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.
Watch what else is making news
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.