Medical profession at the crossroads?

The doctor of future will give no medicine, but will interest her or his patients in the care the the human frame, in a proper diet and in the cause and prevention of disease. -Thomas Edison (1847-1931)

Introduction

As we all know, before the discovery of modern medicine, life was fleeting for humans. The environment was replete with unseen dangers in the form of disease and medical conditions. Then medical practice changed into an organized profession and humans experienced a significant improvement in the quality of life. Aided by modern scientific innovation, the boundaries of medical technology extended to unimaginable limits. Nevertheless, even with all these technological innovations, the position of doctors in society hasn't diminished and doctors remain indispensable.

Why Doctor’s Matter?

In certain circumstances, a doctor can mean the difference between life and death. Accident and violent crime victims and soldiers wounded on the battlefield know this because their lives depend on the skills of trauma surgeons. People who suffer critical injuries need a doctor to attend to them quickly because delaying treatment might simply mean death. Doctors are responsible for increased life expectancy and improved well-being in society. People who survive diseases such as cancer usually owe their survival to doctors, whose skills and dedication are vital for their cure. Modern medical technology coupled with doctors’ care can give persons diagnosed with terminal illnesses hope of living longer.

What is the Issue?

Dr. Kunal Saha’s wife, Anuradha, during a family visit to Calcutta developed a fever and a rash that persisted. She was treated by Dr. Sukumar Mukherjee, who had a god-like reputation in Calcutta, but he made a terrible mistake. He gave her a wrong steroid,Depo Medrol, with twice-daily doses instead of the recommended one dose every 2 weeks. And she died on May 28, 1998.

The medical cause was sepsis, but, DrKunal says, "She died of a deadly combination of ignorance and arrogance." Her death due to a doctor's mistake set him on a new path, working to combat medical malpractice in his native India, where he founded the organization People for Better Treatment to expose and stop the ignorance, corruption and fear that lead to pervasive medical malpractice. Although his full-time job is as an HIV/AIDS researcher at Ohio State University, since his wife's death he has traveled dozens of times to India — five times in 2014 alone — to pursue his cause.

He filed a suit against Mukherjee and three other doctors involved in his wife's treatment and lost. Then he filed an appeal and in 2009 a Supreme Court judgment found Mukherjee and the three others guilty of malpractice and revoked their medical licenses. Later, the courts awarded Saha the U.S. equivalent of about $2 million. Saha gave a sworn affidavit that the money would be used only for the promotion of better healthcare in India, a promise he kept, even though two years later, the out-of-pocket costs of his work in India would force him to file for bankruptcy.

What More?

A renowned physician Dr B M Hegde [Padma Bhushan Awardee 2010.Editor-in-Chief, The Journal of the Science of Healing Outcomes] has shown how a large number of doctors working in five-star hospitals shortchange patients in order to keep their management happy and enrich their own pockets. Here is what Dr B M Hegde writes:

1) 40-60% kickbacks for lab tests- When a doctor prescribes tests the laboratory conducting those tests gives commissions. He probably earns a lot more in this way than the consulting fees that you pay.
2) 30-40% for referring to consultants, specialists & surgeons.
3) 30-40% of total hospital charges. If the GP or consultant recommends hospitalizations, he will receive kickback from the private nursing homes as a percentage of all charges including ICU, bed, nursing care, surgery.
4) Sink tests: Some tests prescribed by doctors are not needed. They are there to inflate bills and commissions.
5) Admitting the patient to "keep him under observation". People, who aren’t really having a heart attack, go to cardiologists feeling unwell and anxious and they admit such safe patients, put them on a saline drip with mild sedation, and send them home after 3-4 days after charging them a fat amount for ICU, bed charges, visiting doctor’s fees.
6) ICU minus intensive care- Most of the Nursing homes are run by doctor couples or as one-man-shows with no proper trained personnel. Such ICUs admit safe patients to fill up beds while genuine patients who require emergency care are sent elsewhere to hospitals having a Resident Medical Officer (RMO) round-the-clock.
7) Unnecessary caesarean surgeries and hysterectomies.
8) Cosmetic surgery advertised through newspapers. Liposuction and plastic surgery are not minor procedures and some are life-threateningly major. But advertisements make them appear as easy as facials and waxing.
9) Indirect kickbacks from doctors to prestigious hospitals. To be on the panel of a prestigious hospital, there is give-and-take involved.
10) "Emergency surgery" on dead body.

Any Hope?

Though our country has a long way to go, the attitude toward malpractice is slowly changing. To judge the progress being made, consider that there were no cases of malpractice in 1998, the year Anuradha died, that resulted in a physician losing his or her license. "Every day, I get 70, 80, 90 letters from India. Each one has a story," Saha says. "In India, corruption is everywhere. Medical corruption literally means life and death. There are a lot of good Indian doctors, but the rotten apples are still running the show. But a lot of people have seen hope. They are fighting back. The huge stone is starting to roll."

Saha feels it is his fate to fight to hold physicians in India accountable for their errors and negligence. "I am a doctor, but I am also a victim. I was born in India, but I am an American," he says. "I am truly uniquely positioned for this," he says. "I believe Anuradha came to me for that reason. I will continue fighting so I can make it an honest and fair system."

What Needs to be Done?

Medicine must change from disease centric care to patient centric care. Teaching must be done in the community and not within four walls of tertiary hospitals where only the filtered few terminally ill get admitted, giving the student distorted version of the pattern of illness in society-a biased view which is the root cause for all the unnecessary over diagnosis and over interventions. Several studies have shown that it is the faith of the patient that cures most of the time and not the drugs or doctors. To command that faith a good doctor must be basically a goods human being.

Conclusion

As rightly pointed out by Prof Hegde, in India medical education has gone completely overboard and needs overhauling. There are three subjects on which the knowledge of the medical profession in general is woefully weak; they are manners, morals and medicine. Let’s hope that something will be done in this regard by all the concerned like Government, Corporates and Doctors, encouraged by people like Dr Kunal who discharged his individual responsibility

By Dr A Jagan Mohan Reddy
Senior Faculty (HR )
Institute of Public Enterprise
Hyderabad