Intensive care units (ICU) cater to patients with severe and life-threatening illnesses and injuries, which require constant, close monitoring and support from specialist, equipment and medications in order to ensure normal bodily functions.
Critical care practices in India have evolved significantly over the past decade. Critical care initially began as a service in major hospitals, but with the formation of the Indian Society of Critical Care Medicine, the development of this specialty has been very rapid.
Regular conferences, updates, continuing medical education programmes and workshops have emerged, and postdoctoral training programmes have been developed. Scientific publications have begun to appear and in spite of the diverse problems and standards, meaningful specialty-related activities have begun.
Factors to be considered when assessing suitability for admission to intensive care are-- for diagnosis, age, severity of illness, associated illness, outcome, anticipated quality of life if survived and patient’s wish. But in India ICU is like the railway service. like the Indian trains, most of the hospitals and ICUs all over India are overcrowded. There are different criteria for different people for admission to ICU. We will not go in to the different types of ICU in sophisticated hospitals.
In India most educated as well as uneducated persons think themselves to be expert in medical science and treatment. They take patients to hospitals when home remedy, quackery, ayurvedic, Baba, and other alternative medicine treatment fail. Those same people break hospital equipment, ambulance, beat up nurses and doctors when the doctor declares the patient as brought “dead”. Even politicians interfere in the treatment and force the doctors to admit dead patients to be kept in ICU till they bring their own physician or patient’s son arrives for ‘mukhagni’. Hospital business in India is the toughest one, that’s why most of the private hospital keep the politicians, Governors or even the CM happy by catering to their different needs and requests.
Most of us do not try to understand that these hospitals have hundreds and thousands of staff who are highly paid or else those trained staffs will go to another organization or abroad for higher salary. Gone are the days and idea of serving the human race with dedicated free service, but it’s the money which comes first.
Where from the hospital authority will generate moneyIJ They have to pay electricity bills at commercial ratesIJ Their resources are the patients and investigations. An MRI machine costs Rs 5-Rs 10 crores, one hospital bed costs a few lakhs, plus the interests and maintenance costsIJ On the one hand, the public expect the latest and best level of treatment to their patients, but not willing to bear the expenseIJ
There is a mindset of the Indian public that hospital treatment should be freeIJ Things have changed of late due to public awareness and insurance policy. Once the hospital authority knows that the patient has a medi-claim plus his or her son stays in USA or Dubai, then its celebration time for the billing section of the hospital.
Neither the patient party nor the treating doctor consider the age factor and associated disease condition for the treatment of a patient in ICU.A 80years terminally ill cancer patient or road accident victim who has no chance of recovery or a fruitful life has no right to live, hence prolonging the life with ventilators and dialysis carries no meaning! Where as a young patient of snake bite or cerebral malaria once recovers with ICU care becomes a normal person and continues to live and earn for the family. There are international criteria for admission to ICU and how long to treat but all these rules, regulations and commonsense in medicines are not followed but weighed against money.
There are communication gaps between the treating doctor and patient party, false hope and unnecessary interventions and use of very costly medicines which result in conflict between the patient party and the authority leading to law and order problems. The poor people sell their lands, house, ornaments, cows and buffaloes to pay the hospital bill. They lose their tolerance capacity, patience once they are told the patient is no more! The doctor seldom tells that a kidney transplant may fail after a few days or a few weeks or a few months and to save the transplanted kidney, the patient has to spend twenty to thirty thousand rupees every month! Similarly the stents cost a fortune but it does not prevent heart attacks. Changing of frequent antibiotics has resulted in development of super bugs in Indian ICUs.
During last three decades, there has been tremendous development in different technologies; medical science and ICU care. We must remember that technology kills more people than it saves. Most of the critical care units are occupied with road traffic accident victims and geriatrics few survive due to intensive traumata care units but majority expire after a few days or a few weeks due to hospital acquired infections or complications of treatment. The author of this article had experience of working in five different ICU units of different hospitals of India including burn centers. The truth of the matter is, critical care medicine has made rapid progress and has saved many valuables lives; there is no questions regarding that, but it has caused more curse and agony to the relatives of the patients.
Instead of the patient dying in hours or days, these critically ill patients survive for a few weeks to months due to ventilators, pacemakers, dialysis and cardiac support but ultimately die. For example, we know a high percent burn case will die ultimately but keep it alive due to modern technology and intensive burn centers.
Everyone is more concerned about treatment aspect of a road accident victim; new trauma centers are inaugurated by politicians and governors but we fail to understand that due to wrong planning, fast vehicles and disrespect to safety measures, a huge numbers of young people are dying on the Indian roads. Preventive medicine has taken a backseat where as intensive care has made tremendous progress. With scarcity of doctors, nurses and paramedical staff, hard days lie ahead because without adequate manpower inside intensive care centers, no one can provide quality care to their patients. Equipment do not make a hospital famous but it’s the people working inside the hospital and their attitude to life.
(Dr Satpathy is an ex-Joint Director, SAIl. Intensivist, IGH and Ayush Hospital, Bhubaneswar)