During an emergency, choosing the right kind of treatment is most important
A middle aged patient once came to the emergency care at Apollo Hospitals, Chennai, complaining of swelling in leg muscles and severe pain.
He was eating in a restaurant when something bit him. He was very sure it was not a snake, just an insect, and he gone to a local hospital where they prescribed him an antihistamine that gave some relief.
But 16-18 hours after, his condition had not improved and he needed something more intense as the leg swelling had increased to the point where he was unable to move it.
Since he was so categorical about it not being a snake bite, the doctors observed that in the time the parameters were being checked and blood being tested, the patient had not produced urine at all, suggesting a kidney failure.
This suggested the possibility of rhabdomyolysis – muscle death - whose classic symptoms are muscle pain in the shoulders, thighs, or lower back; muscle weakness or trouble moving arms and legs; and dark red or brown urine or decreased urination.
His muscles were getting destroyed, a condition called necrotising fascitis. It was an unfortunate case of an insect bite leading to rhabdomyolysis.
“We recommended fasciotomy and immediate dialysis for the patient,” explains Dr. Dhavapalani Alagappan, Emergency Medicine, Apollo Hospitals, Chennai.
When due to tension or pressure, blood circulation to a particular tissue or muscle is cut off, fasciotomy is performed to cut the fascia to relieve the pressure.
A limb-saving procedure, it is used to treat acute compartment syndrome.
However, the cost seemed formidable to the patient’s relatives, who had now gathered to be with the patient. Much discussion ensued and the family decided that he would be shifted to another small nursing home.
“Though I gave a detailed discharge summary despite the patient being here for under an hour, the patient apparently did not survive after being in another hospital for two days,” Dr Dhavapalani adds regretfully.
Around 80% of the healthcare expenses in India is paid out-of-pocket, and is beyond the capacity of a significant number of Indian households.
Nearly 20% of the urban and 28% of the rural households do not opt for purchasing healthcare services due to financial constraints. And of those who do, find themselves slipping below the poverty line.
A National Sample Survey Office health survey of 2013-14 reveals that 36 million households incurred health expenses that exceeded the annual per capita consumption of those households.
Nearly 3.1 million fell below poverty line as a result of this.
Therefore, the decision of the patient and his family to opt for an alternative, low-cost option is understandable. Sadly, he was neither the first nor the only case, and nor will he be the last.
Sometimes, once the patient is out of danger, they prefer to shift to other hospitals for the period of recuperation for the same reason.
Emergency care is all about life and death. While some emergency situations may seem like a false scare, many times, lives can be saved if the patient is taken to the right place.
Emergency care is a specialised field and requires trained doctors specifically in emergency medicine. It must have the right kind of equipment for diagnostics and treatment, as well as access to specialists who can give the right treatment at the right time.
Therefore, the nearest multi-specialty hospital, or a specialised clinic – cardiac in the case of heart-related emergencies, orthopaedic for trauma, and so on – may prove more beneficial than a small clinic not equipped to deal with such situations.
But not just the poor, cost can be a factor even among the more affluent who sometimes are wary of the cost of hospitalisation. “Considering 70-80% of healthcare is provided by private hospitals, the cost cannot be wished away,” points out Dr Dhavapalani.
Emergency comes unannounced and a doctor has to be available at all times. “It is not a 9 to 5 job where the doctor is not available at night or on holidays,” he points out. “When a patient comes to the emergency, our concern is only to save him or her and not assess their capacity to pay,” he points out.
He also adds a rider to the problem, reminding us, “It would be a sad day if the costs factor in big and the patient is given treatment to suit his pocket rather than what is needed. The patient is unlikely to get the optimal treatment.”
Life is priceless and precious. The need for more emergency care facilities across the country to cater to the exploding population as well as those living away from urban centres cannot be over-emphasised.
But for those within reach of such facilities, there should be no second thoughts.