‘Medical care requires personal touch, distance is testing doctors’
Bengaluru: As the pandemic unfolded, medical oncologist Dr Niti Raizada worried about patients who had received a cancer diagnosis months ago and were delaying treatment over virus concerns. Obstetrician-gynaecologist Dr Hema Divakar deliberated on the tricky logistics of bringing expectant mothers to the hospital because, as she niftily puts it, you cannot lock down a pregnancy.
Doctors across specialities have witnessed an intense reversal of normal times, wrestling with questions not just about Covid-19 but about the entire healthcare process. Is it safe to call a patient for a check-up or a procedure; should a problem be allowed to fester to avoid possibly bigger complications the virus may cause; are video consultations helpful; how to protect and reassure stressed-out and stretched staff? These are some of the urgent concerns.
Medical professionals have had to rethink their approach as counselling or treatment for conditions other than Covid-19 cannot be deferred indefinitely. Eminent women doctors, some of whom are part of national healthcare discussions, spoke to TOI about the new changes and challenges.
“We had to completely reorganise our services, from patient admissions to staff shifts,” says Dr Pratima Murthy, head of psychiatry at the National Institute of Mental Health and Neuro-Sciences, or Nimhans, in Bengaluru. “We have special wards with long-time patients, who are old or have other illnesses. An infection would be dangerous here, so we reverse-quarantined the older patients. New admissions are also nursed separately. Everyone is tested.”
A limited number of personnel are allowed inside wards, and preventing burnout is a key concern. “People management is crucial. People make up the system and their health, physical and mental, and functionality determine how well it runs. We had to balance their and the hospital’s requirements,” says Dr Murthy. “As a healthcare worker, your biggest fear is you will carry the infection home to your family. We ease anxieties and ensure staff safety and patient care don’t suffer.”
A big ask for doctors has been to broaden their focus from treatment to organisational protocols, revamps and webinars while simultaneously creating safe access, and peace of mind, for everyone. “We made arrangements that were not limited to patient care. In the early months of Covid-19, we retrained staff and shifted our emergency unit. A lot of liaising inside and outside the institution, especially when an employee or a patient tests positive,” she says. “Figuring out how to extend support to patients wary of coming to the hospital was also very important. Telehealth helped us continue our communication.”
Changing guidelines are an irritant for most medical professionals. “They change while you are setting up a new system... Protocols are mostly set now, and we have held things together by working collectively and adapting,” says Dr Murthy.
According to Dr Hema Divakar, medical director of Divakars Speciality Hospital in Bengaluru, the pandemic-induced distance is testing doctors. “In India, more than systems, it’s the specialist’s personal touch and relationship that reassure patients. We are personally invested in ensuring our patients’ health. The distance created by Covid, where in-person consultations cannot happen regularly, is challenging for us,” she says. “The standard way of practice, which we followed for decades, has changed. New protocols require a complete change in behaviour with numerous precautions. But we are also learning that some ground can be covered through video consultations.”
Uncertainty is a stressor for both care seekers and givers. “Some procedures can be put off, but the question troubling everyone is: what next and when? Childbirth, for instance, cannot be postponed. Thousands of deliveries will happen in the coming months. Thankfully, pregnant women take great care of themselves and stay safe,” she says.
Medical professionals are expected to have the right answers, but the pandemic has left them with many questions. “When patients pose queries now, especially on complications caused by Covid, we don’t have definitive answers as the understanding about the virus is still evolving. Every day, there’s new information. Being unsure is not a position any doctor likes to be in,” Dr Divakar says.
Managing facilities amid staff shortages and creating the right conditions for patients to make a hospital trek take up a large part of the day. “We have to screen everyone. Missing an ailing person, whether they are entering or leaving the premises, is not an option. Many patients don’t want to use public transport or cabs, so we have to arrange transport to get them here,” Dr Divakar says. “Retraining staff and making them confident is so important because they are the first point of contact. They must constantly remind everyone to follow distancing and wear a mask. It’s tough as people don’t always understand. For instance, childbirth is a joyous moment and relatives naturally want to see the baby at the hospital and celebrate. This is not advisable right now.”
Many hospitals are under a strain even as they support government efforts. “People expect the medical fraternity to be kind and compassionate, and waive charges. We don’t consider our work as a business, but there are realities: we need to pay the staff, we need to pay for the consumables. No one is giving us things for free,” she says.
Dr Murthy and Dr Divakar highlighted the challenging situation of veteran doctors, who are advised to stay off active hospital work as their age or pre-existing health condition puts them at a risk. “There’s been a general advisory for some time now that doctors aged above 60 should get into digital consultations and let juniors take over at the hospital. But senior doctors are not particularly comfortable with e-consultations and junior doctors lack the expertise to attend to patients. There’s a disconnect between what’s expected and what can be done on ground,” says Dr Divakar. “In many places, senior doctors are the only help available, so they continue to work despite the risks.”
According to Dr Murthy, experienced medical professionals who cannot help people in a healthcare setting right now are in anguish. “It’s hard to suddenly stop doing the work you have known for years. Patient contact is a very important aspect of the work, and doctors are solely missing being able to help patients,” she says.
Dr Radha S Murthy, co-founder and managing trustee of the Nightingales Medical Trust, which focuses on eldercare, welfare and dementia, says providing regular mental support to patients is crucial now. “Most of my patients are elders, who are prone to multiple health issues. Covid has forced them into extreme confinement, and this has affected them physically and emotionally. As a doctor who pioneered home medical care in 1996, I am in touch with many elderly patients; every day, I attend several calls. More than medicines, aged patients need interactions, eye-to-eye contact and empathy,” she says.
Despite risks to her health — a new reality for all medical professionals — she personally sees patients. “I could have managed them over the phone, but knowing their psychology, I decided to be in the field. Patients feel better this way and their caregivers, who toil 24/7, are motivated. Though telemedicine is promoted widely, it cannot be the ultimate solution to the health concerns of elders” she says. “We have developed new systems, made modifications to infrastructure and constituted a core group to monitor the situation (at our centres).”
She is actively involved in the care of more than 140 people with dementia and 55 elderly destitute women. “In our setups, physical distancing and making patients wear masks won’t always won’t work as dementia patients need physical help for all their daily activities. It’s a huge challenge to take care of them during a pandemic. With strict safety protocols, we have kept Covid at bay from our residential care centres,” she says.
Dr Niti Raizada, director of medical oncology and hemato-oncology and transplant physician at Fortis Hospital, Bannerghatta Road, notes Covid-19 has complicated the straightforward dimension of treatment. “In cancer care, regularity of treatment is critical. The pandemic has disrupted this frequency. Since March, people have been avoiding hospitals. It takes time to persuade them and explain that medical attention is high priority. When they finally come in, they are very sick and in severe pain,” she says. “Suppose, a diagnosis was made in February and you visit the doctor again only in September. You have allowed a lot of time for things to go wrong.”
To read the whole article, click on the link below:
https://health.economictimes.indiatimes.com/news/industry/medical-care-requires-personal-touch-distance-is-testing-doctors/78099374
5th March, 2021
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