Friday, April 15, 2011

The terrible things we doctors do....

The government has recently launched the Rashtriya Swasthiya Bhima Yojana (RSBY), an innovative insurance scheme that will cover hospital bills for people under the poverty line. I will not delve too deep into the details - those interested can read about them here. Suffice to say it is a scheme whereby hospitals will be reimbursed by the government for procedures on poor patients who are treated completely free. As this applies to private and government hospitals it has been hailed as yet another of the poor-friendly schemes this government has brought in. But for every government scheme in India, there will a certain group of Indians who will identify loopholes they can milk for money. And in this instance it is the doctors who are the culprits. I write this with a sense of disbelief and shame that members of my profession can stoop to such levels, but I realise how strong the pull of money is on the Indian psyche and know that incredible though they sound, these things are certainly possible.

It seems that there are many ways that the system can be corrupted. The first and easiest method is of course to perform unnecessary procedures on poor and illiterate patients who have very little clue about what happens to them in a hospital. In fact, before the advent of RSBY, it is probable that some of them would never have dared to darken the portals of a private hospital due to the prohibitive costs involved even to just meet a doctor. This of course, is a time-honoured tradition of milking an insurance system and is practiced, I believe, in all corners of this planet. Then we move to the more innovative schemes that our Indian doctors have devised. A common one is to bill the unsuspecting patient for a different (and more expensive) procedure than he or she actually recieved. A patient may have gone in for a lymph node biopsy, but is told he had a thyroidectomy, or at least, is billed for one. This may cause some problems in the future if he did at some point actually require a thyroidectomy, but that would be his problem of course.

And today, I heard of the most 'enterprising' scheme of all. It seems there is a  huge network of touts, whose job it is to bring patients with the insurance card to the hospital, for which they get paid a cut. This of course, is yet another well-known Indian tradition. There are touts operating even in supposed Meccas of good medical prcatice like CMC, Vellore. But one senior surgeon decided to reduce the stress on the touts. And in the process, increase his profits! So he told the touts to bring him just the cards, without the patients! And then entered their names in his register and billed them for a variety of procedures! This may have continued for many years had he not gotten too greedy. Questions were asked when the numbers emanating from his clinic were hugely different from the numbers of the other practitioners in his town and after about a year of this lucrative enterprise, he was finally caught. Of course, by then he had made more than enough money for his get-out-of-jail-free card and is back in his practice now with hardly any repercussions.

This post sounds a little like a rant, and I apologise. The more I see the way my profession is headed, the more scared I am for its future. We are already at the stage when money and perks define nearly every decision of a doctor from the time he or she steps out after internship. And we seem to be fast reaching the stage when the desperate desire for money and more money make us silence even the little that is left of our conscience after the world of modern medicine has twisted and warped it. Can we ever return to the days when medicine was a noble profession and its practitioners were the moral leaders of society? Will doctors ever return to the Hippocratic Oath that we so hypocritically swear to? Or is our profession doomed to wallow for ever in the murky mires of greed and avarice? Only time will tell, but the signs are not too good.

7 comments:

  1. Warning: This is going to be a long comment.

    Compared to other professions, medical training is much longer and much more demanding in terms of hours and effort spent at work. At the end of it, the financial rewards are minimal compared to say, an engineer or an MBA. Now this might be acceptable to those who had originally chosen the medical field solely with the purpose of serving people. But there are many who join this field for different reasons (and nothing wrong with that, as long as they are honest and ethical in their practice) - out of interest for the subject itself, or even due to parental pressure. For these people, not getting their deserved financial reward can be quite frustrating, and some of them go over to the dark side.

    Nothing justifies compromising patient-care. While I'm firmly of the opinion that it's high time some measures are taken to improve the remuneration and working conditions of doctors in India, it is also important to bring the wrong-doers to the book.

    That brings us to the next problem: when we see someone resorting to unethical practices, we never report them. Squealing on another doctor is considered a strict no-no, and the whistle-blowers are always ostracized by the medical community. Maybe more of us should speak out against unethical practices? Maybe the government should set up an investigating body where one can report others anonymously?

    There are two sides to this story, and unless both are addressed, things will continue to go downhill.

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  2. Thank you for the eye-opening post.
    Hadn't quite thought of in those lines.

    On a different note, do you really believe this word verification thing helps in the comments section? Kind of annoys you at times... does it not?!

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  3. In my opinion, it is unreasonable and unrealistic to expect the doctors who come from the same old mankind to behave like great moral beings. They will not.
    The corruption is there in every man's heart. That's why I become cynical (inside) when I hear of fighting corruption etc by legal means or by activism. There is a limit to it. The gospel alone could bring a total transformation.
    Last week i was in the train. There was a train attendant who was drunk to the core and he had done nothing what he was supposed to do. Talk about corruption in higher levels.
    Or consider Assange who himself is morally corrupt and who thinks he is doing a great thing by exposing cables.
    Whereas different methods of curbing corruption clean the outside of the cup, the gospel alone can clean the inner - another incentive for us to get actively involved in true missions.
    Sorry if it sounds like another rant.

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  4. UB - I agree with you that no one should be exploited just because he or she is ready to serve. But where do we draw the line when it comes to remuneration? It is true that other professions draw much higher salaries than we do. But we need to also factor in the societal status that comes with the tag of being a doctor - there are very few professions that bring this form or respect. Of course, by our own corrupt practices, we are eroding our standing in society, but that is a different matter. The moment a human being thinks of a doctor, the immediate thought is that there is a respected person who is serving others. So when we as youngsters choose to be doctors, it is likely that we part of that choice is because of the respect that society (for whatever reason) bestows. And thus, when we chose to enter society with a distinct advantage over some other well-remunerated professions, we need to remember that for the most part, medicine is not as highly paid as the others. That is just a fact of life - it is our choice that we chose to break our heads studying so long for the satisfaction that our profession brings as well as the respect that society offers us. And I think that once we understand this, we will no longer complain make our remuneration that important. And we will tell our children that if they want to make money, they better not do medicine!! I wonder if I am being a little too dogmatic here - let me know!!
    As for whistle-blowing - you are absolutely right - that is our responsibility if he situation arises.

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  5. NRIG - Sorry about the word verification - I don't know how to turn it off!! Can you help?
    And Ronald - Thanks for that comment - it was certainly heartfelt and not a rant!! Now while I do agree that we humans have an innate evil bent, I believe there are a great many who succeed in suppressing it and bringing out the good in themselves. Some may do it because of their belief in God, some because of their mission and some just because they want to be good. It is dangerous for us Christians to be too dismissive of other belief-systems or faiths (or even those who have none at all). There are enough and more examples of people who have brought blessing, love and kindness and who have been great moral human beings without any shred of belief in any God, let alone Jesus Christ. But, having said that, I must say that personally, my own faith is the only way I keep my sinful nature from taking control of my life.

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  6. You've raised an important question - one that requires a blog-length answer. I'll try to be brief (I know it's difficult for me, LOL)!

    Are we really capable of making a life-impacting career choice when we just come out of school? How many seventeen year olds really know what being a doctor actually entails, unless their parents are doctors too?

    The societal status you mention is largely an illusion, which seldom translates into practical benefits. If the world around me (whose opinion may or may not matter to me) thinks of me as wonderful because I'm a doctor, but doesn't do anything tangible to translate that awe into action, what really is that status actually worth? If I sound cynical, it's because I am.

    Again, none of this justifies wrong-doing. I'm just trying to analyse the reasons behind it.

    I do agree that the satisfaction that a doctor gets just by easing a patient's suffering outweighs the job satisfaction in most other professions, and that is definitely one of the perks of this profession.

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