By Dr Nikhil D Datar. MD DNB FCPS FICOG DGO LLB
Obstetrician, Gynaecologist and Health Rights Activist, Mumbai
“Patient no 13/2017” calls out a nurse. A patient reduced to a number, as if she were in jail. Sounds demeaning, doesn’t it? May I say that this practice is legal and in fact, desired in India by the “Medical termination of pregnancy regulations 2003” (MTP regulations). Shocked? Confused? The Government of India framed these regulations in 1975 and amended them in 1993. The regulations state that the name of the woman undergoing termination of pregnancy (TOP) should not be entered anywhere except on the admission register and consent form. At all other places it is the serial number assigned from the admission register that is to be entered. This “special” provision has been made to safe guard the privacy of the woman. Well, that is fantastic! Privacy of every patient is of paramount importance.
However, let us see how this provision works in real life.
A woman comes to my clinic. An OPD case sheet is made in her name before I see her. Only after some conversation can it be determined that she wants to terminate her pregnancy. Thus it is obvious that one cannot not have the patient’s name on OPD sheet. If an MTP is to be done surgically I need to admit her in the hospital. Now I need to inform the clerk on admission counter to make an indoor paper/ case sheet with a serial number instead of her name. Since this provision is only meant for MTP cases, the clerk or non-medical staff automatically understands the purpose of this admission. Moreover there is a system of obtaining general administrative consent upon admission. When the woman signs it, her name is naturally revealed to those administrative personnel not connected to patient care.
In addition to that, since her name is not written on any other paper work, how should the nursing staff address her? By number? Our teachers in medical college used to be very upset if a medical student would call out any patient by their bed number or by the name of the medical condition patient suffered from. The practice of reducing a human being to a number is a bad bed side practice and extremely devaluing. However in this case it seems to be perfectly legal.
Even the anaesthetist should not (officially) know the woman by her name. The WHO patient safety checklist gives a lot of importance to the identification of the patient in order to reduce medical errors. However here we are expecting the anaesthetist to administer anaesthesia without even knowing the name of the patient!
These MTP regulations state that the consent form should be sealed into an envelope with the serial number and the word “secret” be written on it and sent to the administrator. In India most of the MTP services are provided by small healthcare facilities which are single doctor owned. This means that the doctor doubles up as an administrator or the owner. Thus, the regulation would require a doctor to send the envelope to himself with the word “secret”. Absurd, isn’t it? But the rule of law is followed to the T by government inspectors. They want to see these sealed envelopes presented by the doctor to himself!
According to the regulations, even the discharge card or follow up card should not have the name of the woman on it. So what happens if the patient asks the doctor to write a certificate stating that she has undergone termination of pregnancy? Should the doctor write her name?
The Ministry of Health and Family Welfare itself has contradicted it’s own provision of not writing the name on the follow up card. In 2010 the ministry released a publication titled “Comprehensive abortion care guidelines”. (http://www.nrhmhp.gov.in/sites/default/files/files/Guidelines_CAC%20Training%20%26%20Service%20Delivery%20.pdf ) On page 50 of this guideline the ministry has showcased a standard format of the follow up card. The first column of the format reads as patient’s name followed by the phone number!
Privacy is paramount, not only for the termination of pregnancy but for healthcare in general. The question is: Is the designed system achieving its goal? Or else we are just making complex systems that are more prone to clerical errors for which individuals can be held liable?
PS: In last 32 years no doctor’s association has raised any objection to these absurd, anomalous and impractical provisions or suggested any change.