Which patient to prioritise?

Recently I did a podcast on essential and non essential treatments. This blog is another dimension of the same story. Seventy five year old Mrs. M had come to our clinic requesting for repair of her split earlobe. In south India, some women wear heavy ear studs and rings and sometimes they bear down on the earlobe piercing and split the ear lobe. We have done repair of the earlobe for several women in our clinic. Earlobe repair is considered as a cosmetic surgical procedure. Last Sunday we repaired the earlobe of Mrs. M, but we took a lot of slack for it from our staff. They asked whether such a 'cosmetic procedure' was required at all. They also questioned whether it was right for us to do such a procedure in the middle of a busy clinic day, especially when the number of days we run the clinic is limited. 

Yesterday another woman came to visit us in the clinic. She narrated the story of her neighbour who had fallen unconscious in their home. The man had diabetes and hypertension and had been irregular on his medications due to a marriage in their family. His blood sugar levels had risen very high and most probably that must have been the reason for his unconsciousness. They had brought him to the clinic last Sunday. But they had noticed the huge crowd backed up and waiting outside the clinic. The back log had happened because of this ear lobe repair and another man with a gangrenous amputation stump about whom I have described in a previous blog titled "hope of an end..." both of whom consumed a lot of our time. So they did not even stop out of the autorickshaw and had directly gone on to the nearby town which was about 10 Km from there. 

After hearing the story of this man, whom we could not help or attend to, I started feeling very guilty. My guilt is fuelled by two facts, firstly I was already getting slack for operating on a 'cosmetic procedure' for a 75 year old lady, which was perceived as unnecessary, secondly, I now have proof of how the time invested in the 'non essential procedure' could have better been utilised in helping a man who had a more 'essential need'. 

It seems like a no-brainer to conclude that this whole dilemma is not a genuine one and it is clear case of mistaken and misplaced priorities. One can clearly judge that the decision to operate on the split ear lobe in the middle of a clinic day was wrong. My initial cognitive response to this whole episode was to defend my decision. I said to myself and my staff that the ear lobe repair seems like a trivial and non essential procedure in comparison to other people with diabetes, hypertension, heart diseases and other illnesses, but for that lady it was important. I also rationalised, we must not practice ageism and discriminate against an elderly person and dismiss her needs in favour of the needs of a younger person. I also told myself that we visit the clinic infrequently only a few days in a week and so there is no other 'better time' to do the procedure. 

But after hearing about the missed opportunity to help the man in immediate health care need, guilt took over. I have been thinking about prioritising our time and rationing it between competing needs. Yes, it is important for us to serve those who need us most. But our abilities are finite and our time is finite. So we are pushed to a situation where we have to prioritise. 

All doctors at some level operate with various degrees of saviour complex. I have come to believe over the years that many times healing and improvement in health happens even without us, and sometimes it happens despite us. Our role is largely to care and support the body's natural process of healing. This grounding has helped me free myself a little bit from the saviour complex. It helped me to remember this when I was wallowing in the guilt trip. Even without me, or despite me, the man would have become better. The elderly lady would also have found someone else to suture her ear lobe, or would have moved on and adjusted to a life without it being repaired. I did not wilfully deny care for the man. Neither I did choose to help the elderly woman because of some personal favours or preferences. I am not sure if this is still the right thought process. What do you think?