Cure the doctor

Healthcare in India is a leading cause of poverty. The medical profession must own its share of the blame

Written by Vikram Patel | Published:December 21, 2015 12:00 am
 healthcare, doctor, healthcare in india, healthcare service in india, cost of healthcare,doctors in india According to a report, the cost of healthcare is driving millions of Indians into poverty.

Earlier this month, The Lancet published a paper calling for a radical transformation of the architecture of India’s healthcare delivery system if it is to achieve the government’s vision of assuring health for all. The paper documented India’s progress on major health indicators in the past decade, but also its many deficiencies. The most disturbing indicator of these deficiencies is the observation that the cost of healthcare is driving millions of Indians into poverty. Let us pause to consider the implication of this statement.

In a country where the primary goal of economic development is to help raise people out of poverty, healthcare is driving millions into poverty. Whereas, in other countries, investment in healthcare is recognised as a route to promote growth by enhancing their citizens’ capabilities to be productive, healthcare in India is now one of the leading causes of poverty. We are, in simple terms, out of step with the rest of the world, not only the developed countries whose ranks we aspire to join, but also with other countries like ours.

It is common to lay the entire blame, or at least the lion’s share, for this on the government. This is certainly true to some extent, but the reality is that many sectors must share this blame, not least the medical profession, of which I am a member. In most countries, the medical profession plays a central role in working with the government and civil society towards improving access to affordable, quality care. In India, though, the medical profession is adrift from any alignment with this vision and is, if anything, increasingly seen as being complicit in perpetuating our abysmal health care system, and as an obstacle to a progressive one.

Hardly a day goes by without us being reminded of how corruption of the basic values of respecting patient rights and promoting an evidence-based practice has reduced our professional standards to those where doctors effortlessly associate with crooked politicians and police officers. Consider some stories that illustrate this: Illegal payments for approval of and admission to private medical colleges; falsification of faculty records to meet the criteria for recognition of these medical colleges; unethical and irrational practices of unnecessary procedures, diagnostic tests and hospital admissions with a commercial incentive; kickbacks in cash or kind from companies or other physicians for prescriptions or referrals; fraudulent billing for insurance payments; lack of attention to quality of care leading to catastrophic health outcomes following routine surgical procedures; collusion with pharmaceutical companies to run “health camps” whose primary goal is to create markets for the company; and collusion with families to promote sex-selection.

While much of this corruption lies in the private sector, now the dominant force in healthcare delivery in India, it is equally the case that corruption is also evident in the public sector. Consider absenteeism to run illegal private practices and the lack of basic dignity in healthcare, both frequent observations in the public system. It would be fair to say that the reputation of my profession has collapsed since I was a medical student in the 1980s.

While many of my colleagues may argue this is unjustified, I doubt if any will deny that a radical revision of our healthcare system will need to be accompanied by a radical revision of the medical profession itself. This reform would need to begin from the very nature of the training our medical students receive, so as to prepare them not only to work in specialised urban hospitals but also in primary care in villages and towns.

The reform would need to extend further, much further, to regulate the quality of care delivered, to make costs of care completely transparent in the spirit of the Right to Information Act, and to hold doctors (and hospitals) accountable for wilful lapses. The most formidable challenge to this goal has been the complete squandering of the golden opportunity afforded to our profession for self-regulation through the Medical Council of India, which is itself accused of grand levels of fraud and has singularly failed to achieve its mandate to uphold the high standards of medical education and quality of care. Any reform must begin with a root and branch re-engineering of this moribund body. Ironically, while we have failed to effectively regulate ourselves, our profession has also mounted a robust opposition to independent efforts to regulate us, for example through the clinical establishments act. This leaves an increasingly disgruntled patient community to resort to the consumer protection act and the criminal courts to hold us accountable. This procedure only poisons the precious relationship between our profession and the community we serve.

Whereas the erosion of many fundamental values, such as that of providing scientifically grounded care in an environment of respect and dignity, will require a significant revision of training and continuing professional development, attending to commercially driven malpractices is more amenable to immediate action with potentially profound impact on impoverishment due to healthcare. The Jan Swasthya Abhiyan recently demanded that “all payments of kickbacks and commissions” be declared as illegal and compliance be

The writer is a psychiatrist with the Public Health Foundation of India and the London School of Hygiene & Tropical Medicine. He was lead author of The Lancet paper, ‘Assuring health for India’s people’

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  1. P
    Prasad Kulkarni
    Jan 15, 2016 at 3:57 pm
    Good article
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    1. K
      K SHESHU
      Dec 21, 2015 at 6:56 am
      The commercialisation of medical profession is not only eating into the pockets of the poor, but it is creating unwantedside-effects as the medicine prescribed is often not needed by the patients. There is a large nexus between the doctors pharmaceutical companies and the governments. The doctors try to collect their education money with interest by charging exorbitent fees not just per visit but for number of visits a patient has to go round in order to cure himself of the desease. The doctors deliberately administer low dosages alongwith 'vitamin' capsules and ask the patient to 'visit' him in a couple o days. Sometimes the patients are forced to take the help of quacks in inffordable situations. The government hospitals are pathetic to the core. Hence, a proper system of healthcare is urgently required.
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      1. D
        D
        Dec 21, 2015 at 1:24 am
        The engineers set us an example many years ago by becoming organised and initiating the jee and having aicte as approving body. Today there is no dearth of engineers in India. We export them abroad. But doctors are harsh to themselves and unkind to their colleagues and excel in fault finding and making money only. Until the w system is re organised there is not much hope in improving the system. The MCI and state bodies are in name only. How to do it would be a herculean task made worse by managed care being practised today. India is a healthy country by and large :our huge potion clearly reflects it so what if half of it isn't healthy and that may be the biggest reason why the government is loathe to invest in it.
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          Anand Mohan
          Dec 21, 2015 at 5:14 am
          In India the kick backs from pharma companies (which have rich treasury) to doctors can not be stopped till doctors are banned from prescribing bed medicines/ healthcare goods
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            Rajesh
            Dec 21, 2015 at 7:59 am
            I find this hard to believe. India has a lower healthcare cost than most countries. Its why people from around the world come here as part of medical tourism. The first thing poor people need to do is stop reproducing. Poor people cannot afford to feed themselves, then they produce 10 kids, cannot feed them, cannot educate them and they grow up to be poor too.
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              Biltu
              Dec 20, 2015 at 11:00 pm
              THIS IS A LONG WINDED ARTICLE WHICH DOES NOT PROVIDE ANY SOLUTIONS. IF THE GOVERNMENT CANNOT PROVIDE HEALTH CARE FOR ALL CITIZENS THEN IT SHOULD INVITE CHARITIES FROM ABROAD TO COME AND PROVIDE HEALTH CARE FOR EVERY CITIZEN .
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                Brahm Gaur
                Dec 21, 2015 at 9:44 am
                India lacks effective legislation to regulate the medical profession. In the absence of effective regulation the medical profession will only adopt practices to maximize its profit. The main problem, we don't have any system in Australia. You are caught while practicing illegally you can always find some political connection or bribe. But nothing will happen to you. In the western world if a doctor is found breaking the law then his license is cancelled. This can also happen to the big hospitals too. In India you can always evade the law.
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                  Brahm Gaur
                  Dec 21, 2015 at 9:45 am
                  India lacks effective legislation to regulate the medical profession. In the absence of effective regulation the medical profession will only adopt practices to maximize its profit. The main problem, we don't have any system in India. You are caught while practicing illegally you can always find some political connection or bribe. But nothing will happen to you. In the western world if a doctor is found breaking the law then his license is cancelled. This can also happen to the big hospitals too. In India you can always evade the law.
                  Reply
                  1. K
                    Karunakaran
                    Dec 21, 2015 at 2:14 am
                    Mr Nitish Kumar is indeed “prime ministerial material”. The entire India as well many non-Indians recognise him as “the most competent and honest chief minister in the country”. As there is an absolute guarantee that the current accidental PM cannot continue in Delhi, Mr Nitish Kumar needs to prepare himself to be India's next PM. Mr Nitish Kumar is not only an able national leader, but also is recognised world-wide as a dignified statesman. India can at last heave a sigh of relief of having a leader that is not going to run after the goras for a selfie. The goras are not that special. But who is going to tell the primary-school qualified chaiwallah that?
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                      DA
                      Dec 21, 2015 at 10:17 am
                      The facts are much more pedestrian, dear Doctor. Political compulsions of social justice mean that most medical seats are wasted on people that shouldn't ever wield a stetho or a prescription pad. Cast aside by the system, the best doctors proceed to train abroad. Many return, their services by now well out of the reach of ordinary people. Many never return. Medicine should be spared from the compulsion of caste politics - the cost we pay is not merely in unfairness, but in actual human lives.
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                      1. J
                        Jacob Vadakkanchery
                        Dec 22, 2015 at 1:19 am
                        congratulations
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                        1. N
                          Neptune
                          Dec 21, 2015 at 8:39 am
                          Medical students are exposed to CORRUPTION right at their entrance to a medical college. They pay through their nose for a seat. Blame lies elsewhere too.
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                            GSY
                            Dec 21, 2015 at 1:58 am
                            Any State which can not provide basic health care and education to its citizens is not worth its salt. Unfortunately successive govts in India have abdicated their responsibility to provide these fundamental services . In India we have one of the lowest doctors to potion ratio. There has not been any significant addition in medical seats in govt run colleges in last many years. Pvt medical colleges are beyond reach of majority of potion.
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                            1. K
                              kk
                              Dec 21, 2015 at 11:41 am
                              Dr Vikram Patel, you please suggest what and how you would like t o change the health system , please give your frame work so that some positive discussion can start. we are all aware of problems but no idea of how to bring change to it .
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                                Kirit
                                Dec 21, 2015 at 2:20 pm
                                Failure of India to control potion is major reason why India has so many ugly problems. Rate of potion increase is very high that India simply is unable to cope with. Example: India's potion in 1700 was 190 million. it was 350 millions in 1947. That means it took more than 250 years to double potion. Since 1947, India's potion is increase 4 folds just in 68 years. It is not sustainable.
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                                  Kishore Karnad
                                  Dec 21, 2015 at 3:55 pm
                                  For decades now, this once nobal profession has been sliding downhill into a ruthless business with a single, selfish motive: profit, profit, and profit- at the cost of society which doctors are supposed to care for. Unfortunately, this pernicious phenomenon is not restricted to India. Per say, there is nothing in wrong in doctors turning into business, but our doctors forget that even business can be conducted ethically, lest it is perceived as a fraud and swindle, and that, precisely, India's healthcare has turned into. On the other hand, one must consider the tremendous increase of 'input cost' of this business---mounting of privately run medical education; cost of starting and efficiently running hospitals, shortage of trained para medical and nursing staff; mounting expectations of patients , to name a few. One solution is for States to start a large number of clinics run by medical staff that is trained to address the commonest health problems at modest costs eliminating unnecessary and expensive tests. As for MCI, the less said, the better. This body is perceived as a thieves kitchen protecting and promoting ills that healthcare in India is suffering from. The rot is as difficult to correct as removing Delhi's pollution or finding an honest babu'
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                                    Nagar Iyer
                                    Dec 21, 2015 at 7:51 am
                                    Not necessary to invite anybody from abroad. In fact the basic reason for the collapse of our HEALTH SYSTEM is EXTERNAL INTERVENTION. To make India a healthy nation with a HEALTH FOR ALL achievement, we have to first ban ALLOPATHY - which is a poisonous system. REVIVAL OF AYURVED WITH YOGA INTRODUCED IN SCHOOLS &COLLEGES will bring back those glorious days when the % of sick people in India was only 4. TODAY WITH ALL THESE SO CALLED DEVELOPED MEDICAL SYSTEM, 70% OF THE INDIANS SUFFER FROM SOME DISEASES AT ANY POINT OF TIME.
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                                      Nagar Iyer
                                      Dec 21, 2015 at 7:45 am
                                      To achieve HEALTH FOR ALL, abandon ALLOPATHY & implement AYURVED ----------------------------------------------------------------------------------------------- ALLOPATHY is not a MEDICINAL SYSTEM. - ALLOPATHY is a system of FRAUDS run by FRAUDSTERS to fleece the gullible & unsuspecting patients. - ALLOPATHY neither cures any diseases nor has the capacity to prevent diseases. - Ban ALLOPATHY & revive our AYURVED throughout India. - AYURVED with a judicious combination of YOGA will prevent almost 90% of the diseases & can effective cure 10% of the diseases.
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                                        Niladrinath Mohanty
                                        Dec 21, 2015 at 2:07 pm
                                        The author has put the cart before the horse and has no idea of India' rural poor and has borrowed the idea of health care from Lancet. The first thing we should have done was to invest in education and it would have taken care of aspects of basic hygiene as well as potion control. It would have also contributed to skill development. We have not done enough for economic empowerment of people in rural India. If people have money they can take medical help. I have seen this happen in a tribal village in a poor state like Odisha way back in 1982. When corporate social responsibility had not become a buzz word a particular corporate house had undertaken to economically empower the villagers.
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                                          rajan Karunakaran
                                          Dec 21, 2015 at 2:26 pm
                                          The author also would have taken lesson from healthcare in Kerala which is having life expectancy of developed states. The authors opinion that lack of healthcare cause high poverty is correct. M awareness about need of cheat healthcare from group insurance of mediclaim from banks and other sources also awareness about governments m medical benefits is also needed among mes.
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                                            Rajendraprasada Reddy
                                            Dec 23, 2015 at 1:48 pm
                                            Good article.
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