Health: Care or Scare?

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Every profession has black sheep. The sector is ailing with deep-rooted corruption. Shernaz exposes the rot, as one section of ethical doctors go hammer and tongs on the corrupt ones, in the weekly column, exclusively in Different Truths.

A headline in Pune Mirror some months back screamed, “MCI a den of corruption, says Symbiosis founder,” Dr. SB Mujumadar.  That is the (dis)respect the Medical Council of India earns today. Not just the MCI but a huge chunk of the medical fraternity, including pharmaceutical companies and corporate hospitals, has lost public trust. 

Pune Mirror Wednesday, 4th October 2017 carries an article “Medicine at a crossroads” by Dr. Altaf Patel – the good doctor on modern medicine and age-old common sense.  Dr. Patel says, “Doctors are increasingly being treated as villains with new regulations making medicine more complicated and expensive for patients”. He goes on to say, “After medical negligence was removed from the purview of medical councils and brought under consumer courts, treatments become more expensive. The medical councils, in my opinion, were doing a great job. Faced with the prospect of being called before a judge with little knowledge of medicine, doctors now order every conceivable test so they are not considered negligent.” 

When I was a very small kid, I remember the elders in our family talking reverentially about certain doctors. They were angels who could be woken up in the middle of the night and taken away about seven kilometers, even more, to attend to a patient. They never complained, they were not rude and did not demand exorbitantly high fees. Rather, like my father-in-law, there were those who put money quietly into their patients’ pockets to help them tide through expenses for medicines and x-rays.  Such angelic souls are called fools today.  There was a time, maybe as recently as two decades back, when physicians were like family and were treated with the respect due to a god.  Such doctors raised the bar of nobility and humanism which most of the today’s doctors fail to live up to.

The is such that it has garnered total loss of trust in the general public for the healthcare industry. Who or what is to blame for this?  Unethical doctors, unnecessary medical tests and intervention, a spurt of medical colleges (many accused of unprincipled practices), the ‘cut’ culture, and mushrooming corporate hospitals have all turned this profession into a money churning machine.  Greed has become the mantra replacing the nobler attributes of this profession which, as mentioned earlier, is now an industry.    

Dr. Majumdar and Dr. Altaf Patel have differing viewpoints. Is the dividing line in the healthcare sector becoming more evident now?  Another question I grapple with is – are only the new regulations responsible for making medicine complicated and expensive? Weren’t some of the new regulations prompted by unholy practices in inter-related fields of medicine?

We ourselves or someone we know has at some time been at the receiving end of this callousness. When I had to undergo angioplasty, I was shocked to hear that my investment advisor told my family to ‘bargain’ with the doctors to bring down the cost of the procedure. And it worked! The negotiations went on as I lay on the table in the OT after an angiography, waiting for my fate to be determined by others. I was not allowed a say in the matter by the doctor concerned! Emotional blackmail of worried family and friends!  On that day itself, another patient had undergone the same process. The next morning he was sent walking out of the CCU, not even in a wheelchair. He was so confused; till today he says that he had no symptoms of any kind and had gone to the hospital for a general check-up as advised by his physician.  It remains an enigma – did he genuinely require an angioplasty?  Cases abound in which patients have had to suffer more at the hands of money-minting doctors than from their medical conditions.  A few have been cited in the book I speak about below.

When doctors themselves talk about the malpractices prevalent in the system it is not just appalling, it is scary. The book — Dissenting Diagnosis — is written by Dr. Arun Gadre and Dr. Abhay Shukla.  They identified and surveyed 78 doctors who are known to be ethical and good in their respective fields and practices.  Sadly, these good doctors struggle to survive in an increasingly dishonourable and commercialised environment.  It is a book I recommend to all. It does not just bring out the demons of the system but also offers hope and advises us on how we can select the right doctor.  So I repeat myself, do lay your hands on the book and read it. I will include here the chapter titles to give an idea.

Part One: Diagnosing the Malady

  1. Complete Interview: Dr. Vijay Ajgaonkar, senior diabetologist, Mumbai
  2. Malpractices in Private Hospitals. 
  3. The Toxic Influences of Pharmaceutical Companies
  4. Health Care becomes an ‘Industry”
  5. Attitudes and the Policy Context
  6. Some Solutions Suggested by Doctors

Part Two: Initiating the Cure

  1. Physicians, Heal Thy System
  2. What Rights Do I have as a patient in a Private Hospital?
  3. How can I recognise a Rational-Ethical Doctor?
  4. How should the Private Medical Sector be Regulated?
  5. Moving towards a System of Universal Health Care(UHC)
  6. Joining Hands for Healing the Health Sector

Perhaps tomes can be written about the malpractices of hospitals and unscrupulous doctors but let us concentrate on the advice given in chapters 8 and 9 cited above.

Briefly, the rights that every patient is entitled to —

  • emergency medical care
  • information, including  information on Rates of Services
  • medical reports and records
  • seek the second opinion
  • confidentiality and privacy during treatment
  • informed consent before undergoing a potentially hazardous test or operation
  • choice of the medical store or diagnostic center
  • comprehensive protection when is being involved in a clinical trial
  • right to take discharge of a patient, or receive a of deceased from the hospital, regardless of payment of complete hospital bill.

As with all rights, there come duties too. Patients and their caregivers must co-operate with the doctor in the aftercare of the treatment prescribed. Doctors too are human beings and should not be seen as gods or villains. With all their effort to try and pull a patient out of the jaws of death, they will not always succeed.  Procedures may fail due to no negligence on the part of the medical team. To beat up doctors, destroy hospital equipment and go on a rampage is not the answer. If one has solid proof of mishandling of a case, there are redressal mechanisms one can take recourse to.

How does one recognise an ethical doctor? Here are the pointers from Chapter 9

Ø  He does not mind being questioned by the patient

Ø  Gives sufficient information, enabling the patient/caregivers to understand the course of illness and treatment

Ø  Gives the patient various options whenever possible, and discusses pros and cons, enabling the patient and caregivers to take an appropriate decision.

Ø  Explains to the patient the justification for any major investigations and invasive procedures being ordered.

Ø  Does not create fear or panic but gives timely and balanced information

Ø  Does not pretend to know everything: the doctor can admit that there are aspects of the illness that he or she cannot definitively comment upon

Ø  Does not advice additional  investigations and procedures, due to demand from the patient

Ø  Good doctors continuously manage risk — doctors who are only interested in saving themselves may not save many patients. 

At times, because of the low doctor/patient ratio and unavoidable work pressure doctors suffer from ‘sub-clinical depression or burnout’ needing psychiatric consultations themselves.  Dr. Nandkumar, professor of psychiatry at AIIMS told TOI, “Work pressure was always there. When I was doing my residency, we would party and share our problems with friends, which helped us cope and find solutions. But today’s generation, including doctors, are mostly self-centered, more ambitious and technology takes away most of our time. Hence there is pent-up emotion, which leads to psychological problems.”  There is an urgent need, particularly in public hospitals, to improve doctor-patient ratio, to upgrade their work environment and infrastructure; to provide recreational facilities and professional help where necessary.  

Part of the health sector is sick and distorted by gluttony to an alarming extent. It needs to cure itself by stemming the tide of dishonourable practices and as patients we need to help it out by staying better informed about our rights and duties; by being co-operative patients and caregivers; by taking the correct course of if we have been at the receiving end of medical ethics or insensitivity, instead of taking the law into our hands. Issues can be resolved by having open discussions and giving the benefit of the doubt where needed. 

It is imperative that doctors and patients conduct themselves with dignity, maturity, and honesty. It will be beneficial all around to form mutually empathetic relationships and interactions. May the many good, sincere and truly compassionate doctors ( some I know personally) who have been sidelined and overshadowed,  come to the forefront again so that all of us together can revitalise health care’s deteriorating condition.

©Shernaz Wadai

Photos from the Internet

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Shernaz Wadia

Shernaz Wadia

To Shernaz Wadia, reading and writing poems has been one of the means to embark on an inward journey. She hopes her words will bring peace, hope and light into dark corners. Her poems have been published in many e-journals and anthologies. She has published her own book of poems "Whispers of the Soul" and another titled "Tapestry Poetry - A Fusion of Two Minds" with her poetry partner Avril Meallem.
Shernaz Wadia
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