Ugly Episode Of Bihar’s Muzaffarpur– ICU Ethics And Etiquettes To Keep In Mind

By Sandhya Mishra

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Sandhya Mishra in talk with experts on what’s allowed and what’s not in an ICU


A country, with perpetually failing main stream media gets drummed up with hash tag TRPJournalism, when a journalist was lashing out a doctor on a live TV for the failure of system.

She barged into the ICU of the hospital in Bihar with cameras and mike let alone the intentions to wear sterile dress or gown. In the wake of a disaster, ICU of the hospital was already harboring more patients than it could accommodate, resulting in multiple patients on one bed and some on the floors too. Largely, these patients were children being treated for the three main symptoms of acute encephalitis syndrome (AES), heat stroke, high fever and convulsions.

This disgraceful event of Bihar AES crisis called for an online dialogue between the sentient public and an oblivion journalism and an indispensable need to brush up on ICU ethics and etiquette.

Dr Vivek Kumar, Chief Intensivist, Sir H. N. Reliance Foundation Hospital and Research Centre.

Dr Vivek Kumar, Chief Intensivist, Sir H. N. Reliance Foundation Hospital and Research Centre.

Dr Vivek Kumar, Chief Intensivist, Sir H. N. Reliance Foundation Hospital and Research Centre, retorts, “The Intensive Care Unit is the most revered and sacred part of a hospital. It is home to seriously-ill patients many of whom may die in the near future. The main reason behind limiting visitation in an ICU is to facilitate undisturbed monitoring and delivery of healthcare to these sick patients.

“Before entering an ICU one has to be sure that their presence does not interfere with any form of healthcare delivery. The sick patients are on multiple medications requiring frequent adjustments and some of them are on organ support therapy like ventilation, dialysis, ECMO (Extra Corporeal Membrane Oxygenation) which require a hawk-like vigilance. There are also additional rescue manoeuvres like cardiac arrest resuscitation which take place on a regular basis requiring a team effort from all attending staff.

“If an individual understands this philosophy of working of an ICU he/she will definitely enquire with security before entering the unit. Life in an ICU is not written or taught, it is only discussed in families who have gone through the experience of having a loved one being nursed in an ICU. The other point is that there are very few rule-abiding citizens who will respect the board ‘Do not enter' placed outside an ICU. It is common to see relatives peeping constantly into the ICU whenever they get a chance to do so.”

Dr Karanjekar, CEO, Kiran Hospital, Gujarat.

Dr Karanjekar, CEO, Kiran Hospital, Gujarat.

Dr Karanjekar, CEO, Kiran Hospital, Gujarat, talks on the long smouldering embarrassment of credibility in the Indian news media, he says, “The media and its representatives must spread awareness on good behavior instead of breaching protocols and policies themselves while trying to sensationalize incidents and instigate public. It speaks of deep-rooted hate campaigns which are being driven against the medical fraternity.

“ICUs house the critically-ill patients. Continuous monitoring by nurses and timely interventions by doctors are crucial for ensuring that treatment is unhampered. Many procedures require utmost sterility to be maintained to avoid introduction of infections which can further compromise the patient’s condition. Besides, a patient’s recovery is dependent on several factors such as their age and immunity, existing underlying morbidities and pre-disposition to developing complications are a few. Still, it is not uncommon for a patient’s condition to suddenly deteriorate inspite of all available measures and the care taken. These do not need to be further compounded by irresponsible behavior from members of the community.

"Hospitals differ from other public spaces in that the patients have not voluntarily chosen to get admitted and the purpose of their visit or admission is to get treated and recover from a medical ailment. Hospitals are therefore governed by policies and protocols which direct the activities to achieve the primary aim of curing patients, controlling and minimizing infections and their spread and reducing the stay of patients in hospital. In order to achieve these goals, the patient’s relatives must understand and co-operate with the team involved in treating the patient. Many areas of the hospital are witness to life-saving procedures. Many of these procedures need to be instituted within seconds when crisis develops.

He continued to shed light on the much insouciant perception pertaining visiting a patient in ICU, saying, “Doctors must explain the condition of the patient and expected outcomes and complications at the outset when patients get in. These discussions are meaningful when the first of kin and a responsible member of the family who understands the implications are present. Realistic expectations regarding outcomes must be arrived at thorough a process of counselling and addressing the concerns of the family. Members of the family may not be able to contemplate the possible outcomes instantly during such distressing times. Certain eventualities must be clearly stated and possibilities of their occurrence explained. For example, sequelae of encephalitis which may include behavioral problems, problems in speaking or movements, learning disabilities need to be brought up and informed. The continuity of this is communication is maintained when the same representatives are present for counselling sessions during the progress of treatment. Many a times the relatives present in subsequent counselling sessions are different from those present earlier, this makes it difficult for families to take informed decisions and give consents for the subsequent treatments or procedures.”

Dr Vivek’s opinion echoes with Dr Karanjeckar when he says, “It is the duty of medical fraternity to explain this ICU culture to the lay public both as mass media programs as well as during focused counselling when a relative is getting admitted to an ICU. It is also the duty of hospital to provide counsellor who attend to relatives and resolves their queries on a regular basis. It is not difficult for even the uneducated to understand how an ICU functions and why the visitation is restricted. Once understood, the relatives are peaceful and they wait patiently for the next update. An issue peculiar to India is the large number of visitors and relatives and the concept of visiting a sick relative when admitted. This leads to a large number of visitors and an equally large number of queries besides generating a lot of confusion.”