Thursday, Dec 18, 2014

First, give the patient right to know

doctr It is not surprising that the end result is a practitioner who not only lacks adequate knowledge but is also deeply in debt and has at his mercy a poor, ill-informed and trusting patient.
Written by Samiran Nundy | Posted: June 30, 2014 12:02 am | Updated: June 30, 2014 9:57 am

A recent article in the British Medical Journal entitled “Corruption ruins the doctor-patient relationship in India” made me feel quite ashamed for my country and my chosen profession. The author, David Berger, a district medical officer in Australia, recounted his experiences as a volunteer physician in a small charitable hospital in the Himalayas and concluded that “kickbacks and bribes oil every part of the healthcare machinery”, and suggested that the will to reform it promptly from within the country seems to be lacking.

After working here for 38 years, both in the public as well as in the private sector, I could not, unfortunately, agree with him more. The process of individual corruption starts early, with the capitation fees for entry for the MBBS course in many of the now ubiquitous private substandard medical colleges, which are mainly owned by politicians. There, the student encounters poorly qualified and disinterested teachers and, worse still, few patients from whom to learn. He or she then appears in the final examinations, where there may have been pressure put on examiners to pass him and his colleagues, who hardly then deserve to be called doctors. It is not surprising that the end result is a practitioner who not only lacks adequate knowledge but is also deeply in debt and has at his mercy a poor, ill-informed and trusting patient. Can we expect him to be ethical when, to survive, he has to compete against colleagues who are giving kickbacks or “cuts” for referrals and receiving them in cash-filled envelopes from imaging centres and laboratories? The temptation to do unnecessary investigations, like CT scans (Rs1,500 cut) and MRIs and perform unnecessary procedures in the form of Caesarean sections, hysterectomies, appendicectomies and other operations for cash payments, must be difficult to resist. And this does not only affect the doctor in a single-handed practice. In many of our five-star corporate hospitals, where the main motive seems to be profit for the shareholders, there is an institutionalised system of so-called “facilitation charges” or fees for “diagnostic help” given to the physicians who refer patients regularly and for expensive procedures like organ transplants, which may reach Rs1-2 lakh. The senior doctors, we are told, whose pay is in astronomical figures, are visited by neophyte financial experts at the end of every month with sheaves of financial data and asked to justify whether they deserve the salaries [they] are being paid, especially when the revenue they have generated for the hospital from investigations and operations falls short of certain set goals.

And this corruption is by no means confined to private hospitals. Talking with colleagues in the public sector, it seems that to get selected and promoted or avoid being transferred from a comfortable job to continued…

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