Enigma called as doctors

Dr N Prabhudev

The stalemate over the controversial KPME Act has shaken Karnataka like never before. Many lives were lost, but doctors on strike did not budge.

There were many characters in the sad episode: patients, doctors, government and the media. Who has won at last? No one has. Patients died for want of care. Doctors lost patient’s trust. The ‘patient-first’ image of doctors took a beating. The govt lost face, while conceding the major demands of striking doctors. But it has made its intentions clear that it would put the doctors to sword at the earliest opportunity. In fact, the coming Assembly elections saved the day for doctors.

The government made the patient a consumer and all medical services as commercial establishments. This has changed the equations between patients and doctors. The govt has created consumer courts effectively making medical services a business. Agriculture has no income tax. But medical service is not exempt from tax. The govt has made the services a trade. Doctors have always been respected in our country. The problem was they were put on a pedestal. They are expected to live up to the God like image. The concept of doctor as a God was never true and that image has been broken. Doctors are indeed great — -as long as you don’t need them. Doctors too are human beings and need money to sustain and survive. In most countries, a doctor is considered to be just another professional. He gives his services and is paid for it. The public has lost their trust in us. There has been erosion in this relationship over recent years. There is a trust deficit. They see us as driven for profit.

The amendments, therefore, has a ground swell of support from patients and patient’ groups, social movements who have witnessed the extraction of money and exploitation of the poor seeking medical care in private hospitals. As the healthcare system has been managed by large corporations and business houses, business ethics has threatened ethics of care and concern. Corporate business has compromised the doctor-patient relationship and medical organizations have unfortunately been complicit in this unraveling. Here is a hospital shocker. A child with dengue died and was asked to pay Rs 18 lakhs in a hospital in New Delhi. But during the last 20 years, the number of for-profit healthcare facilities, ranging from national hospital chains to local dialysis centers, has grown at a rate exceeding even that of the computer industry. Mixing business with medicine will inevitably lead to abuses that violate patient dignity. Third parties are often making decisions. The stars are the CEOs, the administrators who are raking in big bucks. Business houses, owning institutions and managements, are fixing revenue targets. Doctors often get payments from drug companies. Doctors take a cut with diagnostic labs, with device companies and their sponsored trips abroad have eroded the implicit faith and belief of patients.

Coming to the media, it’s also an industry. They thrive on instant news. They have found soft targets in doctors. Only the bad points of the profession are highlighted. I agree that there are bad apples among doctors, but isn’t that true for every profession? The media loves to make a punching bag of us. Doctors hardly retaliate. Most people keep doing their job. In their sensationalist outlook, the media ignores our hungry days, sleepless nights and 48-hour shifts. One thing is certain though. I will never let my child become a doctor. He will never know the pain of working six-long years just to get a degree and three more years for the PG and be cast into the same category as a local thug. He will never know the pain of being beaten up by family members of a person you were just trying to save. In very broad terms, the medical profession needs to ensure uniform standards of high probity and integrity amongst its members and good practice of evidence based medicine.

Today medicine is just another profession, and doctors have become like everybody else, insecure, discontented and anxious about the future. In surveys, most doctors express diminished enthusiasm for medicine. Eighty-four percent said that their incomes were decreasing. We strove, made sacrifices — and for what? For many of us, the job has become only that — a job. That attitude isn’t just a problem for doctors. It hurts patients too. Perhaps the most serious downside, however, is that unhappy doctors make for unhappy patients.

We all need to take a stand against those who are abusing the system for their own gain. Patients need to learn that the vast majority us care about them and have their best interests in mind. We all need to become a team again. Our profession needs to re-establish its integrity. “I miss me, the old me, the happy me, the bright me, the smiling me, the laughing me, the gone me.” –The Doctor

(The writer is a former director of Sri Jayadeva Institute of Cardiology, former VC of Bangalore University and former chairman of the Karnataka State Health Commission)