Sunday, May 27, 2012

Doctors are not bad always!

Waiting for the date of joining and hence some engagements to come it’s hard to pass your time sitting just idly at home. Nothing to do and nobody to meet fills you with utter boredom. Being in such a situation where every day is like a Sunday, you tend to forget the importance of a Sunday and then don’t even wait for one. Things are almost similar to me at this very point of time, yet, I was looking for a Sunday today. The reason, well, was Satyamev Jayate, the TV show. The way it has created huge news with its few episodes only, the waiting is actually worth it. Being a fan of Aamir Khan adds to the praise for the show and hence to the waiting too. What actually turned out to be the most interesting was the fact that today’s episode was based on doctors, who have actually, in many ways, commercialized the profession and practice of medicine. Coming from the same profession is what made it the most interesting to me.

The episode was, indeed, apt on the situation that prevails in our profession at this point of time. Many a things that were shown in the show were, more or less, experienced and observed by me at different times. Be it the needless operation of a leg abscess leading to amputation of a toe or the commissions demanded from the pathologists or other fellow practitioners in return for the references or the corruption prevailing in MCI (Medical Council of India) or the overpricing of drugs, everything is too very known to people in my profession and as well as to the general public. These are some of the evils that the profession has adopted as a cost to its commercialization. I am not supporting it. No, only trying to find out where, actually, it came from.

The episode dealt with certain cases where a surgery was performed even without the need of it. The doctor performed that only for the purpose of inflating the hospital bills. No doubt, it happens in our society at such a rate that if really studied, almost 20-25% of all surgeries performed will come out to be needless. In other words every one in four or five surgeries are kind of fake. Shocking, as it may sound, but indeed it is a fact that needs to be stated and needs to be confessed by every person in my profession. Having said all this, one should also remember and notice the fact that each such story in the episode, where there was one ‘commercialized’ version of a doctor, there was one doctor also who was firm in his opinion that what was being done was wrong. My point here is that not all the doctors are from the same league as the ‘commercialized’ one. To every one of them there are, still, tens of ‘true’ doctors in our society. So, the profession as a whole cannot and should not be blamed for this.

The part of the episode that dealt with the issue of dichotomy of fees was the most important issue that the show raised. Indeed, in return for the references that a doctor sends to a radiologists or pathologists for the purpose of investigations and also in return for the referrals that doctor sends to his fellow colleague, the doctor demands a cut, a percentage of the fee. This is a grave situation, no doubt. And this is also not something that people don’t know. They, the public, know it. We, the doctors, know it. This is something like bribery that is ruining the whole system of the country. Nothing much can be done to get free from this evil, except for raising the awareness. Nobody can clear the conscience of the whole society, it can only be done by clearing own conscience and that’s what is needed here. We have to have a firm conviction that we are not going to indulge in such practice. Raising our morality and changing the mentality to pureness is what we require to do. This is one of the simplest ways of how we can lower the monetary burden of the poor patients and we, the professionals, must come forward for this.

The issue of the MCI is not only an issue, it’s a scandal, maybe, a bigger scandal than the 2G spectrum or the Commonwealth Games scandal. But on this very issue these are not the doctors that are to be blamed. The main perpetrators of this scandal are the education mafias of our country who are running the various private medical colleges. They offer bribe to the MCI officials, they pay the doctors to pretend to be their faculty members and in return get the recognition to run the courses in their college. This is similar to anything and everything that, more or less, is running in all the sectors. It’s not only the matter of health sector and hence, should not be taken as particularly against doctors as taken in the show. The project manager of a dam in construction receives bribe from the contractors, the police department gets their cut from the ransom money of kidnappings, the DM has his/her share from all the relief funds. All these things are one and the same. Being rich in no time is the basic idea behind all of it and hence the MCI issue also should not be taken as a different issue, afterall, doctors are also human beings like the engineers, or the police officers, or the DM.

Lastly, the drug overpricing issue. The episode blames the doctors that they don’t prescribe the generic medicine that come as much as ten times cheaper than the branded medicine that they do prescribe. The show took an example from the state of Rajasthan where these generic medicine are being used. Maybe, the Satyamev Jayate team was a little short on its research on this. We in Bihar too have been distributing these generic drugs at all the government hospitals for over 5-6 years now. As far as our experience goes here (of the last 5-6 years of this and even before as I come from a family full of doctors), these generic drugs are not as effective as the branded ones. A same company manufactures both a generic and a branded version of the same molecule and the price range is completely different on them. The generic drugs, maybe due to government regulations, have to be cheaper and hence, maybe this is the fact why the companies don’t manufacture it with the same intent that they do with the branded ones. The generics are known for their ineffectiveness in treating a patient and I, as a doctor, would never prefer something that I have experienced ineffectiveness of to treat my patient even if it comes free to them. But then, the drug overpricing is a real problem that should be dealt strongly with. Maybe, a stronger regulation of taxes and price of the drugs from the government is what is needed the most.

In the end, I must here reiterate the fact that not all of us doctors are the business tycoons that the society has now started to think us like. I admit that there are some people who are doing things that should not be done but then they only make a small percentage of the whole population. Everyone of us doctors want to treat poor patients free of cost but then most of our patients are these poor ones so how would we get our living from them. The amount of time and labour that we put in the rigorous studies before becoming a successful practitioner is not only for getting to be known as the ‘god on earth’. We don’t want to become one. We want to be human beings only. We want to use our skills that we acquire with so much of pain and labour in helping others but then we have stomachs of our own and our families too that need to be filled. Doctor as a profession has been the most respectable profession ever in our society and it will remain to be one. The onus is now on us ourselves to make it as respectable as it ever was.


11 comments:

. said...

Incisive.... You need to follow it up with another post...

Comments on generic is eye opener...

There are many other issues like ever greening (or something like that), over prescription of Antibiotics which is creating many serious health concerns like NDM-1... arbitrary pharmaceuticals pricing policy..

I think large no. of 'unorganized' private hospitals in India is also a big problem...

Aashu said...

Thanks for the valuable opinion. Totally agree to you on the issue of overuse rather abuse of antibiotics in today's practice. To me, but, it is a different issue. Where the issues raised in the show were mostly about the criminal offences of the doctors, the abuse of antibiotics should not fall in that same category. To me, it is more of either a wrong use of a right knowledge or a wrong knowledge altogether. Many a times you are tempted to use an antibiotic owing to the high incidence of infections in our society caused due to the poor living conditions. The major problem is the compliance on the part of the patients. If they are able to take properly the full course, problems like the rise of drug resistance will not be a larger one. The affordability of the sensitivity tests is also one problem faced by doctors for which they tend to use empirical drug therapy. Anyways, the overuse of antibiotics should must be avoided at any cost.
The unrecognized private hospitals or even the recognized ones are the ones that are the most problematic. All the problems raised in the show are a result of the huge flow of money in the health sector and the cheif perpetrators are these private hospitals. If a govt hospital can provide appendectomy in a thousand buck then how come it costs fifty grand at a big private hospital of the metros. This must be taken care of. Health sector is one of the most important sectors that need an immediate govt regulation.
Regarding more posts to follow this up, will surely try to pull out from my own experiences time to time and put it up here. Thanks again!

Anamay said...

This episode had a categorical viewpoint maligning the doctors who are the forerunners of this noble profession. I agree with you that it should have been presented with a more liberal stand. A majority of well learned doctors are contributing a lot without much commercialisation and with utmost dedication. The govt. should check the blatant misuse and corruption associated with hidden aspects of the healthcare sector such as working of pharma giants which is instrumental in originating the first vice in this vicious chain reaction.

Aashu said...

Exactly my point there. Like every other sector, we in health sector are also facing the problem of corruption. The point is that if there is a doctor who demands a bribe or a cut, then there is atleast one person who provides him with these. Both of them should be equally blamed. Maybe, thats where the episode failed slightly!

Vishal Sinha said...

brilliant anshuman.... u have indepth knowledge of the evil practices prevalent in society as well as u have the gud capability to find out the root cause of an evil..... u r absolutely r8 in regard of education mafias.... study of medical course with heavy donations and other corrupt practices have disturbed the whole process....
great effort... love u and your blogs . God bless u

Alok said...

I watched only one section of the show in which he was comparing the cancellation of licenses in UK as compared to in India. You will agree that there is a problem there - that there is no mechanism to hold doctors accountable for their advice and actions. May be not criminal accountability but some sort of internal self-regulation of the medical community itself should be there. In India, I doubt if even big reputed hospitals have defined guidelines, standard procedures & ethical practices, forget about private practitioners..

nidhi said...

nice approach...i totally agree that we,the upcoming doctors should first regularize ourselves and think more about serving humanity than earning money...but i think this is a fact that these days less than fifty percent of us actually do care about..as far as what i have felt.you are well familiar with my subject "pathology" and what is the scene behind it as has already been discussed in the programme...though my idea behind choosing this subject was different but i had also thought of a clean private practice...but i am afraid to say no one has yet supported me in this...i was told by my friends ,seniors as well as family as well as other doctors not to enter it because u can never earn without pacifying other doctors by division of the fees...i am strong headed but sometimes even i am forced to think so...so what can u expect of betterment in this society if the environment around us is this....where the main aim of becoming doctor is to earn money....many times not by noble ways..it is kind of in the roots...you have talked about private colleges giving fees to procure doctors for recognition by mci...i tell you when i had joined physiology the senior doctors whom i talked and even the teachers of our college said its good and be satisfied with it because these days teachers in these fields are hard to find and in times of need like during mci inspection private colleges like katihar would offer about 1 lac per day for being their tutors during inspection plus other facilities!!!!!!!so"physiology" is good!!!!!!see .....this is the scene..even our elders support this just for sake of MONEY....since i have encountered this all myself so i liked that episode as i am seeing on facebook has created a lot of hatred among doctors for aamir...but i also agree there are also many who are "non commercial" as has also been accepted by aamir khan

nidhi said...

one thing i felt he left which he should have mentioned ,so that people..."patients" as such could have realized their mistakes, so that together doctor and patients could work for betterment of health facilities was ATTITUDE OF PATIENTS...what i have seen is that if you prescribe only essential medicines or only essential tests or cheaper drugs or cheaper tests(as the pathologist in the show said)..then patients themselves dont like it or dont trust u or your treatment......just because it does not satisfy them.....and that,s just because other doctors are prescibing more...sometimes "more"is just what they want....if patients correct this attitude then it can be a lot helpful

Aashu said...

Incidentally, I missed the same part that you watched. Anyways, its really tough to self regulate the practice of medicine. Its not really rocket science to understand the fact that not all the patients can be treated in similar way. Individualisation of treatment is what is advocated everywhere. Every case is treated according to its own merit. Now, there are many cases where a definite guideline has to be followed. They mostly are in emegency medicine where ascertaining the cause is not important but stabilising a patient takes priority. In those conditions, like cardiac arrest, there are prescribed regimen that are followed almost everywhere. But, as soon as the patient gets stabilised, each case can be treated in many ways depending upon two individuals. First, the one being treated i.e. the patient and second, the one treating i.e the doctor. This is what is called individualisation. No two minds are the same, neither are two bodies. So, how can one expect two doctors (two minds) having a same opinion about the same patient. Neither can you expect a doctor to have same opinion on two patients (two bodies) having similar problems.
Yes, there must be some regularisation in this profession but its not that simple to apply. Anyways, anyone is free to move to litigation if he thinks he has been cheated in some way by a doctor. After such a complaint, a committte is formed of the eminent people of this profession to look into it and then only a decision on negligence is taken and then proper action is taken that includes deregistration i.e. the professional death sentence.

Aashu said...

Exactly! The patients are to be blamed as much as the surgeons for all these malpractices. I am sure that if Mr Aamir Khan is asked to write on a bond paper that whenever he fells ill, he will take only generics and that he will be treated with minimal investigations, he will not be doing this. Thats the situaton. Nobody will do it but everybody will expect the doctors to do so. Bad!

nidhi said...

Finally some effect shown and i am happy...registration of many doctors in south was cancelled recently for forging as regular teachers in the medical colleges during mci inspection which is underway these days..read it in an article recently in TOI