The nitty-gritty of patient referral

THE clamour for reducing the patient load at the PGI and the Government Medical College and Hospital (GMCH), Chandigarh, keeps getting louder. There is merit in this suggestion since the burgeoning number of patients puts the available facilities under strain. Healthcare administrators lament the impression that doctors serving in neighbouring areas are quick to refer patients to Chandigarh.

I have been on both sides of the fence. I initially worked in a hospital on the periphery of the city and later joined the PGI. While serving in a district hospital, I did overhear a pernicious advice, “If by late evening an admitted patient looks better, send him home; if not, then send him to Chandigarh”. The premise was to refer the patient and be free of all responsibility. Fortunately, most doctors would not buy that argument.

Later, while working in the GMCH, I was once posted in the surgery Emergency at night. The whole reception area was full of patients and their attendants. Since all the beds were occupied, we had to treat some patients on makeshift beds or trolleys.

Around midnight, the languid pace of activity was suddenly intensified by the arrival of about 25 patients from a peripheral hospital. A quick enquiry revealed that they were passengers of a bus that had overturned. They had received first aid before being referred to the GMCH. Many had blood-soaked bandages and some were critically injured. Though already overwhelmed, we began to treat them as per the established surgical protocols. Those who required lifesaving interventions were accorded priority. In about two hours, with the zealous support of the staff, we were able to finish our task.

Later, while surveying the Emergency area again, I realised that I had failed to attend to two of the patients. They were sitting on a patient trolley, but did not seem to be injured. They were conversing with each other while looking nervously at me. Probably they had heard me shouting instructions and going from one trolley to another.

I asked them, “Were both of you on the bus which met with an accident?” I could barely hide my unease at having missed seeing them. After a bit of hesitation, they whispered, “Sir, we were admitted to that hospital for some other ailment. When all these trauma patients were being referred, we were also told to go to Chandigarh. Honestly, sir, we do not have any injury”.

I felt relieved and satisfied to be at the ‘referred to’ hospital and not the ‘referring one’. I considered myself fortunate to have got an opportunity to serve the sick and even the ‘not so needy’.