Kalyanpur is a somewhat isolated headquarter of a block in a tribal district. Kalyanpur Primary Health Centre (PHC) has lots of vacancies and only one MBBS Doctor Kuldeep Goyal manages with a few core staff all the affairs of the PHC. About a year ago, the Pradhan of the Kalyanpur village had approached Dr. Goyal to issue a medical certificate for somebody who Dr. Goyal knew was not at all sick. So he had declined the request. Around same time, Dr. Goyal was planning to build his residential house in the same village. When the matter came up to the village panchayat for issuing a building permission for Dr. Goyal’s plan, the panchayat adopted dilatory tactics in the sense that the panchayat neither gave the permission nor rejected the plan. Dr. Goyal had approached him twice requesting a decision yet there was no movement.
A few days ago in the early morning hours when only a cleaner, the staff nurse and Dr. Goyal were present in the PHC, the nurse received a call that the Pradhan’s son and one of his friends had met with a car accident and that they were being brought to the PHC by the Pradhan and other local people. The nurse reported this call to Dr. Goyal.
On hearing this news, Dr. Goyal thinks of the following responses : Which of those responses is appropriate?
1. Tellthe nursethat whenthepatients arriveshemaygivethemprimarytreatment andinform the Pradhan that the doctor is unwell and may come late. And then he should leave the PHC through thebackdoor.
2. Since almost everyone carries mobile phones these days, he should tell the nurse to make a phone call to callers that as the PHC lacks critical medicines and equipment, they should remove the victims elsewhere.
3. Forget the bad treatment he received from the Pradhan and give the best possible medical attention to the accident victims.
4. Inform the Pradhan that because of the way he handled the house building application, he would find it psychologically difficult to attend to his son and that he should take him elsewhere.
The correct course is fairly obvious. The first course is wrong because it would deprive the victims of the best possible treatment to which they are entitled. The main motive here is to teach the family of the Pradhan a lesson because the latter had not treated Dr. Goyal’s legitimate request for building permission with fairness and had been unnecessarily obstructive. The Pradhan failed in his duties because Dr. Goyal did not agree to issue a false medical certificate. If the building plan had any deficiency, the Pradhan was duty bound to inform the applicant, and he had no business to sit over the application. Conduct of the Pradhan was definitely improper but Dr. Goyal should not imitate it. If the victims are serious, Dr.Goyal’s action will endanger their life.
The second alternative is also a way of avoiding a doctor’s primary duty. In this alternative, the doctor is instructing the nurse to tell a lie and divert the patients to another clinic.
Thethird alternative is theright course of action.Everypublicservant has to discharge hisduties faithfully. He should not shirk his duty even towards those who may have wronged him in some way. This consideration applies with additional force in this situation since Dr. Goyal is bound by the Hippocratic Oath which governs all doctors. They have to do their best to help the patients, and should never harm them. He should not link his duty as a physician with other issues. He should not harm Pradhan’s son for the wrong of his father.
The fourthalternativeis alsoinappropriate. A doctorshouldnot bringin issuesof his psychological attitudes in these matters. He cannot choose patients based on his subjective feelings. He should treat all the patientsirrespective of his attitude towardsthem.