DOCTORS ARE AT A CROSSROAD TODAY

Doctors are putting everything on the line. They're walking into a wildfire of a pandemic, often facing hostile or depressed patients and anxious and agitated relatives with professional calm and dexterity. That takes a monumental amount of courage and deserves profound respect. I and my tribe are there as reserves because we have been told that ‘they also help who stand and wait’.

“Am I doing the right thing?” This is a question which I have been asking myself time and time again in the last two weeks. I am a Plastic Surgeon and so barring occasions like trauma and vascular injury my job is considered “non-essential”, and as per the instructions of the government all non-essential surgical services should be postponed till the time we are sure we have seen the end of this prevailing COVID19 pandemic. And it is from this decision of choosing what is essential and what is a non-essential, stems out my moral dilemma.

Why is the breast lump which I saw the other day and diagnosed as a early breast cancer in a 35 year old mother of two not essential? Am I morally correct in postponing her surgery? Why is the surgery of 18 month old child with Cleft Palate non essential when I know that if I postpone her surgery she may never get a normal speech all her life? So you can appreciate how thin and barely indistinguishable this line between essential and non-essential is……..and still I and many other doctors are searching for it all the time.

Doctors routinely are finding it difficult to provide the kind of care they know their patients need. If we choose not to see patients during the lockdown we are cowards and if we do see them despite all odds then we are greedy and irresponsible. And God forbid, if one of our patients turns out to be COVID positive and we are picked up on contact tracing, then we are considered criminally negligent!

We have a deeply held moral belief of putting our patients first. It truly has very little to do with the oath we took and much more to do with the holy ambers of professionalism in which we were tempered. In the midst of the COVID-19 pandemic, the same belief has morphed and magnified, joined by new threats that come with severely constrained resources. It will be more critical than ever for administrators and clinicians to work together during this time to assess resources, to manage those that are limited, and to face the profound risks attendant in this rapidly evolving environment. COVID patients are a priority no doubt, but all non-COVID patients cannot afford to wait. This is time to show leadership. It is time to find a way. Failure to work together may leave a generation of clinicians doubting and distrustful of the moral fabric of our healthcare system and its leadership.

At no stage am I suggesting that all elective surgeries should be thrown open. Doctors in the U.S. watched, fearing that a tsunami of patients would overwhelm their healthcare systems, preventing them from adequately caring for the ill or managing their own substantial risk. Despite clear evidence of a pathogenic wildfire tearing through China and Italy, consuming personal protective equipment (PPE) at unprecedented rates, many US hospitals continued to perform elective procedures—burning through PPE that would soon be critical to protect healthcare workers—for weeks after the first alarms sounded. And today they are repenting their decision. Only a few weeks into the US spread, but fully 4 months after the disease appeared in China, the dire straits of many US hospitals, and their failure to adequately prepare, is becoming clear.

We don’t want to see hospitals in India run out, of masks, face shields, and respirators. This represents an untenable situation for doctors. Patients will be in desperate need of doctors and doctors will face unacceptably high risk to care for them. Both corporate hospitals and small and medium size hospitals know that elective surgeries are the cornerstone of our hospital system's operating model—and the negative impact due to the cancellations of these procedures cannot be overstated. With elective procedures and all nonessential patient visits canceled indefinitely, many hospitals are probably worried whether their systems would survive the pandemic.

Hospitals are not simply places of treatment; they are also avenues of employment for many. A hospital with its doors shut is like a dilapidated temple abandoned by both God and His/Her worshippers. The self employed doctors, who usually own these hospitals, have to pay all the bills, all the salaries, all the bank loan installments but keep their hospitals closed! While there are no avenues of earning, their expenditure has only marginally come down. Prolong lockdown can result in loss of jobs because most of these hospitals run on narrow margins of profit. Again they confront another dilemma whom to retain and whom to let go? Technical excellence, position in the scale of usefulness and personal preferences will be called into play to make these ugly choices, further difficult.

Protecting the workforce is vital. Skilled, experienced professionals and support staff are the most valuable asset that any institution possesses. Losing them to COVID-19, whether for the short term or the long term—through death or disillusionment—will take a terrible toll. Doing whatever it takes to keep them safe must be a priority.

So both as a clinician and as an employer a doctor today standing at a crucial crossroad. His/her loyalty to the nation keeps him/her home but the physician in him knows that all the surgeries he is postponing is not non-essential, and deep in his heart he is a worried man. Add to this the prospect of economic decline and if the lockdown continues then even losing his trusted skilled helping hands. Today we are a worried bunch of doctors.