The dilemma of a hospital administrator

01/04/2020

The Shakespearean dilemma, “To be or not to be”, holds good for most doctors and surgeons in the country right now. The extraordinary times we live in, with the pandemic looming large and around us, a much-needed 21-day lockdown enforced by the Prime Minister seems the last resort left to take the viral pandemic by its horns.

However, remember the viral illness isn’t the only illness and other non-communicable diseases still continue to be the major killer. This includes diseases related to diabetes mellitus, hypertension, cardiovascular and neurological diseases. The most notable among these are cancers. Most diseases, with the exception of cancer, require a patient to comply with recommendations of a healthy lifestyle, monitoring and drug intake.

The compliance could potentially reduce the need to travel to a clinic/hospital, temporarily reducing footfall inside a healthcare facility, where less-immune people are prone to coming together. However, one needs to weigh the risks and benefits of visting/not visiting the doctor.

We doctors use our learning to decide the need for a planned procedure — the so-called elective procedures. Can we afford to sideline the “elective cases” during the pandemic? Why is it important to withhold elective/planned surgeries/procedures? Unlike any other profession, we doctors deal with humanity at its most vulnerable. It is not just science, but empathy and trust between the doctor and patient that forms the keystone of this scenario.

So why is it important to say no to a surgery/procedure to a patient who needs it, but who is not in immediate danger?The learning from the West and the East has been clear, with hospitals becoming the major source point of infection spread. The lockdown is the biggest social experiment we have undertaken since the partition of India. The current situation warrants a doctor to use his utmost clinical judgement to reschedule the procedure to break the chain, by reducing the contacts of the vulnerable ones. It is also important to reduce the occupancy of patients beds, ventilators and other resources, which will become necessary if a potential need arises.

Clear directions from the ICMR (Indian Council of Medical Research) and PMO to postpone all elective procedures for a month, is a step taken to handle pandemic transmission. But the buck doesn’t stop there — the recent development of implementing a tele-health policy through the recently formed board of governors (replacing the MCI) is a disruption in itself. With high speed internet-enabled smartphones in most hands, tele-consultations for all non-emergency visits is just a click away. What was thought as a tool to reach the unreachable sectors of the society has taken a different avatar now, enabling us to reach everyone.

It is often quoted “chaos is the ladder of opportunity”. This pandemic brings forth a lot of fundamental thinking and action in all sectors of society. A society where public health takes precedence over economy, where family takes precedence over self indulgence, where priorities and culture of the organisation towards its employees matter more than the take-home packages or bonuses.

All it requires for us to do is to sit back and relax, as that’s the strongest weapon to fight the pandemic, and I am sure we will lead by example.