Rare drug reaction puts doctor-patient rapport in spotlight

CHENNAI: Doctors from different departments of the Government General Hospital (GH) have been attending on R Gunasundari for the last two days at the intensive care unit. A week ago, she had visited a doctor with complaints of cold, cough, sore throat and fever, which was then diagnosed as viral fever. The simple drug regimen including paracetamol and a painkiller, pushed her to a life-threatening condition called Stevens Johnson Syndrome where the rapid death of skin cells lead to the separation of the outer layer of the skin, epidermis, from the inner layer, dermis.
While her husband has filed a complaint of medical negligence, the episode has put the spotlight on the doctor-patient relationship. Did the doctor spend enough time with the patient to ensure that she is not allergic to any kind of drugs? Did the patient have enough trust in the doctor to go back and report the allergy immediately? There may not be clear answers yet, but everyone agrees that doctors and patients should share a better rapport.
"Doctors should allow patients to call them anytime in case of an emergency," says Dr George Thomas, editor, Indian Journal of Medical Ethics. But what shocked a senior doctor in the government hospital were the prescriptions. "I realise that most of the time we are in a hurry to send the patient away. We write the drugs but fail to mention complaints and diagnosis. This makes it difficult for the next doctor," says a senior doctor.
Several doctors agree that the consultation time per patient has come down. Says 94-year-old urologist Dr A Venugopal: "I spend at least 30 minutes with a patient. I examine them, listen to them, then explain to them and again take questions and clarifications." That is a rarity today, as patients line up by scores at clinics and hospitals. "It is impossible to spend so much time with a patient today," says TN Ravishankar, honorary secretary of Indian Medical Association state unit. "We see at least 60 patients a day. Patient's don't get anything more than 90 seconds to say their complaints. On most occassions they are out of the consulting room in ten minutes," he says.
The trust factor has also suffered blows. Gunasundari's husband AR Ramanath, a tailor residing in Pazhavanthagal, had lodged a complaint with the suburban police citing medical negligence by a doctor in Nanganallur who presribed five medicines to her. Though GH doctors suspect the paracetamol- ibuprofen combination to have cause the allergic reaction, there is no confirmation yet. The doctor who attended on Gunasundari said she would have immediately stopped the medicines had the patient come back to her. "I was hurt when I saw the visual of my patient on the TV in a bad situation. I called the patient and inquired but by then she was in GH," the doctor says. Ramanath said they returned the hospital three days later and the duty doctor prescribed new drugs. The same day, the patient was given injection at the Government Royappettah hospital and rushed to the GH on August 6 with severe complications. So why, did doctors not suspect a serious allergy earlier.
Senior family consultant Dr KV Thiruvengadam says it's not easy. "Stevens Johnson Syndrome usually begins with fever, sore throat and it's difficult suspect drug allergies" he says.
The Suburban police are confused. "We need an expert view from the Medical Council of India on whether there was any negligence," says Manohar Sundar Das, assistant commissioner, Mount range. Gunasundari, doctors say, is off drugs now. "We are replacing body fluids and giving her symptomatic treatment for specific complaints," says Dr C Rajendran, director, internal medicine. "She is stable, but is at a risk of contracting bacterial infections as the protective layer of her skin has peeled off," he says.