The time is 8.55 pm. Five patients stretched on trolleys are rushed in, one after the other, into the main hall. As a doctor moves to examine the first patient, attendants of the others start asking him to pay attention their way too. Helpless, frustrated, the doctor folds his hands and asks them to “wait, please”. That can mean three hours.
We are in the emergency wing of the premier Post-Graduate Institute of Medical Education and Research (PGIMER) in the centrally-governed capital city of two states, Chandigarh.
With one doctor for up to 40 patients, such scenes are common here. At times, attendants lose their cool, and arguments, even fisticuffs, ensue with the resident doctors. In the past fortnight alone, there have been two incidents of attendants manhandling a resident doctor; and that led to a two-day strike by the doctors.
The PGI’s emergency outpatient department, or EMOPD, has at least 150 patients at a time, which is five times its one-time capacity. Going by the guidelines of Australasian College of Emergency Medicine, the area here is adequate only for around 29,000 patients a year. That is, 80 patients a day, and not necessarily all at one time. This is only the walk-in count, while there are those who are admitted after going through the EMOPD.
The number of doctors and new cases varies in the day and at night. “Every night, 45-50 new patients are brought to the Emergency, while there are around 100 patients already there at any time. On an average, one doctor looks after 35-40 cases during the night,” said a senior resident, not wishing to be named. At night, there are four doctors at the Emergency, of which two examine new patients and other two senior doctors carry out investigation on older patients.
“In the daytime, 60 new cases are reported on an average. There are eight doctors on duty, of which five examine patients and the rest work on sampling and reporting.” This brings the load to 30 per doctor.
“It takes a minimum of 20 minutes to examine a patient, and, in case the person is critical, the time can stretch to two hours too,” says a senior resident. In this “warzone-like scenario”, doctors can be seen even doing odd jobs like pushing trolleys, running to deliver samples, getting ultrasound tests done, fitting oxygen cylinders, et al.
“We cannot waste time and wait for other staff to do things for us, says a resident doctor, while fitting an oxygen cylinder. “The patient might die if I start waiting.”
While he is fitting the cylinder, another patient’s attendant comes to him and asks where to hand over samples. “Abhi tak sample nahi diya? (You haven’t done that yet?),” he asks the attendant; then takes the sample from him and rushes towards the testing facility.
PGI runs on the strength of its resident doctors, who remain on their toes more than 16 hours a day to save their patients’ lives. According to a study conducted by the School of Public health of PGIMER in 2014, the guidelines adopted by American Academy of Emergency Medicine say that one physician is required per 2.5 patients per hour and the nurse-patient ratio should not exceed 1:3. Yet, in the Emergency, 10-11 resident doctors and 12-14 nurses cater to a daily load of at least 150 patients.
Time to refer back
Such is the rush that at any time, around 100 patients are on trolleys in the waiting area, the open reception and the corridor of the Emergency. A senior resident said that nearly 90% of these patients can be referred back after diagnosis. “The ailments of these patients have been diagnosed and they have been put on the appropriate treatment. Now they can continue the treatment in any other hospital,” said the doctor.
“In case the administration starts the system of referring back patients, the entire problem of Emergency being overcrowded can be solved and doctors can give quality time to critically sick patients who actually need tertiary care treatment,” he added.
Such is the load that the study in 2014 by the School of Public Health for the Emergency revealed that, after their ailment is found, 30% patients under observation wait for 16 hours for further treatment. Also, 5% patients wait for 13 hours to be seen by super-specialty doctor. And 7% patients have to wait for 38 hours for an operation after coming to the Emergency.
Dr SK Sharma, former director of PGI, now chief of urology at a private hospital in Panchkula, says, “The institute was conceived for tertiary care, not routine care. But instructions from the top are that you cannot refuse any patient. That’s unfortunate. In Delhi, AIIMS refers patients to the Safdarjung hospital, but here the two other main hospitals in public sector (GMCH-32 and GMSH-16) are not sharing the load.”