Tuesday, March 25, 2014

How can we get doctors to improve ?


I sometimes despair when I see the deplorable state the medical profession in India today . Doctors are no longer held in the high regard which they used to be in . Even though patients still respect their personal doctor, lots of people feel that doctors are corrupt ( because they take money under the table) and unethical ( because they take cuts) and greedy ( because they over-test and over-treat in order to make more
money) . The reputation of the entire medical profession seems to be set on a downward spiral .

It's easy to blame the declining state of medical ethics on the fact that society as a whole is seems to put money before professionalism . Commercialism has become rampant and affects all of society, so why should we expect doctors to be immune to this. Also, because of the large number of private medical colleges set up by politicians to make a quick buck, new medical graduates will do their best to recover their fees by overcharging patients so they can get a return on the capitation fees they have spent in order to become doctors.

I see lots of examples of bad behavior on the part of doctors . They routinely demand money under the table ; do not provide the patients with receipts ; and not provide medical documentation of the treatment they have provided. Doctors can rationalize and justify their behavior – but the fact remains that this is wrong – and illegal.

So how can we get doctors to improve ? Passing laws never helps, because while passing them is easy and they look great on paper, they are practically impossible to implement in India in real life.

I think the real reason doctors don't improve is because patients allow them to get away with their deplorable behavior !

Sadly, Indian patients today routinely put up with the fact that

doctors perform underhanded activities such as demanding cash payments
doctors make them wait for hours on end ,
doctors are rude and uncommunicative
doctors don’t bother to explain what’s happening
doctors cover up and hide facts when there is a medical complication or error

It’s true that patients feel helpless and powerless ; and that there is a power imbalance in the doctor-patient relationship. When you are sick , the last thing you want to do is to challenge and confront your doctor. However, it is also equally true that by allowing doctors to get away with this behavior , patients are tacitly encouraging this, so that he continues to behave badly with other patients as well. As the Rabbis say - "It's not the rat that steals, it's the hole that steals". In other words, if the rat (aka the thief) would know that he wouldn't have a hole to conceal what he steals from others, he wouldn't steal.

Remember that doctors cannot survive without patients – and doctors don’t have a monopoly ! Patients need to learn to put their foot down , and say No ! If patients are willing to put their money where their mouth is, and refuse to tolerate bad behavior from doctors , things will definitely improve . It’s only when patients reward good doctors for good behavior and start punishing bad doctors for bad behavior will changes occur. The next you complain about your doctor, ask yourself – what did I do to fix the problem ? And if you are not part of the solution, you are part of the problem . If we refuse to take responsibility for our own actions , why should we expect things to improve ? The only reason doctors are on pedestals is because patients are on their knees !

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