"Dear Minister Choube, Don't Ask Doctors to Deny Treatment to Sections of Patients Please, It is Illegal, Immoral"

NEW DELHI: Editor's Note: “"I have asked the director of AIIMs that patients who can be treated in Patna AIIMS should be referred there immediately," the minister said at a function recently. "There is no need to increase the crowds here... you know how patients flock here..." So said junior Minister for Health Ashwini Choube recently,triggering a controversy with his suggestion that patients from Bihar should stay in Bihar. Choube is a legislator from Bihar's Buxar and his remark have raised a storm of protest in his home state.But also from a conscientious doctor in Delhi’s All India Institute of Medical Sciences who has questioned this stipulation in an open letter to Choube published below:

Dear Sir,

I am a doctor, working at AIIMS, New Delhi, for the last 14 years and have been treating all kinds of patients. By all kinds, I literally mean all patients, irrespective of region, caste, religion, gender, social status and even nationality. My specialisation has meant treating patients from Nepal, Bhutan, Bangladesh, Iran, Dubai, Mongolia, Sri Lanka, Pakistan, Nigeria, Iraq, Afghanistan… the list is endless.

I was so bewildered to read and see your recent comments on patients from Bihar that I thought of writing to you. There are certain facts that need to be clarified. Since you took charge as the minister of state for health recently, it is important that someone apprise you of the some facts. The following are also important from a legal point of view:

As doctors, we cannot (and should not) refuse treatment to any patient based on their region, caste, creed, religion, gender, social status and nationality. It is not only morally incorrect but actually illegal to do this. So please do not advice doctors from AIIMS, or for that matter any doctor in the country serving under your government, to withdraw treatment to a section of patients. The doctors are morally and legally correct in ignoring your ‘advice’.

AIIMS is the apex referral institute that was formed as part of a visionary thought process by the then policymakers of the country. Being a tertiary institute, it is reasonable if patients from distant states flock to the institute. I agree that at times, there is a loss of gate-keeping in referral practices but then that is not a fault of the patient and they should not be punished for this.

Let me tell you that coming to the AIIMS out patient department on a working day, getting yourself registered by standing in long queues and then waiting to be seen by a specialist is no easy task. Your premise that Biharis come to AIIMS for even trivial diseases raises some doubts. I would not waste a day, surrounded by the dying and the diseased, just to be seen for something that could have been treated back home in my hometown. And even if we believe that the diseases for which Biharis come to AIIMS are trivial, the patient’s perception is all that matters.

It is the patient’s right to determine how unwell they feel, unless told otherwise. Perception is a matter of behaviour and I do hope that you do not intend to change patient behaviour? If you do, then please don’t, sir. It can be counterproductive in more ways than one.

The problem of overcrowding at AIIMS is not a problem caused by Biharis or even by UPites, Rajasthanis or Chattisgarhis. It is a problem created by the poor infrastructure of healthcare in the country. And who will know this better than you, sir? The serial publications of data on various conditions by your own ministry is a grim reminder of this.

The recent data revealed by the Global Burden of Disease Study in The Lancet (which is an important medical journal, sir), should be heartbreaking for all nationalist Indians. I am sure you are aware of that?

So in a country with poor health infrastructure, and a shortage of doctors, hospitals and other medical modalities, if there are medical setups that are delivering, patients should not be denied entry due to overcrowding. The poor are reasonably intelligent, they flock to places they trust. Please let them continue to do so.

Finally, sir, a 14-year-old patient of mine who has widespread bone cancer and probably will not be alive to see this winter, visited me yesterday. He is from Bihar. Despite such a serious illness, he hasn’t lost his liveliness. Yesterday, in light of your statement, he wanted to know if I’ll continue to see patients from Bihar. I asked him to come and see me next week. He kissed my hands with his parched, paper thin lips.

Sorry, sir, I couldn’t obey your orders. He had immense hope in his eyes.

I hope you will understand my dilemma and excuse me.

(Shah Alam Khan is a professor in the Department of Orthopaedics at AIIMS, New Delhi. Views are personal.)