Sunday, June 3, 2012

Aamir Khan lays bare medicine's deepest secrets

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.

63 comments:

  1. Yeah I agree woth u, I also saw as my friends told me about it, but it also creates problems as its just one side of the coin but what about other positive side of the coin? whos going to talk about that? bad news spread fast but to talk about whats going gud in this world is difficult and not that interesting to spread? i feel both sides of the views must be added in any awareness prog, amir is a very responsible citizen and to that matter whoever runs the prog need to discuss scenarois both in +ve and also -ve ways, as spreading -ve wibes is also not gud

    ReplyDelete
    Replies
    1. You have brought up the main argument with the programme. He did try to bring in some positives about Dr. Devi Shetty and the Rajasthan programme, though

      Delete
  2. Thanks Arpit for the article.. i totally agree with you.. i many times feel that we the medical community of today have brought down a once noble profession and the healing ministry if i may call it so to a mere 'health industry'. We can see in CMC itself that most of the time by the time a patient has reached our center he has already been through so many unwanted scans/investigations that he has already pledged all he ever owned once, not to mention the insured ones who get their own fantastic deals.. I have seen adds in front of CMC main gate which read " incurable cancer?..not to worry!..definite treatment available.. contact...". This is just to name a few and unfortunately is the sad state of affairs.
    What makes me most upset in this whole scenario is that after this episode of satyameva jayate came out the entire medical community is so consumed in seeking an apology from aamir khan that they have forgotten the whole issue he was trying to highlight. I think we need some serious introspection into the values and ethical standards we base our practice on. Quite frankly even though he might have dramatized the episode a little i would like to thank for opening the eyes of many poor common man not to be naive anymore and wake up to the unfortunate reality that the doctor might not be working in the best interest of the patient in question.

    ReplyDelete
  3. Many of the doctors I communicated after the program were furious. . . I did not see the program . . . One of my patients asked me the other day on what I felt about it. I told him that I did not see it. He told me he was sad to see the profession being shown in a bad light. I told him that many of the things are in fact true . . . He told me, 'Why did Aamir have to handpick the doctor community. Are our policemen, government officers, autorikshaw drivers any better? And to put it as a subject along with other social evils such as female feticide, dowry etc did not look good'. Well, I cannot comment without seeing the episode . . . However, my question is whether he brought forth any positive examples of integrity and selfless service by doctors or hospitals . . . One parting shot to Aamir. I understand he is a brand ambassador for UNICEF to promote child nutrition. How is it that he endorses Coca Cola and in fact Coca Cola is one of the main sponsors for SMJ. I propose that there is a conflict of interest here as Coca Cola has managed to penetrate the most interior parts of the country where malnutrition and poverty abounds at the expense of traditional dietary practices and agricultural practices . . . The fact remains that we as a country stinks of corruption and malpractices in all spheres of life. . .A marriage of corporate greed and a bored entertainment industry can sensationalise this decay to further their ends . . . The question is about what is achieved at the end of such programs. . . I suspect that there is no knowledge gained at the end of it . . . We already know about it. . . It is sad if it boils down to pure entertainment where families sit in front of the idiot box and ogle at the unfortunate events . . . But, Arpit, I do not think there were any great secrets that Aamir has exposed.

    ReplyDelete
    Replies
    1. You're right, we doctors know all this and chose to be part of it or do nothing about it. But the general public is not so knowledgable. So for them it may be a revelation

      Delete
  4. Thank you for the article.
    Just by posting passive aggressive words on a blogging site you have made a huge difference.

    ReplyDelete
  5. Nice article Dr Arpit.. I agree to most of what u have said .. but will highlighting doctors in bad light bring any change to the corrupt. I feel that this will only cause more mistrust in the doctor - patient relation ship which will affect the few good & sincere doctors. Imagine what message Aamir gave through the programme : Dont go for a kidney transplant as u will die; forgetting the fact that transplant is the best avlbl option in ESRD. Now no patient will give a consent for a life saving surgery for the simple fact that the program depicted doctors forcing patients to unnecessary surgeries to make a quick buck. Corruption is rampant in any field and it can never be fully leeched out. These can be only brought under control by stricter laws, efficient enforcement agencies to scrutinize and punish the erring doctors. Provoking the public against doctors will only bring about mistrust and harm the few good doctors our country has.

    ReplyDelete
  6. Nice article Arpit!!! I really hope some sense dawns on the doctors. Everytime some body criticise or some untoward thing happens, they come together and defend. In reality they are actually creating a deeper rift between the medical fraternity and the common people! I really wish some sane medical person gets up and gives a really tight slap on the face of MCI and other medical communities. It is becoming ridiculously stupid!

    ReplyDelete
  7. thanks Arpit for the insightful article. After all the Aamir Khan bashing on Facebook, it was refreshing to be here!

    ReplyDelete
  8. 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.

    Arpit... the above should be the standard of care that MCI should vouch for. Thanks for the article. I do not understand why our community and our organization cannot see the good side of a positive criticism... It at least made a few of us think... so thanks to amir.

    ReplyDelete
  9. its good to have this write up from you Arpit bcoz being in same profession you are the one who know both of side of coin......and i think you are right here that "They are after all humans and will work selfishly for their own interests just like all other humans...." buttttt unfortunately we and our society is still treating them as their God......:(

    ReplyDelete
  10. great post. one of the good things that has emerged after the aamir khan sermon is that right-thinking doctors are coming forward to share their views too. i believe at the root of all of this lies greed. that is what has turned the concept of trade into the concept of wealth creation. the moment we are able to see that our vocations are merely to act out the will of the universe to help each other live better lives, and not for the purpose of self gratification, a lot of our troubles will be laid to rest. heartening to read your post on this.

    ReplyDelete
  11. Dr.C.VaijayanthiJune 4, 2012 at 8:20 PM

    Happy to see a few honest comments.My humble request to youngsters who want to pursue a career in medicine[ESPECIALLY TO THEIR PARENTS]- would be to choose it ,only if you have a passion for it.There are so many ways of making money.Please dont choose this as a means of earning name and money.As Arpit has said- this craze to become a doctor should go.Definitely I cant see the logic in spending crores to become one.Invest the crores and relax.Let someone who will work ALSO for money choose this profession-NOT SOMEONE WHO WORKS ONLY FOR MONEY.

    ReplyDelete
  12. Sadly, some of the doctors are up in arms against Amir Khan for bringing up the ugly face of medicine which has become alarmingly dominant anyway. My question is, why shoot the messenger?

    It is an excellent post and a nice reminder of the perils we Indians must live with.

    ReplyDelete
  13. I think it is impossible to practice medicine if patients dont trust us. For patients who come to medical opd come with psychosomatic symptoms, your reassurance can work only if they trust you. Especially in emergency and icu settings, a suspicious patient and a defensive doctor can lead to disastrous consequences.

    ReplyDelete
  14. Hi Arpit, insightful as usual, The timid Indian paying respects to his god needs to learn that there is only a flesh and blood imperfect human being in front of him in the consultation room. The dream remains after more than 55 years of freedom..
    Where the mind is without fear and the head is held high
    Where knowledge is free

    Where words come out from the depth of truth
    Where tireless striving stretches its arms towards perfection
    Where the clear stream of reason has not lost its way
    Into the dreary desert sand of dead habit
    Where the mind is led forward by thee
    Into ever-widening thought and action
    Into that heaven of freedom, my Father, let my country awake.
    Well it is still a dream....

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  16. Looks like you got the pot boiling Arpit! Perhaps you could follow Amir and have a special programme each Sunday? I am sure there would be some local cable wallahs who would be happy to beam 'thoughts from Amir ooops Arpit'

    Systemic failure is the most crushing for us - and tempts us to throw up our hands and run away. Thank God for people like Jeevan Kuruvilla at our beloved Nav Jeevan Hospital who are still plugging away. A number of your blog readers are clearly making a difference too.

    Medicine has always been seen as an earning profession. Lets not put too many rosy spectacles on it. If it were not, why would it rank so high. I don't ever remember people crowing about their kids getting into a B.Ed course. In fact I have memoirs of my great-great-grand uncle in the US who learned 'surgery' in a year during the US civil war and hung out his shingle for some years before deciding that he would rather run a local newspaper.

    What is pathetic is that the MCI or any of our 'professional bodies' has not debarred a single member. That totally shows how self-serving these bodies are.

    So. Back to square one. Where to start? Right with me. The good Book tells us to act justly and love mercy and walk humbly with our Lord. That has to take place at every level of our work. And it has always characterised the heroes of medicine.

    Keep doing the good work bro - and all the others who are reading this! Eternity is watching us closely.

    ReplyDelete
  17. Nice article Arpit. I did not watch the programme but I read Aamir's article in the Hindu.
    I concur with what you say.
    I find the patients also on the wrong side (may be because of the wrong knowledge fed by the docs) when it comes to over-investigation and demanding unnecessary stuff.
    I had gone to U.P and there was this poor lady who was begging me 'Ultrasound Khar Dheejiye Saaar'.
    And come to Vellore, I meet the patients who regularly demand MRI to see if their brain is okay.

    I would like to echo Andi's thoughts - Where to start? Right with me. The good Book tells us to act justly and love mercy and walk humbly with our Lord. That has to take place at every level of our work. And it has always characterised the heroes of medicine.

    Satyameva Jayate.

    I mean the Satyam of the good Book.

    ReplyDelete
  18. This comment has been removed by the author.

    ReplyDelete
  19. Hi Arpit... thanks. I have been dreaming for some time to initiate an "Indian Association of Ethical Practitioners" where doctors who commit to certain standards in practice could become members and with mandatory periodic updating of medical knowledge! The program has further motivated me to pursue this dream...any thoughts or ideas?

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