It is heartening to read a series of open page articles in the India’s national news paper recently which started a lovely debate about how the medical profession and doctor’s behavior is being perceived in this country . It all began with this article by Dr Araveethi with serious criticism of the ways and means , by which doctors indulge in forbidden unethical acts . (mainly involving financial benefits ) Click on the Image to read the article.(Hope it works)
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While most agreed with his observation surprisingly one response by Dr. Manoramma Gadde tried to justify it ! promptly evoked strong reactions for and against.
And this response from Dr .A.R Antony to Dr Manorama Gadde CAME A WEEK LATER seemed a best one. Read for yourself
I enjoyed the entire article by Dr Antony , especially when he observes ethical doctors are a rare breed and even be a laughing stock among their colleagues. This is very much true but as he rightly points out , the majority of goodness should prevail over the minority of evil . ( Let us hope it is not vice versa , as evidence is mounting against this assumption )
What is the role of modern science in making medical profession into a self less service to service only for self ?
Read on this article : Truths when silent are not heard in consultation rooms
Is there acceptable level of unethical acts for doctors ?
100 % perfection is never possible in any field .
Like permissible carbon levels in environment and permissible contaminant in tinned foods one can suggest doctors can also be allowed a quantum of immorality ! (This is akin to making corruption legal still the ultimate aim is to control it ) .Probably this is what Dr Manorama tried to convey in his article !
What is the patients role in the perpetuation of un-ethicalness of doctors ?
A patient with half-baked ( internet fed ) medical knowledge asking for various tests is quiet common phenomenon . This is termed as pressure prescription . Patient interference in medical decision-making and doctors yielding to it is also a rampant phenomenon. Empowering patients beyond a level is unreasonable or not a desired goal.
Why doctors continue to be noble but many hospitals are not ! How is this possible ?
We have willfully accepted medical care to become an industry .When corporate hospitals are listed in stock exchange what do you expect of them ? I do not know how the current generation of prepaid medical professionals manufactured from various medical education factories in our country side will behave . It is them , who are running these dubious hospitals and nursing homes . In my observation a genuine and meritorious medical student is never interested in starting a hospital or nursing home . He lacks both the business sense and also the resources . Hence he or she often becomes an employee of a hospital or institution run by capitation fee fed neo- medical graduates with Dalal street mentality.
Counter point
There are thousands of doctors especially in primary health centres and emergency wards working round the clock in all those ill equipped poorly staffed Govt hospitals trying to save lives desperately . Similarly many private practitioners sitting in the remote towns and villages spending their precious evening caring for the sick.
So , the problem lies mainly in the proliferation of pseudo – modern medical science in an unregulated fashion mushrooming into the urban and semi urban areas .
Solution ?
Never believe the private sector in the present form (*Total chaos) will provide an inclusive health care to our population. The recent WHO statistics say India is the only country where permanent assets like houses , livestock are sold by people to get a seemingly modern and scientific health care .(Poor villagers are asked to spend their entire monthly salary to do a costly PCR test (Now proved useless) to diagnose a AFB positive open tuberculosis !)
The current model of health care in most developing countries especially India , which our corporates are actively pursuing is counter productive for both rich and poor.
A rich old man is simply not allowed to die a natural death without spending a chunk of his accumulated wealth , while a young , active poor men of our country die for want of those same facilities which goes futile those dying elite bodies !
*Let me drift to a different topic . The private sector health care is totally disorganized , lies in complete chaos though enriched with infrastructure and other resources. What they lack is the terrible common sense. While the Govt sector has a organised administrative and functional model with huge expertise which lies mostly dysfunctional due to various reasons. Which is causing more danger to society ? The answer is tough one It would a close race between hyperfunctional private sector or dysfunctional Govt Sector .
I dream a day when these private sectors take over the Govt hospitals and vice versa so that both can complement the best between them.
Final message
Most doctors are really noble in their thinking. In few ,their action may occasionally touch the lines of immorality .( The definition of immorality or unprofessional acts are often reset according to our convenience ) .
Even if a conscious doctor wants to do genuine work in the existing system , he is rarely allowed to pursue it . So , in the current situation most doctors are at risk of tasting the bad fruit every day with or without their knowledge.
The doctrine of hospitals lack ethical code , while it is expected from individual doctors is the single important factor that is responsible for the present chaos in medical care delivery
So in my final analysis I agree with many of the arguments on both sides .Even though ethical doctors are available they are in a very short supply . We need much , much more . . . I am afraid the future looks bleak ! . . . with humble excuses to all optimists out there.
What is your take on this issue ?
Dr.S.Venkatesan MD 