Members of the Indian Medical Association (IMA), the nation’s largest professional society of medical practitioners, marched in New Delhi earlier this week to signal their protest on a range of issues concerning the profession. Every state branch was instructed to mobilise at least 1 per cent of its membership, including medical students, and every doctor in India was exhorted to participate in a “pen down” strike (implying that no prescriptions would be signed) while the “satyagraha” walk was in progress. Symbolically, the programme began at Raj Ghat; it was estimated that about 10,000 doctors took to the streets.
The IMA president justified this national action on account of the “injustices” meted out to the medical profession, exemplified by increasing instances of violence against physicians, the growing number of cases of criminal prosecution against physicians, the imposition of bills to regulate hospitals and nursing homes, and the “trampling” of the prescription rights of doctors consequent to the government’s diktat to use generic medication. He has been quoted to say that “there is absolutely no end to the injustice being heaped upon the medical fraternity and this noble profession”.
The IMA is absolutely right in demanding action to stop violence against physicians. This violence is consistent with the growing trend of vigilantism in India, leading bigots to murder those who are perceived to be eating beef, or the lynching of suspected thieves, substituting the due process of the law with criminal acts.
I do hope, however, that this national action also offers an opportunity for my fellow physicians to reflect on the reasons why there is rising anger, both in the community and amongst policymakers, which leads to the kinds of actions the profession is concerned about. If indeed we are a noble profession, why do our patients increasingly despise us to the extent that they beat us up? Why does the government implement policies, including disbanding the Medical Council of India, which has been denounced by the courts for its failure to regulate medical education and practice, which seemingly reduce the dignity and autonomy of the profession? Why are cases of malpractice and negligence on the rise? Surely these are symptoms of a serious trust deficit between the profession and the people of this country.
Most people, including most physicians, know exactly what I am referring to by the trust deficit. More than a decade ago, Transparency International published a report based on a survey of 5,000 Indians, which identified corruption in the health service as having the most impact on the people of this country, second only to the police. Shockingly, the report observed that “the key actors leading to corruption in this sector across zones are allegedly doctors followed closely by hospital staff”. Kickbacks for unnecessary clinical tests or referrals,
an irrational use of medical procedures for commercial gain, illegal payments from corporations in return for prescribing their over-priced products, and bribes for obtaining health care services are everyday examples, but this corruption now extends to even more disturbing instances of criminal acts, such as collusion with sex-determination and the illegal organ trade.
While enriching a few, these practices have had profound economic consequences, in particular for the poor. Unsurprisingly, while healthcare in most countries is viewed as a key strategy to enable people to rise out of poverty, healthcare in India is the leading cause of impoverishment.
And, to a large extent, the medical profession remained a mute spectator to this denigration of medicine’s basic values, reinforcing beliefs that the profession only responds collectively for its own interests.
My fellow physicians, I believe, that if we really wish to regain our reputation as the noble profession and be trusted by our people, we will need to radically re-imagine our way of practicing medicine, to become genuine guardians of the health of Indians. We will need to play an active role in addressing the shameful observation that India has, for a country with its economic and health resources, the worst health indicators in the world.
To do this, we will need to restate our commitment to evidence-based medicine, which champions the use of affordable and effective treatments through a universal health care system. We will need to actively cooperate with the government as it implements its progressive National Health Policy, and become an indispensable partner of the movement that is so urgently needed to repair our broken health care system. We should be advocating for and celebrating efforts to reduce health care costs. We should stand in solidarity with our people to hold the government and the private sector accountable when they fall short of their responsibilities.
When the government insists on our using generic medicines, instead of viewing this as an intrusion into the privileged relationship we enjoy with our patients, we should demand action to assure the quality of these medicines and ensure that the cheapest generic drugs are sold by chemists — we should welcome the government’s initiatives to strengthen the oversight of medical education and our own clinical practice, for we have miserably failed to do so ourselves.
And, most of all, let us stop serving the interests of our corporate masters, from the hospital chains which have commodified the most sacred aspects of our profession and our humanity, to the pharmaceutical and biomedical device industries, to which we have sold our souls for trinkets of gold.
So, as my fellow physicians reflect on the reasons why some of us marched through the capital, I hope we will also take a moment to question why the medical profession has plunged from being the guardian of people’s health to demanding protection from the people.
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