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Sunday, November 30, 2014

Earlier "noble" now a "heartless" profession

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Fortis Hospital, Bangalore
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 arterial 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 ill-equipped sub-standard government hospitals or, worse, quacks. At 70%, the out-of-pocket expenditure on healthcare in India 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.

Apparently India is not the only country where such unethical practices are rampant. Highly disappointed in the way the healthcare system functioning in the US an Indian-American physician, Dr. Sandeep Jauhar, has, in a candid mia culpa, called it a “heartless profession”. For raising revenues of the corporate hospital doctors now have very little time for patients as they have to check many more than what was actually the practice earlier. He has blown the whistle on American medical practice which he says has “become pitiless, mercenary, money-ripping vocation where doctors treat patients as revenue generators rather than as human beings”. They keep patients in hospitals longer than necessary, order needless tests and cozy up with predatory pharmaceutical companies to sell dangerous drugs. In India it is not much different in the private corporate healthcare establishments. 

 Another Indian-American, Dr. Surya Prakash, has confessed that in the changed environment medical practitioners have increasingly lost that vital much-needed human emotion of “empathy” for their patients. If that is so in the US, perhaps, it is truer in India.

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Photo: from the Internet


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