People
& Their Problems
New Delhi, 28 November 2014
Medical Profession
‘HEARTLESS’ & DUBIOUS
By Proloy Bagchi
In the midst of the
ongoing controversy over deaths of 13 women in Chhattisgarh after their
tubectomy procedure another massive case of professional misconduct by doctors
was reported the other day from Delhi.
For the common man medical treatment is increasingly becoming dicey, given the
proclivity of medical professionals towards illegal gratification sought and
taken from the pharmaceutical companies and prescribing medicines that may or
may not be necessary but for which one has to pay unscrupulously hiked prices.
The two cases mentioned
above show some similarities. The deaths in Chhattisgarh were initially
reported to have been caused due to botched up operation by the surgeon, who
was otherwise a reputed professional. Since the entire blame was being heaped
on him he went underground and was eventually arrested. In the meantime,
however, autopsies revealed that the deaths were not really caused by the
surgical procedure but by the post-operative medicines that were administered
to these unfortunate women.
They were given locally
manufactured brand of ciprofloxacin, a commonly prescribed antibiotic, and
ibuprofen, a pain killer. Analysis of the antibiotic revealed that it contained
poison that is used to kill rodents. The other relevant fact that was revealed
that there was no need to procure the drug locally as the same was available in
the hospital stores suggesting some link-up between the local manufacturer and
the hospital administration.
The other case that has
been reported to the Medical Council of India has put as many as 300 doctors
under investigations for prescribing drugs of a particular pharmaceutical
company when cheaper alternatives manufactured by better-known companies were
available. The doctors were, in exchange, being paid substantial amounts of
money and were being gifted cars and flats and were also being offered all-expenses-paid
foreign pleasure trips. The investigations have been initiated on the basis of
an anonymous complaint from Ahmedabad. All the doctors have been asked to
produce copies of their bank accounts and passports and present themselves with
their originals.
Of late, the reputation
of the medical profession – once upon a time considered noble – has taken a
severe hit due to the indiscretion and the dishonest ways of many of its
members. Perhaps increasing materialistic culture in the country has enticed
even the best of medical professionals to cross the ethical line and forget the
Hippocratic Oath. It was not so earlier. Five or six decades ago there were
hardly any specialists; most patients used to go for succour to general
practitioners – medical graduates or even licentiates. None ever recalls any
ethical wrong-doing; the physician may have gone wrong in diagnosis but one
never heard of commissions from diagnostic clinics or from drug manufacturers.
In most cases, the doctor used to have an attached dispensary that dispensed
medicines.
The development of
specialities and super-specialities, upgrading of investigative tools and
surgical methods and equipment have, while promising far better healthcare,
mixed a lot of poison in the curative potions. Modern hospitals are generally
mammoth organisations full of specialities, super-specialities and their
concomitant highly qualified physicians and surgeons. Not only the hospitals
are exceedingly large, the salaries paid are also astronomical. In order to,
perhaps, even to break even these hospitals, their physicians and surgeons tend
to compromise on the ethical content of their profession, breaching the Oath
that they were sworn to.
In India today
there is a race to become (at least) a rupee billionaire (a crorepati). Half a
century ago even a hundred thousand rupees were beyond the reach of many. In
the absence of a rat race, the professionals retained and maintained the
nobility of their profession. Today, in the highly competitive and acquisitive environment,
doctors – physicians and surgeons – are also in that race. Armed with a degree
obtained after maybe bribing his way to a medical seat, paying a huge
capitation and other fees to go through a medical school, then spending years in
graduation, post-graduation followed by studies for a doctoral degree a medical
student is ready to enter his profession, mostly, deeply indebted. As
practicing in government institutions does not quite meet the requirements to
square off his commitments, the private, or even better, the corporatized
healthcare institutions are found attractive. It is, inter alia, here that the
ethical compromises commence.
Receiving a handsome
package, he is asked to generate revenues for the corporate house that runs the
establishment. The game starts when a patient is viewed not as a human needing
succour but as a revenue generating medium. He is asked to go through several
needless investigative procedures, he may be admitted as an in-patient quite
needlessly and administered drugs that cost the sky, and occasionally gratuitously
put under the knife or on the ventilator.
I recall a case of a
corporate hospital where a lower middle-class boy was kept on the ventilator
even after he had died only with a view to claiming a fat bill. In another case
a man was subjected to an angioplasty and a stent was placed at the site of the
blockage. However, a year later during an angiogram of the same patient in a
public healthcare institution of repute the stent was not visible. Obviously,
the stent in question was never implanted though the cost was recovered in
full. A corporate hospital in the South was caught over-charging for a stent to
be used on a patient whose relative knew exactly how much the hospital had paid
for it.
Reports have appeared of
hospitals charging for hip implants that were obtained free on bargains such as
buy-one-get-one-free. The hospitals seldom mention in the discharge certificates
the particulars of the implants disabling patients from claiming damages in
case the implants cause problems later, which they frequently do. Things have
become so bad that even Pappu Yadav, a supposedly shady leader, has called
doctors “executioners”.
Dr. David Berger, an
Australian medical practitioner, writing in the British Medical Journal said
that bribes and kickbacks oil every part of India’s healthcare machinery. He
had come as a volunteer physician in a small charitable hospital up in the Himalayas. “A model of iniquity”, the healthcare system,
he says, is highly privatised extending the facility of latest technological
medicine to higher strata at a high price leaving around 800 million people in
the hands of inadequately provided and equipped sub-standard government
hospitals or, worse, quacks. At 70% the out-of-pocket expenditure on healthcare
in India it is higher than
even in the US.
The editor of the Journal Fiona Godlee had recently urged for stopping
corruption in healthcare or else other nations could turn away Indian doctors.
A campaign against the evil is being launched starting from India.
Highly disappointed in
the way the healthcare system functions in the US, an Indian-American physician,
Dr Sandeep Jauhar, has, in a candid mia culpa, called it a “heartless
profession”. Another Indian-American, Dr Surya Prakash, has confessed that in
the changed environment medical practitioners have increasingly lost that vital
human emotion of “empathy” for their patients. If that is so in the US, perhaps, it is truer in India,
particularly in the country’s corporatized outfits. ---INFA
(Copyright,
India News and Feature Alliance)
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