Physician, heal thyself

B L Razdan
Wherever the art of medicine is loved, there is also a love of humanity. – Hippocrates
Just two weeks ago, a long standing friend asked me for a favour. I was more than willing to oblige even as he told me that his relative would be telling me about the matter directly.. Only when the relative told me what favour he was seeking did I develop cold feet. The favour was to help his son overcome shortage in attending the classes at a medical college. I plainly told him that his son will become a doctor and rather than treating me, will send me to the bureal. And look at the audacity of the relative or the father of the prospective doctor when he said, “Sir, it is the unimportant subject of medical jurisprudence that he requires a word of recommendation in and not in any other subject.” I felt all the more sorry. The would-be doctor has scant respect for medical jurisprudence, does not take Hypocrates Oath seriouly, what kind of a doctor will he make?
When my mother had pulpitations in heart over two decades back, a cardiologist at the All India Institute of Medical Sciences had advised angioplasty. A private cardiologist, however, suggested implanting of a pace-maker. While I looked confused as to what to do, a friend of mine suggested consulting Dr. Mehta, a cardiologist in USA, where he had migrated after practicing for 10 years in London, and who was in India attending an international condiology conference in New Delhi. He fixed the appointment at his mother’s place in Noida on a day when he would be visiting her. As advised, accompanied by my mother and the reports, I reached his mother’s place exactly at 6 P. M.  Dr Mehta arrived at 20 minutes to 10 P. M. The first thing he did was to lay hand on the reports. He prescribed a medicine that saw my mother live for over two decades thereafter without any angioplasty, pace-maker or any other intervention. Could the advice of the Indian doctors have been motivated especially because pace-makers led to huge kick-baks to the prescribing doctors?  The cost of medical devices like stents and pacemakers is enough to give anyone a heart ache. Because the patients are being forced to pay double or even triple the price for medical devices at hospitals.
The commonly held view that doctors in general donot enjoy the same respect they used to not long ago and “have fallen in people’s eyes’ has found resonance in the Union health minister Dr. Harsh Vardhan’s views, when speaking on the eve of Doctors’ Day recently, he said that there is need to infuse a culture of introspection in the fraternity. It is noteworthy that Harsh Vardhan is himself a practicing doctor and his remarks have a ring of credibility around them when he says, “We have to acknowledge that the image of the doctor has somewhat fallen in the public perception. New positivity needs to be injected in our attitudes to correct this, as, it is not desirable to have a country without faith in its doctors”.. The minister’s comments come days after an editorial on corruption in the Indian medical practice by Dr Samiran Nundy, one of India’s leading gastroenterologists, was published in the prestigious British Medical Journal. Dr Nundy, who is chairman of the department of surgical gastroenterology and organ transplantation at Sir Ganga Ram Hospital, said that corruption was all pervasive in healthcare delivery in India starting with capitation fees for entry into medical colleges.
The article to which Dr Nundy had responded was written by Dr David Berger, an Australian doctor, who had volunteered in a small charitable hospital in the Himalayas. He spoke of how reference for an electrocardiogram (ECG) at a private heart clinic or other investigations attracted 10 to 15% kickback to the referring doctor. “I saw one patient with no apparent structural heart disease and uncomplicated essential hypertension who had been followed up by a city cardiologist with an echocardiogram every three months, a totally unnecessary investigation,” wrote Dr Berger.
“In many of our five-star corporate hospitals, where the main motive seems to be profit for the shareholders, there is an institutionalized system of so called ‘facilitation charges’ or fees for ‘diagnostic help’ given to physicians who refer patients regularly and for expensive procedures like organ transplants which may reach Rs 1-2 lakh,” wrote Dr Nundy, adding that doctors were confronted by financial officers of hospitals asking them to justify whether they deserved their salaries especially when the revenue they generated for the hospital from investigations and operations fell short of set goals. The “temptation” to do “unnecessary investigations like CT scans and MRI” and “unnecessary procedures like caesarean sections and hyterectomies” was “hard to resist”, he added.
Dr M K Mani, chief nephrologist in Apollo Hospital Chennai, told TOI that the practice of doctors getting kickbacks from any expensive operation or diagnostic procedure was pervasive and openly done. “In the case of doctors who have pointedly refused to take such ‘cuts’, it is given back to the patients as discounts. But hospitals have not stopped this practice and doctors who take such cuts continue to do so. In 1995, I had filed a complaint with the Medical Council of India (MCI) with all the relevant proof and yet the council took no action,”said Dr Mani. Dr Mani had been given cheques as “professional charges”by an institution for referring patients for a particular procedure. He wrote to the MCIl stating that its guidelines clearly stated that it was not acceptable for medical practitioners to indulge in fee splitting. Evem Ambani hospital at Mumbai has reportedly admitted to offering `incentives’ to the doctors. It is, therefore not without reason that there is a consensual view among eminent doctors across India that doctors play a key role in “the kickbacks and bribes that oil every part of the healthcare machinery”
The Medical Council of India is itself a den of corruption inasmuch as the Union Health Secretary known for integrity was transferred for resisting the re-induction of the once disgraced Chairman of the MCI. I recall a friend, who is a trustee of the Kasturba Gandhi Medical College having complained to the Prime Minister, Dr. Manmohan Singh that the MCI creating all sorts of obstacles in considering the increase in the seats of the college on merit even as it allowed such proposals from private medical colleges without adequate infrastructure. The PM rather than helping in the matter himself remarked that MCI is a very corrupt body.
Who does not know how Medical Representatives keep the practicing doctors in good humour only for prescribing the medicines of the manufacturer he represents. When I was in secondary school, decades vback, one of our teachers who doubled up as a medical representative gave up the teaching job because the pharmaceutical company whose sales he used to promote gave him a car. The malady of prescribing branded medicines instead of the generic medicines as they do in USA and Europe is clearly motived by the desire of making quick bucks through kick-backs.
And then there are cuts in the purchase of equipments, medicines, referrals and second and third opinions. The protocol visits to indoor patients by various doctors not at all connected, but only to inflate the bills are institutionalised ways of making a noble profession, corrupt and inhuman. It is particularly sad to see those doctors who have been the beneficiaries of the heavily subsidized medical education, instead of being grateful to the tax-payer, fleece him yet again. Physician, you are suffering from a chronic malady and need an overdose of Humaneness and a strong antidote for your greed. Please, for God’s sake, heal thyself.

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