Dr. Prakash Budhathoky

There is no denying the fact that COVID-19 has adversely affected every sector - be it education, health or business. Still today, lockdowns are in place in various parts of the world. Based on the gravity of the situation, different countries have adopted their own measures in response to this pandemic.

While majority of people are inside their home in these testing times, some professionals have always remained at the forefront. The nature of their work and the demand of the situation have not allowed them to have a single-day break, let alone the indefinite period of forceful holiday. Putting their lives in peril, the medical doctors, nurses and lab technicians have been providing relentless services to the people. Amid limited resources, their persistent efforts need to be greatly acknowledged. However, the public responses to their services have appeared humiliating, further undermining their praiseworthy contributions.

Heroic services
Healthcare workers in many countries have been praised as the heroes for their vital contributions to dealing with COVID-19 as well as other health problems at a time when the deadly virus has gripped the whole world. However, there are some individuals and groups who have started stigmatising such frontline workers despite their relentless services to the coronavirus patients. Instead of receiving high regard from the general public, the healthcare workers are being mistreated across the world. Such cases are particularly emerging in the urban areas where majority of people are expected to be well-educated and aware of the situation. This indicates that the frontline workers in various fields have been working in a state of dilemma.

However, the government has warned of taking stern action against those found involved in harassing doctors and other health workers. The government must come up with the policy of zero tolerance against violence and stigmatisation against the health workers as we cannot conquer the battle against COVID-19 without their active involvement in it.
We all know that there are four types of patients and they need to be handled differently. The first ones are ignorant patients who have 100 per cent faith in the doctors and go by their decisions. Second are informed patients with some science background. They are aware of illness and wellness and need proper counselling. Third are empowered, Google-friendly patients who would not only like to be counselled but also want to be a part of shared decision-making and the fourth category includes the most important and the enlightened patients who believe in taking multiple opinions both nationally and internationally and believe more in Google than on an individual opinion.

All categories may get hurt if they lose their trust. Their expectations are also different. Most of the educated people today want a shared decision as they are educated and empowered. In medical practice, we also need to take lessons from the way advocates and judges practice. They don’t believe in spot decision or diagnosis even in emergent situations. They take time to listen to arguments, reserve the order and when in doubt, often take a joint decision by a number of judges sitting together. When a patient comes to us, he has not come to us for a life he has lived but for advice for a life which is yet to be lived. Therefore, we should plan a wellness plan for him to live rest of his life and not only concentrate on his present illness alone.

It has taught us that there are two states of mind - sympathetic and parasympathetic. Every patient is in a state of acute stress or a sympathetic state of mind and needs both treatment and counselling at the same time. We also must understand them from principles of Bhagavad Gita that a person in acute confusion like Arjuna will require multiple sessions of counselling, like 18 such sessions between Arjuna and Krishna.
Doctors are considered next to God and therefore they have no right to be in a sympathetic state of mind while treating a patient. They need to relearn staying in parasympathetic state of mind. The two main components of parasympathetic state are beneficence and non-maleficence. Two sympathetic states of mind interacting with each other will only end up in a disaster. Sympathetic state of anger or ego lasts only for 10 seconds and is hence, manageable and preventable.

Trust deficit
It is necessary to discuss on trust deficit in today’s patient-doctor relationship. Over 20 million people are seen by doctors daily. Incidents of major violence occurring once or twice in a year do not amount to calling mistrust against medical profession as a widely prevalent issue. Always, what the patients expect is ALERT (acknowledgement, listen to them, explain to them, review what they have understood, and thank them). So, it is imperative to address them to minimise violence in medical sector. On one hand, there is a need to have a strict anti-violence law within the purview of Act and on the other hand, we also need changes in the way patient-doctor relationship is thought of today.

We are on the eve of big festival-Dashain-and the frontline health workers are serving the patients round the clock but in the absence of special incentives, they have felt demotivated day by day. This sort of situation does not help combat COVID-19 effectively. What will happen if doctors and nurses start giving up their duties owing to a poor job satisfaction? Hence, it is really urgent to introduce a handsome package to improve their social, mental and economic wellbeing.

(Dr. Budhathoky is a Central Treasurer Of Central Nepal Medical Association. drprakashbt@gmail.com)