Doctors at fault

Of the many roles such as healer, soother, guide and teacher and that a doctor dons for his patients, one important one that often goes unrecognised is that of serving as a scapegoat to provide emotional comfort and solace to those who have been through bad times.

When 45 year old Rahul (name changed) who had collapsed at home after vomiting two litres of blood, and had been rushed to a nearby hospital where he died within 2 hours, the family blamed the doctors and the hospital for delay and mismanagement.

Rahul had died of a complication of liver cirrhosis, a disease that had developed from 20 years of heavy drinking. It must have been frustrating for the parents to helplessly watch their son drift away despite their urgings, and fall into the company of delinquent friends and a bad habit. The parents however did not blame themselves or their son or his friends for the habit.

For them it was the doctors and the hospital that had snatched their son and happiness!

By picking on one external scapegoat, the family members had unconsciously found a way of remaining united emotionally. Scapegoating, therefore, is the perpetrator’s defense mechanism against unacceptable emotions such as shame and guilt.

Scapegoating or blame transfer is something we do almost everyday without quite realizing.

When a smoker develops lung cancer after years of heavy smoking, it is the tobacco lobby at fault.

If the cancer, when detected is at an advanced stage, the fault is of the 1st doctor who ign ored that nagging cough and did not ask for a bronchoscopy. If he finally succumbs to his disease, then the cancer specialist and hospital are guilty for not being able to achieve a cure. Everyone is guilty, except the smoker himself or his family, or the people who really allowed all this to happen.

In another interesting case, a 29 year old man, who seemed frustrated and angry, came to consult me for constipation. He had consulted 5 doctors in a year, who had all prescribed mild fibre-based laxatives by various names. These had provided him releif too, but now he blamed the doctors for getting him “hooked” to “Isabgol”.

I learnt that he had quit a stable job 2 years ago to follow his dream of becoming an officer of the Indian Administrative Service. When I asked him if he had a back up plan, he broke down and said if that happened he would hold the doctors and the laxatives responsible for his failure!

Happiness has become our right and if we are prevented from achieving it, someone must be responsible.

And as often happens in matters of health and life, doctors are the favoured scapegoats.

Doctors need to understand this unique need of desperately distressed patients and their relatives to want to paradoxically blame them instead of thanking them for their efforts.

It is distressing to doctors to see their patients react this way, but they need to understand their “special need” and be kind and generous to them.