An Australian doctor, David Berger recently published a scathing report on the state of affairs of medical practice in India, in a highly reputed journal (British Medical Journal). Dr Berger worked in a small hospital in Himachal Pradesh for a few months and writes from his personal experience. The article “Corruption ruins the doctor-patient relationship in India” refers to the corrupt practices in the medical system and the lack of respect that patients have for doctors. The article has received considerable attention, both in the press and by powers that be, including the Honorable Minister of Health. When queried on this, he admitted to the widespread corruption in the system.
It is indeed unfortunate that we have reached this low point, in a society where traditionally doctors were venerated next only to Bhagwan – reflecting the great faith that the ordinary person placed on those who they turned to in times of pain and sickness. While this burden of expectation always sat heavily on members of the medical profession, it may have been carried with more grace in the past. Over the recent decades, social transitions have not, and could not have, left the profession untouched. And if people’s perceptions of the doctor have changed, we have no one to blame but ourselves.
Everything from the motivation for becoming a doctor (all the wrong ones), the processes for entry into the educational system, the teaching/learning process, the entry into the world of medical practice and the advancements within the profession is embroiled in questionable practices. The more dramatic exposes, like the recent Madhya Pradesh and UP admission scams, are seen as news worthy – maybe for a day or two!! But, this is but the tip of a large iceberg. What is really disconcerting for me, is that there are so few voices from within the profession that are willing to stand up and shout.
In 2002, Medical Council of India which is the oversight body for professional conduct of doctors, issued a set of regulations “Professional Conduct, etiquette and ethics”. Every doctor in the country is bound by these regulations which if followed even in part, would have winged angels looking after us in health and sickness. But, like in so many other areas, laws need to be respected. After, we have the highest road accident rate in the world not because of the poor roads and infrastructure, but because most people act as though traffic rules are made for all but me!! Although, paid endorsements for various products is not allowed, the Indian Medical Association (largest body of doctors) justifies its endorsements of health drinks by saying they have no other source of income. When confronted with the issue of huge commissions paid by laboratories to doctors referring cases, a senior functionary of another association is reported to have said “This practice has now crept into the system. Young doctors entering practice cannot survive without it”. The medical profession has to bear the major onus of responsibility for the abominable undr-5 sex ratios in this country. And were admonished for this by the Prime Minister himself in his Independence Day speech.
There are a large number of doctors who practice ethical medicine and a number of groups trying to spread the message of ethical practice. But, the days of self-less service are probably over – and it cannot be left to the doctor to protect the interest of the patient, which he is actually mandated to do, by the Oath of Hippocrates! The oversight has to be stricter, as has the strictures for malpractice. But, ultimately change has to come from within. Members of the profession have to integrate the importance of these issues in the training programs, lead by example and encourage ethical practice among peers. We need to institute the changes before others step in and take over this role. I am willing to do my bit, and trust that we can raise our voices above the cacophony of scandals and scams, that seem to be crowding the media these days.