Last Sunday, we were on a holiday to the quaint little hill station of Kasauli. And since we were on holiday, a lot of time was spent in front of the idiot box to make up for all the time at home where this pleasure is not available to us! And thus it happened that I was able to watch the entire episode of 'Satya Meva Jayate' where Aamir Khan tore into the medical profession. For those of you who have not watched it, the link is here and the main points he talked about as far as I can remember are the following
- Surgeons have been caught performing unnecessary operations (I heard somewhere else that the main indication for a hysterectomy in some areas of our country was............. the presence of a uterus!!)
- Doctors take commissions of upto 50-60% to refer patients to their colleagues as well as to testing centres
- If a doctor pays huge amounts of money to get into medical college, it is likely that he will spend the rest of his life trying to earn that money back!
- The MCI (medical council of India) has no interest in taking action against the wrongdoers. While there have been 50-70 doctors debarred every year in the United Kingdom for malpractice, in the last 4 years, India has debarred none!
- The MCI itself is hugely corrupt especially in the area of accrediting medical colleges. We all know the story of Ketan Desai who has made us all ashamed to be called doctors considering the amounts of money that he was found taking and the number of scams he was involved in.
- There is a nexus between the drug companies and doctors. Doctors can prescribe whatever medication they want and patients have to buy the specific brand. More often than not, the brand prescribed is based upon the benefits that the company provides the doctor
- There are some innovative schemes like the generic drug scheme in Rajasthan and the insurance scheme of Narayana Hrudayalaya which are providing equitable health care.
I wish these accusations were figments of Aamir's imagination, but sadly they are all valid allegations and are happening with increasing regularity throughout our country, even in our most reputed institutions. I have found many links to stories about corrupt doctors from the top 5 medical colleges of our country, but will not post them here to save face - search for them and you will find them!!
Now over the past week, I have heard a vast variety of views on the subject. Most of them have been uncomplimentary, and criticisms have ranged from 'there are only a few doctors who do these things' to 'who is he to lecture us - what about Bollywood!!' My own feeling is that there was a sincere attempt to highlight some of the issues that most of us in the profession know about but try to ignore and most of the public are completely unaware of. Agreed there were some unnecessary theatrics, but then, what more can you expect from an actor! And for that matter, it was rather kind of him not to go into too many details - had he done so, we may have been more embarrassed!! (Especially the present head of the MCI, Dr. KK Talwar who was squirming in his seat throughout the programme, not just when he was grilled by Aamir!!)
After I watched the programme I was filled was a growing sense of helplessness. We all know how deep the rot runs in our profession. There is no use in covering it up. I have seen with my own eyes or heard first hand reports of every one of these allegations occurring in medical practice. Just because the medical profession is so closed to the outside world, we have got away with our 'playing-God' attitude till now. But with the internet and the spread of education, the world is waking up to the fact that doctors are also just ordinary human beings who make mistakes, work for money and are always looking out for 'number one'. I think there are very few doctors who can honestly claim to be practising medicine solely to help people. We are actually just helping ourselves. By being doctors we find ourselves at the top of the social ladder, given respect and privileges in nearly all aspects of life. By being really good doctors, we can make a lot more money, do much better research (which gives us glory among our peers) or get more professional satisfaction (either with patient numbers or with specialisation). There are still a few centres and individuals for whom service is the core ideal, but lets face the facts - these are few and far between.
The chance of anything changing is very bleak, however much Aamir may shout about it. Many of the responses to the programme were on the lines of 'even doctors have to make money' or 'we need to make a lot of money given that we have worked so hard'. One body of doctors went on record asking for an apology. There was little or no introspection into what Aamir Khan insisted was the crux of the discussion - what is our attitude to our profession and to the patients who put their lives and faith in our hands.
I think it's time to stop berating the doctors. The age of the sacrificial and respected community doctor who gives his life to helping people is over. Now it is merely an industry just like any other. Even medical students who join their course planning to 'serve humanity' are lost along the wayside thanks to the overwhelming peer pressure and lack of inspiring examples. So let's stop hoping for an Utopia where young people join the profession to 'save humanity' and continue doing so throughout their lives. Let's treat doctors like we treat all people in other forms of business. They are after all humans and will work selfishly for their own interests just like all other humans. But at the same time, let us take them down from the pedestal that society has placed them on. They are only humans and therefore must be treated just like any service provider. If you go to a shop and find that the shopkeeper is rude, his goods are bad and his prices are high, it is unlikely you will ever go there again. So let it be the same way with doctors. Take 3 or 4 opinions for everything. Treat us all with distrust. If we are rude, go somewhere else. Demand to see our accreditation and experience certification. Don't get carried away by the big words we speak. Ask as many questions as you need till you completely understand what we are talking about. Then go home and google it. Then go to another doctor and see if he says the same thing. It is a sad state of affairs, but then this is obviously what we want! And in this way, the standard of doctors may go up and the rate of malpractice go down.
The day after the programme I saw a patient in the OPD with metastatic stomach cancer (which means that the cancer has spread and as such is inoperable and probably fatal within a few months). It had spread throughout his abdomen, but he was neither bleeding nor obstructed which are the usual indications for any intervention. He was told in one of the top surgical centres in Ludhiana to be admitted for an operation. Now what the doctors were planning to do, neither the patient nor his relatives knew. They were only told that he would be cured...... And that it would cost him about 2-3 lakh rupees...... Not only would the doctors reduce his quality of life, but they would also bankrupt his family in the process. With nothing to show for it...... We doctors do this everyday......... And justice weeps.......
UPDATE: Follow up article here.
UPDATE: Follow up article here.