The Unit Head’s Signature

 

This incident is pretty old. In the government-owned, Sawai Man Singh hospital or SMS Hospital, in Jaipur, Rajasthan, India, the patients were charged a small amount for investigations such as x-rays and laboratory tests. Although the amount was very small, many very poor patients found it difficult to pay even that amount.

To give relief to the poor patients, the hospital administration made the rule that if the Head of clinical units recommends in writing and put their signature for authenticity that the patient is poor and that the charges be exempted, the x-rays and other laboratory investigations will be done free of cost.

The investigations slips were almost invariable filled by the first-year junior residents in the wards and out-patient departments. The patient who wanted free investigations would then will take the requisition slip, trace the Head of the Unit in the hospital and get it signed by him. 

The problem arises that the Unit Head may be busy with some other work like in a meeting, taking class, etc, or in the case of surgical departments may be doing a lengthy operation and may not be available to sign the slip for free investigations. Sometimes the patient may be admitted to the emergency ward at night when the Unit head is not available but the poor patient requires urgent investigations for his/her proper treatment.

To solve the problem of the poor patients, the ever-innovative first-year residents with the blessings of the unit heads formed a plan. The first-year junior residents practiced and started signing duplicate signatures of the unit heads on the free investigations slips. After a year when the next batch of junior residents joined the hospital, the first thing they were taught by their seniors, the now second-year junior residents, was how to make a perfect duplicate of the unit head signature. This tradition continued over the years.

Once a patient was seen by the unit head. Instead of delegating the task of filling the investigation requisition slip to the junior residents, the unit head himself filled the slips, signed it to be done free, and sent the patient to get the investigations done.

When the patient showed the investigation slip at the counter the staff member looked at him suspiciously. He asked him who had signed the free investigation slip. The patient replied that Dr. X, the unit head had signed the slip. The staff member scolded the patient, ‘Do you take me for a fool? I very well recognize the signature of that unit head.

The staff member checked the bundle of investigation slips with him. Selecting a free investigation slip of a previous patient from the unit head’s unit he pointed at the signature done by the junior resident and said, ‘This is the true signature of Dr. X.’

What had happened was that when the first junior resident copied the unit head’s signature, some minor difference had crept in. When the next batch of junior residents copied this copied ‘Unit head’s signature’ again some new minor difference occurred.

Over the years with each new junior resident practicing the unit head’s signature more minor differences had crept in the signature so that finally the signature was vastly different from his actual signature. As the differences had occurred slowly in stages over the years it was accepted all over the hospital as the authentic ones. So when the unit head actually signed the slip it was deemed as a duplicate and rejected.

Another tactic that is used in such situation, especially if the unit head’s signature are too complicated for easy copying was that unit head sign a few blank investigation slips, in advance, to exempt charges and keep it safe with ward resident doctor. In case of emergency, the resident doctor just fill in the patient’s details and sends the pre-signed slip for free investigation.

This is not just limited to resident doctors. When costly investigations such as CT scan and MRI scan were ordered by the doctors, many patients used to go to the local politicians and get a signed recommendation letter from them to exempt charges, sometimes within hours. The amazing thing was that sometimes the patients will come with this letter even the politicians were out of town.

On inquiry from close sources to the politicians it was found that the patient usually never even meet the politicians. They usually meet his personal assistant (PA) or secretary. After confirming the genuineness of the patient’s request, the PA will fill in the patient’s and hospital’s name in the pre-typed letter to exempt the charges which were already signed by the politician before leaving town.

If there are impractical orders than the people will usually find a way to get around it. Before giving any order examine if it practical in implementation and how your employees/staff/juniors may get around it.

 Sometimes the copycat might appear more genuine than the original. It is said that once Charlie Chaplin without his distinctive mustache and boots was visiting a fair. There he entered a contest in who could imitate Charlie Chaplin’s famous walk from the movie ‘The Tramp’. The judges who did not recognize him without his mustache, did not find his walk impressive enough and he came in 20th place.

— ND

(Based on allegedly true incident.)

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DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal, and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to NMC and other Board norms.