Medical profession is the noblest of all ! . Doctors are akin to God in many ways ! They have the potential to remove the sufferings of mankind . These are the often made quotes about doctors for many centuries. Today’s medical professionals are , a strained lot to fulfil their role expected of them .They have to maintain the social identity and earn enough to sustain their image in society. The onslaught of commercial and pseudo-scientific concepts have ruined the profession considerably.
Those were the days when the family physician concept was flourishing , where in a doctor was taking care of entire family. This concept has taken a different avatar now .
Now a doctor feels , once the patient is seen by him becomes his/her patient rather a property! This perception has grown in a malignant manner , many doctors do not refer to a specialist even in deserving cases fearing patient poaching .
This possessiveness of doctors about their patients leads to many of the unethical behavior .
My case . . .my patient . . . my fees , . . .this sort of approach though appeared good in the past , is rapidly becoming a liability for the patients .Lack of organised health care by private and Government sector also amplifies the issue .It is pathetic to note , at least Govt hospitals have some accountability , majority of private health systems do not have mortality or morbidity auditing .
The my patient, my property doctrine is playing havoc in medical health delivery system .The following are the situations where a patient genuinely suffer due to this abnormal thinking pattern of many of the medical professionals today.
- When general practitioners want to have control of their patients even after referring them to big tertiary care centres.
- This is being encouraged by the corporate desk of big hospitals as they probably send financial benefits to the referring doctors. Hence doctors are worried their property may get lost during transit or inside the big hospital. There are instances , I have witnessed , where severe mitral stenosis are manged medically by some established physicians fearing that their property will be lost .
- Patients with severe angina are not offered angiogram and remain on medical treatment fearing loss of monthly consultation fees.
- When the care takers energy and thought process are consumed in many non academic activates one can expect how the illness can be taken care off.
- When investigations are ordered the primary referring doctor feels he is being denied of kick backs from costly investigations which is enjoyed bu the specialists .so these general practices what to finish of all required investigations in their desired lab and sent to the specialist.
- This has led to curious situations where a ENT surgeon calls for a 64 slice CT scan and obstetrician asking for MRI brain ( because the patient is theirs ! )
The sequale is two fold .
The specialist often gets annoyed and feel insulted to read an investigation ordered by a different physician( rather irrelevant physician !) done in a non friendly lab without incentives.
- Either he looks at it reluctantly
- Or orders fresh investigations
(Some physicians show extreme arrogance , as they call for fresh investigation even if the patient is having good quality , investigations with images done recently !)
Finally , the most dangerous thing
A patient once admitted under a doctor, the prescriptions and procedures are often controlled by the admitting doctor .We have seen a pathetic situation of plastic surgeon admitting a rheumatic heart disease and trying to manage with the help of telephoning consultations with a cardiologist .
There is a chaotic discipline in ordering Investigations and treatment modalities in our country .Any one can order any thing they want .In this scenerio, abberrant patient behavir leads to further complications as patients themself decide what investigations they want.
What is the solution* ?
The concept of family physician is still a best option . It has to be continued. There need to be a proper referral services into well equipped, staffed , audited institution in every district and counties either controlled by Government or well-regulated. private bodies . The financial remuneration for the doctors should be constant and fixed irrespective of the form treatment they provide.
In other words the entire health care delivery should be centralised and institutionalised .The need for specialist to be assessed properly and care should be rationed .
Consider this anarchic situation – An asymptomatic, incidentally detected 30 % PDA lesion in a rich, bed ridden , old man is stented by a 3rd generation drug electing stent in a corporate hospital, while many young Indians with a productive life with critical left main .proximal LAD is allowed die in peace .
Where are our medical economists and health care planners hiding ? ! And we are talking about billion dollar medical tourism industry .
A general practitioner should receive same amount as consultation as a neurosurgeon or cardiologist .If we divide the doctor into different grades according to the knowledge and place of work , the lesser doctors will find someway to equalize their earning with their superior colleagues.
After all , all doctors take the same oath . . . A doctor who treats a febrile convulsion in a remote village by administering a timely diazepam injection can not be considered unequal to a Cleveland neurosurgeon who clips a AV malformation in the circle of Willis to terminate recurrent convulsion in a similar child .
* One would tend to think , these solutions are highly theoretical not implementable in today’s world. But trying to bring order to a dysfunctional medical care delivery system is not a crime any way !
Final message
Most doctors continue to be noble and dedicated. But the faith in them is rapidly eroding .This is becoming a dangerous trend . They can not to be blamed in isolation. It is the dynamics of social and economic scenario that are driving the medical profession in a journey towards a commercial extravaganza , where humane care is as obsolete as a Mediterranean dinosaur !
Now young doctors are readily manufactured in the countryside (Not my merit , but bought as commodities akin to real estate) . A three bed room flat and a MBBS seat roughly costs equal in India !
There is no wonder then , doctors will treat their degrees and patients as precious property . Nothing wrong to consider them as their property , but let them handle the property with at most concern , faith and trust !
Disclaimer *This article does not intend to defame any doctor or medical profession . It aims to encourage a wider debate on the issue . This is about many physicians which we come across everyday in our towns and cities .This article may be irrelevant in many other countries and to those physicians working in a completely institutionalised health care delivery system including Govt .hospitals where the collective care (or is it collective no care ?) is the norm .
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Dr.S.Venkatesan MD 