Dissenting doctors seek cleansing of greedy medical practice

A patient sought a second opinion for an existing heart problem and was again unnecessarily subjected to all the investigations that had been earlier done during the first consultation. On enquiry, the patient was consoled that this is all just a ‘routine matter’ in every hospital and that is how it works. This has been the experience of most patients that have utilised the dominant private health provider in India.

In fact, there are several other facets which include excessive and irrational medications, procedures, surgeries and investigations. In addition, kickbacks for referring substandard care with unethical practices leading to gross violation of patient's human rights have become part of the well-established private health sector. During several informal discussions, many people recount a variety of negative experiences with great disappoint while being treated in private hospitals.

The patient is often in a helpless situation and during these critical hours of ‘life and death’, he is more often unable to take any logical decisions. All these create a feeling of being totally helpless.

This is one side of the picture. Has anyone at any given time wondered as to what is the state of mind of doctors who want to be ethical, rational and want justice to be delivered to their patients? How they wished that there was some platform where the doctors could pour their hearts over the existing ruthless system and perhaps even build on it a system that works and brings in useful changes.

Until now, this was just a wish and a distant dream but the winds of change seem to be blowing. A group of doctors have courageously come forward to document by holding up a mirror to their own profession. There is rage in their statements. Yet, at times, they seem helpless at the state of affairs of their own once ‘noble profession’.

The lead for this so called beginning of the cleansing has been conceived and initiated by Dr Arun Gadre with a team of his friends in and around Pune. Initially, he went around and contacted his friends’ circle and slowly expanded to several metropolitan cities as well, who shared a similar vision. Dr Gadre, himself a practicing gynaecologist in rural areas, was well aware of the exploitative system and decided to interview other doctors after preparing a simple questionnaire. Over a period of a decade, with continued persistence and perseverance, he compiled the confessions of 78 doctors from all over India.

The interviews by these practicing doctors and some leading consultants in the private sector shatter the myth that is created by members of the medical bodies that there may be few ‘black-sheep’ and that everything else is fine. On the contrary, the interviews bring out ugly facets of the deplorable decline in ethical standards due to a high degree of commercialisation. They point to a serious and ugly reality.

There is anger and frustration expressed by these doctors on many of the irrational and unethical practices that are rampant and abundant. A vast majority of these doctors often have a tough time as they continue to struggle every day to maintain a good distance from the jaws of unethical and commercial practices.

Testimonies of doctors

Most testimonies bring out the various facets of the unprincipled practices. But the one by Dr Vijay Ajgaonkar, a senior practicing diabetologist from Mumbai who has given extensive evidences says, “Huge corporate hospitals put pressure on all doctors linked to the hospital, and on their full-time employees. They demand that they must send a certain quantum of business to the labs and the radiologists. There is no doubt that this practice has become commonplace. Unnecessary investigations are then forced upon the patients. The unfortunate patients are often trapped. They keep running from one big hospital to another”.

Dr Shyam Kagal, a physician in Pune says, “I know a gastroenterologist who performs numerous endoscopies on the same patient, when one is sufficient”. Dr Sanjay Nagral, a surgeon from Mumbai recounts painfully that “the criteria of doctors’ success have changed. Now, the successful doctor is one who has a big car and earns a lot of money! Due to this, everything is now dictated by the logic of money. The very structure of private medical practice has become such that there is no place left for ethics”.

Evidences one after the other by these various doctors from divergent specialities bring forth the anguish and pain as they keep the struggle on. The news of these statements seem to be spreading slowly as evidenced by the coverage this issue got in the prestigious British Medical Journal of March 2, 2015. Reacting to these testimonies Dr Samiran Nundy, a gastrointestinal surgeon at Sir Ganga Ram Hospital, New Delhi, mentioned to the BMJ that “I’m optimistic that this campaign will expand – such a movement gains credibility when it is driven by doctors”. He further added that “the silent minority must try and do something about it.”

But the picture is definitely not rosy as the forces acting against these doctors are much stronger and have powerful lobbies including the huge corporate hospitals. There is an intense and genuine fear that such ethical doctors may soon become endangered species. If such a situation has to be avoided, then the government through the Medical Council of India (MCI) must proactively create structures and mechanisms that would ensure protection of rational and ethical medical practice. (References:  http://privatehospitalswatch.org)

(The writer is President, Drug Action forum, Karnataka)