Maximum Mumbai: Decoding the doc-patient bond

Cancer surgeon Praful Desai recently deposited a fine of Rs 50,000 with the metropolitan magistrate’s court in a case of medical negligence for which he has been convicted and which he has challenged in the Supreme Court. He also executed a symbolic jail sentence. It was a low-profile court affair but has many implications for one of the most uneasy of human relationships — the doctor-patient bond.

This bond has always been iffy for both the parties, with a fair list of grouses running into pages. Doctors came under a rigorous legal scanner in 1995 when the Consumer Protection Act was applied to them and their work deemed “a contract for personal service”. The Act sent a shudder down the spine of the medical community which feared abuse but, as it turned out, it didn’t fare too badly as proving medical negligence in court
has been quite difficult.

Desai’s opponent PC Singhi has taken this battle to a new level. To say this 84-year-old is tenacious is to limit him. He hauled a doctor to court, not so much for the disputed act of negligence but much more for a perceived snub, and sustained the battle for well over two decades.

Singhi was upset as Dr Desai allegedly did not attend to his wife at the operation table on December 22, 1987, after recommending an operation against the advice of American doctors, and also did not meet the family thereafter to express his regret. Dr Desai had recommended removal of Singhi’s wife Leela’s cancerous uterus but gave up the idea when she was opened up and found to be in an advanced stage. She developed a fistula in the process and died over a year later.

For the last 15 years that I’ve known him, Singhi has maintained one thing: “Had Dr Desai apologised or shown some remorse, I would have forgiven him.” Dr Desai has argued that the question never arose as his wife was never his patient.

Whatever be the merits of the case, it has got the medical community in a ferment on the one hand and awoken the patient population to the potential of a doctor’s kind word on the other. While doctors lament lack of time to indulge a patient, patients complain of the hours they have to wait after taking an appointment and not getting the doctor’s ear.

Global studies have shown physicians tend to get into diagnosis before letting the patient air his full spectrum of concerns. This is particularly true in India where the doctor-patient ratio is unfairly weighted against the former — almost 2,000 patients per doctor compared to about 400 in the US. But a sympathetic doctor is often half the battle won for the patient.

An initial study by the Michigan State University, published a month ago, suggests that better communication with the doctor can kill pain. It measured the neurobiological response to an empathetic doctor for the first time and found lowered pain-related neural responses in the brain when faced with a friendly doctor.

Singhi’s win, whether it is upheld or not, is unique for its novelty of cause. It seeks to remedy the finer nuances of a doctor’s manifest behaviour rather than the tricky implications of medical science or treatment that were till now the primary source of concern for doctors.