Wednesday, July 09, 2014

Diagnosing Indian Doctors

A friend forwarded this email to me. I think it's worth sharing and hope it will nudge you into treating your doctor with a little more kindness.

I am grateful to my patients. Helping them get better adds meaning to my life. But the way in which doctors are being maligned today makes we wonder if it's worth continuing practising medicine anymore.

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Recently read a flash news about Eminent Doctors taking cuts / referral fees. There cannot be any justification. But if a whole system based upon corruption, a whole society facing inflation expects only one of its components to be sane, it’s insanity.

Hence these thoughts.

I apologise in advance if this hurts some feelings. This isn’t a placebo though.

For the “Nautanki” people who appear so shocked to hear about corruption in the Medical field, here’s the naked truth: There is corruption in every aspect of every field including religion, law and judiciary, government, politics, police, press, military, film industry, YOUR FIELD, and also medicine, as the doctor is a part of this very same society, not from Mars. There is corruption in every aspect of medical field: referring a patient, lab tests, CT/MRI, Surgeries, Cross referrals, almost everything.

But as in every field, there are people who do it by choice, there are some who have to be a part of the system to survive in India, and some who refuse to be a part of it all, facing many other problems including a perpetually low income.

Think Simple: why would a person with highest of merit, hardest of hard work, tendency for helping others want to become corrupt? Not by choice. No one becomes a doctor for greed (Someone might attempt, but these people drop out in the first six months or a year: Those not dedicated to a hard life cannot endure medical education in India).

Every doctor wants to do good to his patient and also live a decent life. After a lifelong meritorious career, why should he be expected to toil in villages / rural areas without any rewards for it? Why should he not want his kids to go to the best schools? Why should he not want a decent lifestyle? Why should one give up a lucrative career in the west and return to the homeland feeling patriotic, to just be told that in your own country you are doomed to a life of sacrifices just because the society expects so?

“Someone who wants money should not become a doctor” said a dropout actor who is seen doing all immoral things (from peeing openly in a garden for press in real life to cruel crimes and revengeful murders on film: while running a show to change India to an ideal country.. I hope he and his family only use Indian things, medicines etc.). Why?

Why should a doctor not want money for a decent life? Why should he endure the humiliation of so many non-meritorious people from his class living in luxury because they chose not to be a doctor, while he chose the noble profession? Listening day-in and day-out to patient’s problems, tears, cries, allegations, threats, and expectations, not ever having a peaceful sleep for a week at a stretch, not eating in time, not having enough time for family, why should a Doctor NOT want to earn well?

We are not supposed to refuse a case in emergency. Do the Judiciary or Police or Politicians do that?

We are fined crores for medical negligence. What if the Judge is wrong? What if the police are wrong? What if the politician is wrong? What do they pay even when proven wrong? Why the presumption that the negligent doctor’s intention was bad? Negligence is possible in all fields (reactors/ bridges/buildings/ food/ trains/ public transport), can cost life in many, how come the doctor alone pays in crores for a life that he was attempting to save, while in all other cases the motive was profit, not saving life…?

How come the judges decide the amount of fine? In a recent case, the fine was in crores. If the patient had survived, would the court have ordered the same payment for the doctors? Doctors save millions of lives. Some through heroic /exceptional efforts, without thinking of rewards. If a young patient is saved, shall we charge according to all the income he can make all his remaining future? Than why this criteria for fines?

World has become a global village. People travel to the developed world often. Highly specialised doctors in India are expected to be at par with their western counterparts. They often are, because half the world travels to India for medical advice.

But the Indian community is yet to awaken to the Doctor’s fees. An average specialist in the developed world charges between 10,000 to 30,000 INR for the first consult. Appointments are very difficult to get. They don’t work out of 8 am -4 pm slots except in emergencies (some honourable exceptions). And yet they get so many benefits from the hospitals they work at, and also from the government. THEY SEE NO FREE PATIENTS. Most doctors live in luxury in the western world. An Indian doctor on an average charges 200-1000 rupees for an OPD patient. Sees many free patients (almost 40-50%) everyday. Continuously has to be occupied with: 1. Patient’s health and benefit 2. Relative’s expectations, their anger (many think that every patient must get well irrespective of his / her health status). Many hold the doctor responsible for their illness / failure to improve/ complications. 3. Continuous suspicion: Many patients think Doctors are out to loot! Every investigation is with an intention to get more profit out of the patient. They want the best, but like “sabji”, they want to bargain. 4. There is also a widespread belief that pharma industry is actually serving the doctors, not patients. 5. Google searchers who think they know better medicine just because of what they recently read about a tiny drop in the ocean of medicine. They eat up a lot of time, but don’t want to pay for that additional time. 6. The very relatives who shout at the doctor seldom know what medicines the patient is taking: it is all supposed to be the doc’s responsibility. 7. So many Toms, Dicks and Harrys coming over and threatening: this is everyday nuisance in ALL casualties in India. There is no sensible Director in Bollywood to have realised a Doctor’s plight while working under threat in casualty. Everyone loves the populist “Doctor-Threatening” hero!

Then the seemingly innocent weapon (The secret bleeding wound in many a Doctor’s heart!!)

“But Doctor, You are like God / Next to God. The whole society respects you”

That respect is divine for us, that respect and the satisfaction of doing something godly by saving lives, helping people live better lives alone keeps us from going on and not quitting the profession for better incomes. Don’t you think we had the options of making more money had we used our talents elsewhere, especially in today’s IT world?

But that respect does not substitute for our children’s fees. Not for our rents, electricity, travel ANY expense. Almost all doctors and their family members end up paying full bills for themselves at the very hospitals that they work in… some minor exceptions. Everywhere a doctor goes, he pays the same money that any other citizen. There isn’t a separate queue for a doctor anywhere in any office just because he / she has patients waiting. There is no pension. There is no security. I can show you some highly successful (in patient care) ethical doctors who can’t pay for their own treatment TODAY!! If a doctor is sick, his / her income is zero as long as he does not work: No one cares if he has treated hundreds for free. The respect does not substitute for the stress a doctor bears: of years of listening to and attending pain and tragedy, years of sleepless life, fasting days, lost precious time with dear ones.. as with anyone else, the DOCTOR ALSO HAS ONLY ONE LIFE… WHICH HE CHOOSES TO SPEND HELPING OTHERS.. is it a crime to be living well for such a person?

And if Doctors are next to God, very respectable, how come their mistakes become villainous immediately when something goes wrong?

As for the other side:

There are corrupt doctors, corrupt practices. But please understand, a single doctor did not create them, nor did a group plan them These developed over time as the system evolved. One had to fall in line or quit the profession in want of better life. Like in every field, there are greedy among doctors. They ruin the reputation. But a single doctor cannot do anything. Those who try to change the system are boycott, thrown away, maligned. There are some continuously fighting this.

Every doctor cannot afford to start a hospital of his own. He has to choose a specialty hospital which has all the facilities to practice his specialty. These come at a price. I appeal the people who feel bad about investigation prices to just enquire the rates of the machines/skills/ licences/ manpower/maintenance required to make these facilities available. The government makes it compulsory to attend many of its employees free / at subsidized rates, and never pays.. who will pay for them?

So hospitals have their systems. A single doctor cannot change them. Also, not all hospitals are corrupt.

The Medical councils do not have any protocol / system to protect a doctor who faces vindictive attitude from hospitals if he / she wants to argue. Many specialists DO NOT RETURN TO INDIA OR HAVE ALREADY LEFT INDIA AFTER RETURNING due to this one reason. Because specialist practice is based upon referrals, and where most of the referral system itself is corrupt, one has little hope of survival especially in a decent city / town.

Doctors who want to run their own hospitals face same bribery, same licencing scams, same corrupt government practices that any other business does. The rates are probably higher, and the regulations stricter.

Doctors are a weak vote bank., hence not on priority of any party. It is more practical for the politicians to openly criticize the doctor / profession in hope of gaining public sympathy / attention. No one wants to attend to their problems, which are many.

The medical council never protected any doctor against court cases or hospital victimising them for fighting against corruption. The regulations made are ancient, primitive. When a whole medical system is corrupt in almost every step, they have taken the approach of superficial actions against individual cases: typically populist and sensationalist. The medical councils KNOW every aspect of corruption, but have opted to fit in some screws where the whole building needs extensive repairs. One’s degree and education of fifteen years becomes meaningless in the eyes of medical council just because there is delay in renewal of licences. How can rules be applied only partially in a system? While many people practice without degrees or knowledge, the councils choose to target the qualified for not renewing their licences: a process that involves acquiring CME points, the money for most such events, travel etc comes from pharmaceuticals, the patient pays. They do not have the online option of CME / licence renewal like most western countries, even in this advanced age! So a doctor is expected to leave his town and practice, get involved in events sponsored by pharmaceuticals, travel with help from pharma companies, stay in hotels with their money so as to renew his licence. But not online. And there is no compulsion that he has to attend the event for his specialty. So a Neurologist could attend a gynaecology event just for CME points and its ok for the renewal of his Neurology licence!! One can easily get such CME credits without attending the event! There has to be an online option, or a rethinking of this whole business. And an option to do it without involving pharmaceuticals.

The whole Mediclaim business in India is a fraud: they don’t pay for

1. OPD consultation / investigations of a patient: even if serious. 2. Patients with genuine illness, but without injectables or surgery. 3. When they do not understand the diagnosis or the fact that some cases do not have a proper diagnosis. 4. Emergency / Critical care / Specialist charges etc. 5. Even when they pay, it is their choice how much.

This results in many a wrong practices, or the patients can't afford treatment at all.

So in a mediclaim case, no one benefits except the company: Patients, Hospitals, Doctors all lose. Still, the Medical councils do not want to do anything. In fact, they don’t have a say.

Add to these:

Incessant calls / emails/ whatsapp messages for any enquiries that pop up in the patient’s or relatives (usually the cousin in America) mind at any time of the day or night: and bitter words to follow if reply is delayed. (That doctor has advised so so… what is your opinion?... I just read on google about stem cell therapy to improve my anger… what say? Etc. etc.).

Then there are sons and daughters who stay in US / UK etc., but leave their parents back in India. They expect the same care but at a low price, and also a daily update by the treating doctor. NO WESTERN DOCTOR GIVES OUT HIS CELLPHONE or EMAIL ID TO PATIENTS, THEY KNOW THIS, but they talk from there as if from the top of a mountain..They don’t want to come and attend their dying parents, but vent out this guilt in form of anger towards the treating doctor: Do everything doctor, don’t worry about the money.. I am unable to come to attend my MOM because of business meetings/ no tickets / kid’s exams etc. I lose my patience here often.

If a Judge / lawyer is ever reading this article, Your Honours, please consider these when you next fine crores to a doctor (even if insured, he has to pay huge):

A doctor should not be held negligent if

1. The patient does not follow advice as written 2. Patient continues to drink / smoke /eat tobacco/ or does anything that the doctor has prohibited. 3. Does not follow up as directed (most patients miss their follow up dates: doctors are supposed to jump from illness to illness). 4. Does not show the same care towards his own life that the doctor is expected to take. 5. Has not given all correct information about himself / herself / his/ her illness 6. Hidden some information from the treating doctor. 7. Has lost treatment details. 8. Self medication / cross consultation without knowledge of the earlier doctor, resulting in multiple medications. 9. Has had unknown allergies / reactions in the past.

There should be a doctor’s board for each specialty which opines about every particular medicolegal case before the court makes its final decision.

I always wanted to be a good doctor, like most other colleagues I know. I have always heard the courts of justice demand that one speaks the truth. Here it is. Hope I am not punished for speaking the truth. I am not always correct, I am sure some of my friends will correct me. I will keep learning too.

A warning. If the whole medical system becomes non corrupt, patients will end up paying far higher consultation /surgical fees than what is paid now. This is inevitable. Add the legalities to everything, and many specialists will become non-affordable / non available to most. The many many who get free treatment now will be denied that.

Or the next generations will see less and less specialists opting to settle in India.

I love my profession. I Love my country. I love my patients too.

But I also deserve a good life. It is time I stop thinking I am God because the society has presumed so.

May God confer best of health upon all humanity. May God guide me to always do good to my patient.


2 comments:

  1. All Doctors should be like you. You patient are very lucky. Keep doing good work...

    ReplyDelete
  2. Very well written article considering all the facts. Thanks a lot for representing the problems and difficulties faced by a Doctor community in India. Some of the doctors behaving cheaply and practicing at low standards are also responsible in particular.

    ReplyDelete

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