Thursday, October 22, 2009

Getting doctors to act as professionals

Many Indians will agree that the Indian healthcare system needs an overhaul and quite a few young entrepreneurs are trying out clever new ideas to help patients get better medical care. A good example is the use of PHRs to help patients become empowered consumers. The major stumbling block they face is getting acceptance from doctors.

We all know that patients will do anything their doctors will tell them to do. However, if you suggest they try something using their own initiative , which their doctor has not explicitly recommended , most become passive observers and flatly refuse. They feel that medical science is best left upto their doctor . They don't know enough to try to do anything about it. My doctor knows best is a very comforting mantra ( even though it may be false !)

Doctors play a disproportionately important role in the healthcare system. They act as gatekeepers; experts; confidantes and advisors, and pretty much control the patient's purse, heart and mind. While this is all for the best if you find a good doctor, what happens if your doctor has a vested interest which is not aligned with yours ?

The tragedy is that it is bad doctors who are the biggest hindrance to fixing the healthcare system. The key question is - Who will bell the cat ? While everyone has a horror story to share about how bad the new generation of doctors is; and how commercial the profession has become, no one seems to be willing to do anything to address this. It seems that it's always "another doctor" who is bad or corrupt or who takes kickbacks - not yours ! Why do we take such an ostrich in the sand attitude ? If we refuse to acknowledge the problem ( no matter how bitter it is), how will we ever solve it ?

It is a few bad doctors who have ended up giving the entire medical profession a bad name. I am a practising doctor, and this hurts me. All doctors end up getting tarred with the same brush, making a bad situation even worse. The young doctors will often use the bad doctors as a role model . It's easy to salve your conscience by saying - I am just doing what my seniors do ! Justification becomes easy. Even the honest ones start giving in to temptation. If everyone thinks I take kickbacks, then I might as well start taking them anway !

My purpose is not to take a "holier than thou" attitude or to criticise. The medical profession is meant to regulate itself but we have failed to do so miserably. Turning a blind eye does not help - it just allows the pus to fester !

Talking to bad doctors is unlikely to help - they are not going to improve their ways. Good doctors don't need to be told - they are upright and ethical anyway. So how does one solve this situation . The only solution is to ensure that patients understand enough about their medical problem and treatment options, so that bad doctors cannot take them for a ride. This will help to weed out bad doctors - and will encourage the good ones, who will automatically start doing even better !

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