Between a doctor and a patient

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Atanu Biswas

A doctor in the 4th century BC was facing a tribunal in ancient Athens. The allegations against the doctor were quite serious, of illegal and abusive relationships with the women of Athens while treating them.
To prove innocence, the young doctor undressed in the courtroom and proved that she was, in fact, a woman, carrying out the treatments in the disguise of a man. She was Agnodice, perhaps the first female physician in history. However, doctors had to face trials for molestation of patients even in that ancient era.
Far away from Athens, another legendary physician, about 2 millennia senior to Agnodice, treated a female patient in the ancient city of Saket (old name of Ayodhya).
The physician, the patient, her family or Indian society – no one had any problem with it. It might be interesting to know what kind of precaution the physician Jivaka would have taken had Section 354 or Section 376 (2) (b) of IPC regarding sexual harassment been prevalent at that time. By these sections, a doctor might face a charge of harassment or worse only on the basis of a complaint of a female patient.
In September 2016, Kolkata was disturbed by news of a senior and leading city pulmonologist being arrested on a complaint of molesting a female patient. Around the same time, a doctor in an Ahmedabad hospital was arrested for allegedly raping a patient with dengue fever in the secluded intensive care unit.
A resident doctor at the Nanavati Hospital in Mumbai was arrested in December 2016 on the charge of sexually assaulting a patient in the intensive care unit 6 months earlier. We cannot comment on the merit of any sub-judice case.
However, here we try to look at the picture from a larger social perspective. In all these cases there is a conflict between ethics and security.
Even before Jesus was born, in ancient Greece, midwives gradually began to lose credibility during delivery. Since the era of Hippocrates male doctors developed expertise in gynecology.
Female midwives slowly disappeared, but it was never easy to seek help from male doctors during childbirth, and the consequences were destructive for society. In the meantime, female physicians like Agnodice appeared on the scene.
But, even today about 70% of American doctors are male, and that percentage is nearly 80 for India. So, overall there is no way to avoid male doctors for female patients in today’s world.
Unlike Agnodice, all accused doctors are invariably not innocent. Drs. George Reardon, John Schneeberger and many others have been sentenced by courts. The recent controversy involving Larry Nassar, the former American gymnastics national team osteopathic physician, is also shocking.
Hundreds of lawsuits were filed by athletes for being sexually abused under the pretence of providing medical treatment. Even Simone Biles issued a public statement. On the other side of the coin, the charge against Dr. Angus Thompson in the UK has been proved false.
There are examples of such molestation charges framed against numerous doctors in different corners of the country, be it the case in Gujarat in 2015, the case at a Puducherry hospital in July 2016, the case of a private clinic at Anjana Nagar in Bengaluru in January 2018, or the molestation charge in a private hospital of Delhi in February 2018. Here lies the scope of care for society.
In the early 19th century in India, male physicians got the right to treat female patients in the presence of chaperones. These women used to give emotional support to patients and assured them safety and security during embarrassing or uncomfortable situations.
A chaperone is usually a married or older woman, who for the sake of propriety, accompanies a young unmarried woman in public. The role of a chaperone present in the chamber of a doctor is basically that of a neutral witness who will be able to protect both the patient and the doctor from any possible embarrassment.
Can we create an environment where there will be no possibility of complaints under Section 354? This is about security and dignity for both the patient and the physician. Certainly, CCTV is not the solution. Note that a chaperone is a must in Singapore when a male doctor examines a female patient.
In a mixed society like Malaysia, a chaperone is compulsory irrespective of the patient’s gender or age. It is clear that a relative or friend of a patient cannot be a reliable chaperone. First, they may not be able to appreciate the necessity of every kind of check-up by a doctor for the patient.
Again, they may, if necessary, testify against the doctor. Moreover, the privacy of the patient may not always be protected in front of relatives and friends. In a similar fashion, a relative of the doctor like his wife or daughter cannot be a chaperone.
Hong Kong’s rules recommend the presence of a chaperone for sensitive physical tests. Even if the patient does not wish this, that request should also be recorded. American Medical Association has similar guidelines, from the point of view of morality and safety. In reality, the rules may not be followed always, for lack of staff or discomfort of the patient.
Chaperones can be appointed in public and private hospitals in a country like India too. On the one hand, it may generate huge employment. I have no idea about the amount of extra cost to be incurred in the Government hospitals.
Patients will definitely be charged by private hospitals, and it will become an additional burden. But, what will happen in the hundreds of thousands of private chambers of physicians nationwide? How can neutral chaperones be available there? The only solution may be the joint presence of a relative of the patient and also a person appointed by the doctor.
The problem however, doesn’t end with doctors; what about pathological examinations? With the evolution of society, new problems are being created, which Jivaka or Sushruta could not even imagine. However, societies find solutions in their own way. In between there lies a transitional period.
Our medical system comprises doctors, patients, public and private hospitals, nursing homes, some illegal mediators, an inadequate and occasionally amateur insurance system and some mismanagement. .
The equilibrium gets disturbed when some doctors are accused and arrested under Section 354, and subsequently sentenced or acquitted. It is essential for society to find ways to reach an equilibrium with this delicate relationship.
The writer is Professor of Statistics, Indian Statistical Institute, Kolkata (Courtesy: TS)