Physician, Heal Thyself

Politicians never lose an opportunity to get traction from a system of controlling prices of cardiac stents as forced by courts and health activists.

Written by Amar Jesani | Published:March 7, 2017 1:07 am
stent price, cardiac stent price, stent price reduction, cardiac stent price reduction, cardiac stent reduction, doctors stent, medical community stent price reduction, india news Over decades, by ignoring the full development of public healthcare, the barrel makers of our country pushed a large number of doctors into private practice, making them entrepreneurs. (Express Archive Photo/Representational)

I expected the medical profession of the country to welcome the reduction of the prices of cardiac stents by 85 per cent with great jubilation. My expectation, and perhaps also of all those who trust medical professionals, emanated from the simple understanding that doctors have the best interests of patients at heart. A cheap life-saving device would facilitate their ethical commitment to do good for patients. But these expectations were soon belied. Doctors felt insecure, irritated, some even attacking price control and other regulations. Social media was full of lamentations by doctors: “Why do politicians hate us?”, “Society has unreasonable expectations from doctors”, “Lay persons will never understand how hard we work”, “A few bad apples should not make all of us look bad” and, “Why only we?”. Each dismayed remark was invariably followed by a long narrative.

Yet, to use the analogy of a famous TED talk given by renowned psychologist Philip Zimbardo, titled “The Lucifer Effect: The Psychology of Evil”, blaming only doctors as “bad apples” would not do justice to the evil within our healthcare system. Corporates making astronomical profits using unsavoury means, writing off bad debts and making ordinary people pay, allowing top managers to draw obscenely high salaries, all these factors have created too many “bad apples”. Preaching ethics is never going to turn so many bad apples into good ones.

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In my view, equally important is the barrel in which the apples go bad; that barrel is corporate-dominated, private sector-driven, for-profit healthcare where doctors practice medicine. A young doctor, who studied medicine by spending crores at a private medical college, would cherish the opportunity to get back their educational investment from such a system. The perceptions of their role many such doctors would have will be in line with other “apples” in the system — and not in line with the interests of patients. Medical ethics are easily trumped by this affinity, over an ideological conviction about healthcare.

Politicians never lose an opportunity to get traction from a system of controlling prices of cardiac stents as forced by courts and health activists. The barrel makers — who have encouraged healthcare to flourish in the private market — have presented themselves as friends of patients. Many doctors look completely taken aback; hence, their lament, “Why do politicians hate us?”; “We are not villains”. The irony is lost on them as they have aligned with the barrel makers and their policies.

What has brought the medical profession to this state? Ethics, with science, as basic tenets of medical professionalism once fetched the profession rich dividends. These made professionals respectable, trustworthy — even demigods — with society constantly ensuring their comfort and wealth. But unwavering loyalty to patients got corroded by the rise of a condition called “Conflict Of Interest” (COI). This is defined as a condition that exists when there is a secondary interest for the doctor competing with their primary interest — patients’ needs.

Over decades, by ignoring the full development of public healthcare, the barrel makers of our country pushed a large number of doctors into private practice, making them entrepreneurs. Many entrepreneur-doctors evolved into owner-practitioners of private healthcare institutions, and with corporate hospitals, doctor-administrators and investors. Add to this the system of earning from commissions levied on patients, shared between the pharma, medical device and hospital industries.

Therefore, many doctors have direct confluence with their secondary interest: This is highly pervasive. But doctors feeling anxious about a loss of trust from society are not able to recognise that they have converted the strict avoidance of conditions conflicting with patients’ best interests into the confluence with those conditions in daily practice. No doubt this will corrode the trust of patients and make them look like villains. The way out of the situation is neither lamentation, nor demands to make such confluence legal. Such efforts would only sink doctors deeper into a quicksand of social distrust. The truly ethical way is to end the present cosy relationship conflicting with patients’ interests.

The writer is editor, ‘Indian Journal of Medical Ethics’

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  1. B
    behera
    Mar 7, 2017 at 4:58 pm
    Healthcare is a mess in India. Where 80% people are poor, how can we make healthcare privately controlled. It can't be profit making machine. It should be discouraged. Fundamentally a person's wage doesn't take into account the expenditure for healthcare. It's a burden should helped out.
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      Dr.Basavaraj Modi
      Mar 7, 2017 at 8:24 pm
      Being a medical teacher of 40 years of standing experience ,now I'm very much dejected person. Gone are the days when doctors were commanding the respect of all strata of society including the richest and the policy makers. That was because the doctors were service minded,dedicated to profession and the patients. They were honest to core. Never indulged in duping the patients .activities. Never practiced the "cut" practice. lt;br/gt;lt;br/gt;They were so competent and honest that diagnosed the diseases just on patients' appearance, patients' history, and by the use of simple "gadgets" like stethoscope and B.P apparatus! The investigations recommended by them were few and precise. They were meant for confirming their clinical diagnosis. There was no underhand understanding with laboratories on commission. In fact no doctor had his own laboratory, even not a benami one.lt;br/gt;lt;br/gt;The drugs prescribed by him were very cheap and few.Here also doctors never ventured to have their own drug stores and never had cut practice understanding with the drug sellers.lt;br/gt;lt;br/gt;They used to refer the patients to competent super specialists but not to persons who had "underhand dealing" of commission.lt;br/gt;lt;br/gt;Then also many patients used to land up in complications, many used to die while being treated. But public never abused the doctors, never manhandled the doctors, never dragged the doctors to courts for compensation and punishment.lt;br/gt;lt;br/gt;This was simply because that doctors were respected for their honesty, service mindedness and compion. They were even considered as 'demi Gods'!lt;br/gt;lt;br/gt;Where have gone the days!?
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        Girish Rao
        Mar 7, 2017 at 1:42 am
        Dear doctors people trusted you with their lives and you will agree there are rotten apples too. Then how many doctors were deregistered by MCI none. Just as an example how many births in India are by c section done as compared to the international average. The above two points lay question to your credibility.
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          dr Vivek
          Mar 7, 2017 at 7:23 am
          I think you have got it wrong,It is only the interventional cardiologists are cribbing about the reduction in prices of the cardiac stents as they were getting huge commissions on insertion of stents.Please don't blame the w medical fraternity be cause of these cardiologists.Even various corporate hospitals are involved in this scam of stents.
          Reply