by Abhay Vaidya
Soon after the world’s biggest chemical disaster occurred in Bhopal in December 1984, among those who swooped down enthusiastically were American liability lawyers — the so-called ambulance chasers. Richly experienced in suing American corporates, or forcing them into settling hefty out-of-court compensations, they had smelt an opportunity in the tragedy involving Union Carbide. They wanted to sign contracts with the survivors and families of those killed in the Bhopal gas tragedy and, rather appropriately, were seen as vultures rushing in to feast on the dead.
The Indian medical fraternity, with its malpractices galore, increasingly resembles this image. Rather than ponder on the gruesome reality of widespread medical malpractices and ethical misconduct in the country, the Indian Medical Association (IMA) on 2 June demanded an "immediate apology" from actor Aamir Khan for having “defamed” the medical profession in the 27 May episode of his TV show Satyamev Jayate. The show graphically depicted various instances of medical malpractices in the country and the IMA warned Khan of legal action if he failed to submit an apology.
Javed Akhtar, the well-known Bollywood lyricist, was among the first to criticise the IMA calling its action "really sick". As he said on Twitter, it was not Khan “but some immoral, dishonest, greedy and corrupt doctors who are insulting the medical profession and many honest doctors".
Increasingly, Indian doctors are being spoken of as scoundrels and not saviours. Almost everyone has a bizarre story or two of a personal encounter with unethical medical conduct. These incredulous stories sound like those Sardarji jokes we heard in school — where one sardarji’s boast is competitively crazier than his neighbour’s.
A healthcare professional once related to this journalist how he finally quit the profession after being appalled by what he saw: A patient who had died before a scheduled operation was nevertheless cut open and stitched back so that the hospital could add the cost of emergency surgery to the bill.
In another case, the relative of a patient undergoing heart surgery was taken aback when the doctor emerged from the operating theatre and asked, “Should we implant an Indian stent or an imported one?” The cost differential was substantial and, in that state of anxiety, there was no time to think and make comparisons. The surgeon was obviously promoting the expensive imported stent and got what he wanted.
It has become a standard practice for Indian doctors to not just thrive on commissions, expensive gifts and junkets from pharma companies but also extract commissions from the neighbourhood chemist by helping promote his business. Unwritten and unspoken commercial tie-ups with diagnostic labs and specialists to whom patients are referred to are routine. And then there are the unnecessary tests and surgeries that unsuspecting patients are made to undergo by their doctors, all driven by greed.
It is common knowledge that just as unscrupulous doctors cheat their patients, many hospitals too fleece the insurance companies and the government, especially if the government is paying the bill under schemes such as the Central Government Health Scheme (CGHS). Hospitals being accused of excessive and fraudulent billing under the CGHS, followed by disputes and suspension of service to government employees, have caused much distress to patients and their relatives.
Such is the intense rivalry and competition among hospitals that in many cities they have refused to collaborate on creating a smooth Emergency Medical Service or introduce a single emergency telephone number that citizens can remember easily. Under this system, the hospital nearest to the emergency patient would respond and shift him to his desired hospital only after he had stabilised. However, as one intensivist confessed, hospitals prefer their own emergency telephone number, because they don’t want to “lose” their patient to another hospital.
Why has the Indian medical profession come to such a pass? The same question could be asked of every other sector in Indian society —be it the media, education and even the defence services, where the previous army chief, Gen (Retd.) VK Singh shocked the nation with his revelation of a Rs 14 crore bribe offer.
In a state like Maharashtra, which has played a pioneering role in women's emancipation, a doctor couple absconded from Beed last month after their illegal abortion racket was busted, while a doctor and two midwives from the same district were arrested a few days ago for allegedly dumping two female foetuses under a flyover.
The sensational arrest of the Medical Council of India President, Dr Ketan Desai, by the CBI for allegedly taking bribes from medical colleges and the arrest of doctors in organised kidney rackets from time to time are only too well known.
At the other end of the spectrum is the substantial number of selfless medical practitioners committed to the Hippocratic Oath and illustrious examples such as Drs Abhay Bang, Binayak Sen, and Govindappa Venkataswamy who founded the Aravind Eye Care Hospital and numerous healthcare NGOs doing exemplary work for universal and affordable healthcare.
The issues raised by Aamir Khan are not “stray cases” and are only too familiar because of widespread prevalence. Since healthcare concerns us all, it is for the society at large to push professional bodies such as the IMA to take responsibility for the prevailing situation. If the IMA is found lacking, it is for others to propose stringent norms, guidelines and laws that will deter unethical conduct and malpractices. This is the only way out and the sooner this gets done, the better it will be for all.