 |
| 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.
_____________
Photo: from the Internet
No comments:
Post a Comment