Would I do the same?

A lot of the details have been omitted or changed to the best of my ability to protect the doctor whose clinic I saw this in.  

It was my first day in clinic, I was just trying to figure out the ropes of not just LIC but also outpatient care. Here I was, seeing vastly different patients than I had seen the week before, understanding a completely different kind of care. Not the one where you treat acute strokes and then let the physiotherapist, occupational therapist, and rehab deal with the rest. Here one was going through the grit of the community issues, trying to mediate not only diagnosis and treatment but management and multiple psycho-socio-economical issues.

My doctor, Dr. M was trying to drill into me that in this setting, it's not about trying to figure out what’s wrong with the patient. There aren’t enough resources for that. Here you balance the competing principles of autonomy, beneficence, and non-maleficence while trying to administer care.

A patient in a wheelchair, Mr. F, was present in front of us talking to Dr. M in mandarin making it difficult for me to understand the conversation. He was unkempt and had come in alone. His wheelchair was surrounded by plastic bags. In one of the plastic bags, I observed large amounts of tissue packets- he was a tissue packet seller it seemed. He was talking to Dr. M in a very friendly manner, perhaps he was a regular patient of Dr. M’s. As their conversation was coming to a close, I saw Mr. F asking something from Dr. M in a very bashful manner. The atmosphere suddenly felt different, Mr. F seemed to have asked something out of the ordinary. Immediately, Dr. M asked her clinic assistants to go find the expired medications in a hushed tone. There was a sudden increase in the amount of noise as everyone tried to find ‘the expired medication’ as quickly as possible; as if trying to shorten the time

After the episode, Dr. M reflected to me the dire economic situation Mr. F was in and how his expensive his medical treatment was. To offset some of these costs, Mr. F illegally sold recently expired Viagra that he got from Dr. M. This has been helping Mr. F survive for years since his double leg amputations and other surgeries. He doesn’t have the support of any family. Dr. M chose to help Mr. F in this case, albeit illegally because it helps Mr. F survive and have a good quality of life. Dr. M and I were unable to discuss the ethical implications of this case as she had to quickly move on to the next patient.

As I continue to reflect on this episode, I’m conflicted on where I stand. I didn’t bring up the case to Dr. M again that afternoon out of fear of my inexperience. Perhaps I didn’t understand what it was like to be working for 30+ years and having established deep connections with patients. From the mannerisms of the clinic assistants and Dr. M- the hushed tones and the secretive manner in which the medications were given- it seemed to me they knew that giving a patient expired medication to sell illegally is ‘wrong’. However, the benefit to Mr. F’s life also seemed clear- giving him a better quality of life, allowing him to sustain not only his livelihood but also his medical expenses. Something that I think about and I hope Dr. M has considered is how Mr. F selling Viagra illegally affects the community around him. For instance, Mr. F probably doesn’t tell the correct doses or side-effects to those he is selling to; neither would he be there for them in-case they overdose. Perhaps this Viagra is having negative consequences on the families of those buying it and Dr. M doesn’t know. The other significant question I ask myself is, would I do the same if I were in Dr. M’s situation and knew the significant benefit to Mr. F’s life but did not know what consequences there are to the community that Mr. F is selling to. The answer is, I’m not sure. At this point of time, still undergoing ethics training, without the many years of practice behind me, I probably would not. However, perhaps there are times that a doctor puts the patient’s autonomy and beneficence above all, as Dr. M did in this case.

This is a  Public reflection which is publicly available for anyone to read.

Created on 24 October 2017 by Aadya Deshpande