Sunday, August 28, 2016

How doctors have contributed to the trust deficit

Most doctors are getting increasingly upset about the large number of rules, laws and regulations which the government is passing in order to control what they are allowed to do. Most of these are punitive laws, which impose penalties on doctors, and many doctors resent being treated as potential criminals who need to be policed.

The reality is that the government has been forced to step in because the medical profession has failed to regulate itself. Society grants professionals such as lawyers and doctors certain special privileges , and in turn expects that they will hold all their members to a minimum standard. This means the profession has the right as well as the responsibility to regulate itself. The leaders of the profession  have the  duty of pulling up members who do not follow accepted guidelines , so that they cannot abuse the privileges which they have been granted by virtue of being a professional.

Unfortunately , this doesn't seem to happen in the medical profession in India today. We have abdicated our responsibility of regulating the few bad apples we have in our profession. We continue to allow them to get away with egregious malpractices, and when these are highlighted by the media, the government cannot afford to continue turning a blind eye to these, and is compelled to take action. Unfortunately , the problem is that government regulation is heavy handed and clumsy, because all it can do is punish offenders - and when you have a hammer in your hand, all you see are nails.

Sadly, we are to blame, because have abdicated our responsibility of regulating ourselves. Our apex body , which is empowered by the government to regulate medical professionals , the Medical Council of India , has itself been plagued with corruption, and is not trusted or respected by doctors themselves.

Doctors have been extremely myopic. Most good doctors are so busy taking care of their patients that they don't have the time or energy to contest medical council elections. This means that these elections are often power plays which are usually won by politically active doctors , who have a lot of spare time because they don't have many patients.  They are resentful of their more successful colleagues, and will often try to pull them down once they achieve positions of power. Even worse, because they don't have a thriving clinical practice, they are much more vulnerable to being lured by the bribes provided by the influential politicians who run private medical colleges . They are happy to do "inspections" and grant them recognition, even though they are poorly equipped and understaffed, and provide sub-standard medical education.

Why have doctors failed to weed out the bad apples in their midst ? This is partly because most of us judge the world through our personal lens.  Good doctors assume that all doctors are as upright as they are , and that doctors don't need policing. They treat the imposition of regulation by the government as a personal affront, because they feel that members of an honoured profession should not be subjected to hounding by bureaucrats and clerks. They  look down on them, because they don't have a deep understanding of the technical depths of medical science. Sadly, they are so engrossed in the technical minutiae of delivering high quality clinical care to their patients , that they  keep quiet  when they see other doctors doing what is patently wrong . This is also because they feel it's not their job to police other doctors , and most don't want to say anything critical in public about another doctor,

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