'Noble' Doc, regulate your greed first Prescription for doctors: regulate your greed

An online petition on  Change.org  to the Governor of Karnataka has been doing the rounds demanding the dismissal of Health Minister Ramesh Kumar. The petition at no point clarifies its real  grouse  against the minister – namely, his strong push to regulate, through amendments to the Karnataka Private Medical Establishments Act, the private sector, a move that has been supported by citizens' groups, health rights  groups  and  academicians.

The  petition  starts by accusing the minister of being "extremely intolerable, incompetent and highly corrupt,' who is 'abusing' the medical profession that 'he needs to lead, guide and promote'". He apparently, "out of his ignorance, lack of social responsibility/leadership and desperation, bordering on insanity is giving unwarranted, unsubstantiated and irresponsible press statements that are demeaning and detrimental to the noble profession of medicine and instigating unrest and undermining the very trust between doctors and patients".

Firstly, the  job  of a health minister is not to "guide and promote"  private interest but to look out for the health of every citizen, including the poor, the marginalised, the vulnerable and the voiceless. It is highly likely that the break-up of the 4,500 people who have signed the petition for removal of the minister would have zero representation from patients or government doctors and would comprise entirely the same group that has been  protesting  in loud voices against amendments  to the Karnataka Private Medical Establishments Act 2013.

Secondly, it is shocking that the doctors use words like 'insanity'  when as professionals they should know what the implications of using such language is, when they should instead be at the forefront to oppose such stigmatising labels.

Thirdly, the statements of the health minister are neither  "unwarranted, unsubstantiated nor irresponsible". The evidence about violations by the private healthcare industry is widely available with clampdowns by the  Centre  as well as several  state governments, the most recent being in West Bengal. It seems that the minister rather has a good understanding of dealing with the private sector, considering that the involvement of the  private sector  through government health insurance schemes in the state has only led to care becoming fragmented, unaccountable and more expensive to the government as well as patients, with patients  continuing  to have out of pocket expenses ranging anywhere from Rs 10,000 to Rs 1 lakh.

Fourthly, the responsibility for statements or positions that are  "demeaning and detrimental to the noble profession of medicine"  rests squarely on the shoulders of the very same profession that is now claiming victimhood. The medical profession has had ample opportunity to uphold the 'noble' nature of the profession by putting the patient's rights and interests above all else and by self-regulating itself. The highly commercial interests and lack of self-regulation of this so-called 'noble' profession have led to violations. Regulation of the private sector is no small step towards that accountability required of every service provider, particularly one who deals with life and death, and the government is well within its right to take on the role of regulator.

It is within their ambit for private doctors to make profits to meet their own costs and also for institutional and other expansions, but exorbitant  profits  is what has, in fact, led to the dismal undermining of trust that doctors have been vested with. The erosion of trust has been gradual, but at no point have doctors' groups felt the need to protect this trust. The supreme confidence that doctors have placed on this very same trust is what has led to wilful unethical treatments in many private hospitals –unnecessary  procedures,  exorbitant  costs,  unethical  clinical trials - the list is depressingly long.

In fact, it is of concern that despite the  negative  fallout of engaging with the private sector on health insurance schemes, the government is still pushing forward with the Arogya Bhagya  scheme  announced recently.

As emphasised by  Oxfam, the way forward for the government would be to realise that those countries that have been successful at reaching the poor at scale have done so by prioritising the scaling up and strengthening of public healthcare delivery rather than the ongoing promotion of an ever-increasing role for the for-profit companies.

The best that the private doctors of Karnataka should do if they really care about patients is to put forward regulatory mechanisms that they would like to enforce on themselves, apologise for the innumerable violations that have taken place till date, ensure grievance redressal for all those patients who have experienced negligence and violation, set limits on costs and stop viewing the government as an endless source of funds that can be squeezed to its last paise. This is the only way the 'noble' profession can be salvaged. Otherwise, they should call themselves a business with a purely commercial interest and stop hiding behind the 'noble profession.'

(The writer is a public health professional working on universal access to healthcare)

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