the less under the circumstances- is that of a relative of ours who recently lost her mother and had to call-up as many as four doctors in vain, before my father requested our family doctor on the relative's behalf, to provide a death certificate for the departed woman. One 'nieghbourhood doctor' refused to even speak on the phone, let alone decline a visit, when called up for the request.

Such callousness as shown at Bowring should not go unpunished, for there is absolutely no reason why doctor should deny service to anyone. One can look at it in several dimensions. As pointed out in the article, there is no legal impediment to providing service. Medical negligence of the popular kind (misdiagnosis, failure to exercise diligence during procedure etc) comes later. One must first ask the question- Can a doctor be punished for providing service. Obviously no! Additionally, there ought to be no economic impediment, at least not in Shivaraj's case, as he was brought into the hospital by his father to a government hospital. In any case, the responsibility of the cost of the treatment in an emergency cannot and should not be the doctor's responsibility. The doctor is expected to skillfully do that which is technically apt in his judgment based on his training. Economic responsibility lies with the patient or his kin as the case may be. Denial of service on grounds of economic status certainly is unconstitutional. There is no evidence of procedural impediment either, because the patient in this case was not a victim of crime. Typically, one requires an FIR or some police report for an unaccompanied or unidentified patient where foul-play is suspected. Shivaraj's case is plainly that of a one-party road accident and moreover the police themselves shifted Shivaraj from one hospital to the other.

Come to think of it, basically, it makes no economic sense for a doctor to behave this way. Thousands of doctors pass out every year from greater Bangalore given the plenteous harvest of doctors from medical colleges in the region. Good doctors might be in short-supply but medical graduates are not. How can a doctor think he can grow by turning away or turning off patients in this demand-supply situation?

That the accused doctors shouted at the grieving party and refused to read the report given by NIMHANS, let alone admit the victim, itself tells that they are not fit to be doctors. Of course, suspension of the doctors has been issued and a 'departmental enquiry' ordered, but this will not help the dead man's family, for whom he might just have been the sole bread-winner. It can be fairly estimated that after having paid tons to get into the medical education-and-profession the doctors will try to buy their way out of the death on their hands. If the case goes judicial, all hope is lost for the survived, who might find themselves in a dilemma to choose between survival and legal (and moral) victory.

Treating this as a second degree murder (their action directly lead to the patient's death, did it not?), the doctors should be stripped of privileges to practice, barred from IMC and made to compensate the Shivaraj's family financially.

This may be an odd case that has made it to page-2 of a popular tabloid, hundreds more may not even be noticed. But this should be made a precedent for other doctors who consider themselves as human gods and take their roles for granted.

After that, the doctors might not live in and patients not die out of denial.

Games Indians Play


If your mind is running in the direction of the popular transactional analysis book of similar title, you are not too far from the truth this book has to tell you. An interesting take on 'Desis in their own Des' , this is the name of a book by (erstwhile) Prof.V Raghunathan of IIM Ahmedabad.

Most of us would have argumentatively discussed at length, albeit with a pinch of self-righteous exclusivity, about why we are 'like that only' but without questioning why not? When I discussed this book with a couple of my friends, the system came out at the cause rather than the effect, a stance that is opposite of what this book takes. Just so you know the book is not passionate about reformation, but the cold logic of it is bound to leave a whiff of reason on you.

Offering umpteen Indian-way-of-life examples which all of us have lived through, the author sets the context for his analysis of this drama that we play in daily social life (read as behaving as a community). The message is clear- social life is what we fail at. Ironically, while we are, and not without reason, rational individuals, we are victims of our own over-rationalisation. Artfully, Prof VR tells the reader why Indians are some of the brightest somebodies but a miserable community living with their self-created acceptance of norms. He explores Why spitting, relieving,shoving, queue-jumping and many other "-ings" in public that have impacted all but bothered the more reasonable of the lot, are not just hangovers of pre-freedom era, but realities of post-60-year-freedom age.

We may have argued passionately about what can be done to improve it, only to conclude by questioning how much can one-in-a-more-than-billion person's action change the system.It is this 'what can just one do' premise that Prof.VR skillfully counters through the applications of Game Theory to social life. Taking the uninitiated reader through basic of GT, the author pushes it to the next level by explaining work done by various award winning elite researchers in applying GT to real-life situations and war strategy (Life in India is a big fight? Touche!). Then taking the book to its logical crecendo, Prof VR guides us into his perspective of what strategis in social life can reduce dissonance in person to society transactions. A small relief that I had been not wrong in playing this game right myself.

The intent of the book is quite clear, to give a logical basis for the Great Indian Drama and then, atleast, telling the reader that his action can indeed make a difference. Again, the intent is just to educate the user of the option he has to keep in mind the 'larger good' while deciding his next action. Author leaves it at that and makes no lofty pursuasions for a better India.
It is possible that the book will be read by a portion of the reading urban community. Even if they, if not already, start following the 'tit for tat' strategy in life ***in its true spirit***, I think my life will be a little easier, and so will theirs from my point of view.

I would recommend this book. At 150 pages you can breeze through this hard-bound book over a Sunday afternoon. The other 25 pages comprise bibliography, but has some interesting extracts too. The language is concise and the author makes his point quickly and crisply. A foreward by Mr. Narayana Murthy is an added shine for NRN's fans given that his writings are rarer than his speeches.