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Doctors Vs Satyamev Jayate

Doctors Vs Satyamev Jayate

September 10, 2012

The truth about medicine in India is a bitter pill to swallow.



One of the many things I tend to miss about home in my life in the US is Indian television (I know they’re available, but I’m too cheap to get the desi channels on cable, and too lazy/busy to watch random TV online). Whenever I’m back home I tend to get an unhealthy dose of TV shows amongst other things like chaat, mangoes and my mothers cooking. I had heard some of the buzz about Aamir Khan’s Satyamev Jayate but hadn’t really been able to watch any episodes until a recent trip back home where I did manage to catch the show about medicine in India.

The show’s highlighting of the way medicine is practiced in India, with a special focus on how hospitals and physicians work on commissions for referrals did not win it many friends in the medical fraternity. There was a strong reaction from the Indian Medical Association, asking Aamir Khan to apologize, who of course, refused to do so. Many of my friends are physicians and I recall my Facebook newsfeed being cluttered with disparaging remarks about the show.

Medicine, like many other things back home, is in a rather sorry, disorganized state. That is not to suggest, even remotely, that things are perfect in the US. Each health care system is bound to have its flaws and is eventually going to evolve according to the needs and culture of the society it services.

Being a physician, this is an issue that I feel strongly about. I haven’t really practiced medicine independently in India since I left for the US shortly after completing my internship, but I saw enough of the ‘real world’ to know that Satyamev Jayate wasn’t making stuff up. Even in my brief clinical time in Ahmedabad/ Ghaziabad / Delhi I came across plenty of situations where reasonably senior physicians were talking about ‘commissions’ or ‘incentives’. I was hence not particularly surprised when I saw the show delve into these subjects and was actually rather impressed by the thoroughness of the show and their team’s research.

That should, however, take nothing away from the thousands of doctors who work incredibly long hours and spend years training to excel in their chosen fields. Residency training, especially in government hospitals in India can be particularly brutal, where the resident doctors have no time to call their own. It is virtually indentured servitude for a period of anywhere between 3 and 6 years. Indian doctors are in general very skilled and the respect they have gained not only in India, but the world over, is testimony to that.

There will sadly always be rotten apples amongst the good ones. The problem here though, is unfortunately on a scale much larger than the individual. It is a problem of the ‘system’. It has become a part of the culture; just the way the private practice medicine world is now. A combination of peer pressure, a lack of education about ethics (we had zero classes on the subject) and a fear of lagging behind in the never-ending rat race are probably what make many of the same hardworking doctors act in an unethical manner.

Like many of the problems that plague India today, there doesn’t seem to be a clear solution in sight. Some semblance of action against individuals involved in unethical medicine would certainly be a deterrent. Introduction of medical ethics in the medical school curriculum could potentially be helpful. The best place to start with though is with oneself, as clichéd as that may sound. One of the most important things I’ve learnt during my training in the US is an oft-repeated phrase – “Do right by your patient”. Perhaps if we all just focus on doing the right thing, we can fix this problem, and fix it soon.

Photo credit: cryptome.org 

19 Comments

  • Atheist Indian
    By
    Atheist Indian
    13.10.12 06:21 PM
    James has a good point. It makes absolutely no sense to compare the cost of medical education in India with other countries, given India's low exchange rates, measly family incomes and cut-throat competition that makes professional education an expensive affair. The competititon for getting a 'free seat' in a medical college is extremely tough for the average Indian; without the right kind of family environment, money and contacts. And yes, most of these 'free seats' are actually sold in underhanded deals.
     
    Even though I dislike the lack of professional ethics among medical fraternity in India, I can still understand why they do what they do. The hard reality is, currency and power are the currencies of the country that we live in, not ethics or honesty.
  • Rajpriya
    By
    Rajpriya
    08.10.12 10:05 AM
    @Harry,

    I thought you said you design and manufacture roller doors / fire doors and variety of security products.

    I am surprised your business premises were robbed. Sounds it could have been an insider job? Were you insured?
  • HARRY
    By
    HARRY
    08.10.12 12:24 AM
    @ Vijay

    I agree in what you are saying but the real world is different out there isn't it. I wish all the major company had the same vision as Mozilla Foundation but they don't do they, therefore we can say most thing only happens because of money.

    Yes, you are right in saying that I am surrounded by not so good people because my business premises was robbed on 2 Oct. Either they are good in what they do or I am shit at my job. Now can we say it's about money and nothing else?

    HARRY
  • vijay
    By
    vijay
    07.10.12 11:04 PM
    @Claudia
    It should NOT be like this. However unless there is clear law that states that this is illegal, hospitals will form cartel and try to charge more fees to foreigners. Try complaining/reporting to German embassy etc.

    @Harry
    Higher Education does not have to be costly. It could be paid up by the taxes, with rationale that higher educates help EVERYONE in the society and so everyone must pay for it.
    In any case, circumstances should NOT justify unethical behavior, otherwise society will degrade and it will make everyone miserable.
    I am sorry to know that you believe financial gain is MAIN factor in everything people do. Clearly you are surrounded by not-so-good people.
    For example: I typing this is a browser called "Firefox" from Mozilla Foundation, go find out if they developed this complex software application for financial gain or "greater good" of the society.
  • HARRY
    By
    HARRY
    16.09.12 10:04 PM
    @ Sonal

    I design and manufacture roller doors / fire doors and variety of security products. One thing I can say is, I like what I do.

    First I din't compare your profession with that of a Whore. It was only an example that I was giving you that you and I don't go to work for our health or our ego.

    The financial motivation is a driving force in what You and I do. By telling me that you are doing this is because you love it or out of charity then you will be the first person that I know who's different then the rest of the whole world.

    When I asked you repeatedly was to see if you agreed with each one of the points that I had made.

    If you are one of those doctor who works for NGO or charity organisation then let me know, I will pitch in my support.

    HARRY
  • Sonal Mehta
    By
    Sonal Mehta
    15.09.12 09:56 PM
    Harry,
    First things first. I actually don't agree. So repeatedly asking me "don't you agree" is not going to change that.

    Secondly I really don't think you can compare my profession with that of a 'whore' and not expect me to get offended.

    May I ask you Harry, what line of work are you in? Just to get a better sense of your perspective.
  • HARRY
    By
    HARRY
    13.09.12 08:54 PM
    @ Sonal

    I agree with your first paragraph, that's what the doctor should be, but lets face it we don't live in ideal world do we? Our bill doesn't get paid by tooth fairy are they? So my question is where do you draw a new line, which will satisfy all the equations where a doctor can earn enough not to charge referral and will be able to pay his / her education cost because last time I looked at higher education in UK, it was not cheap and it's not cheap anywhere either and also do as you suggest.

    I think financial motivation is the biggest driving force in the world, do you not agree? rest is all small details in the picture. Therefore we can generalize in what I said, don't you agree? otherwise next you are going to tell me that a whore enjoys her occupation. We know that she does at some extent but not the way you and I may think. So from this we can conclude that what I said is some what fair and true, would you not agree?

    Or as you said perhaps we should all leave this for health minister to sort it out and you know what nothing going to change in India.

    HARRY

    PS Don't take this personally the things that you are aiming to do is good and yes I can see your points in all this.
  • Sonal Mehta
    By
    Sonal Mehta
    13.09.12 01:19 AM
    Harry,
    I agree. We are all trained to do right by our patients. However, in medicine, much like any other profession, there are times when the lines become somewhat blurry. There are grey areas. It is at times like that when we need to remind ourselves that its about the patient, not about money or academia or being a hero.

    I also absolutely agree that in India doctors are not compensated as well as in other countries - I'm not talking about the big multi specialty private practitioners- and if they were provided better working conditions and appropriate compensation there would be fewer of us leaving and perhaps a lot more returning to practice in India.

    The motivations for people leaving are different - ambition, a better life, more money, better opportunity and I don't think its fair to generalize it to just financial motivation for everyone who goes overseas.

    Perhaps these are good ideas for our health minister to work with. He seems to be in dire need of some.

    Joseph, yes, there is a lot wrong with the system. I really dont want to start an argument or belabor the point, but I think its still unfair to claim that people are "buying" their way into medical college in India when they actually go through some of the most competitive exams in the whole world. As someone who's gone through those, I very strongly stand by this statement.
  • HARRY
    By
    HARRY
    12.09.12 10:59 PM
    @ Sonal

    Aren't all the doctors not trained to do right by their patient, because I think they are regardless weather they charge referral or not. And what is wrong in charging referral fees, as long as what they do is in best interest for their patient.

    The doctors don't have to charge the referral in USA or UK because they get paid top wages unlike where in India they have to go and earn their wages, which is a kind of different goal post, don't you agree? I'm not taking sides with the bad doctors but what I'm saying is, they should be paid right for their skills. Isn't this why you left India and gone to USA. Because it all comes down to money and working conditions, don't you agree Sonal?

    HARRY
  • Joseph James
    By
    Joseph James
    12.09.12 07:52 PM
    While I do not wish to get into an argument, I still stand by my point that medical education has become beyond the reach of an ordinary man. True, the merit seats in govt. colleges are relatively cheap; but getting into merit seats has become impossible without expensive coaching.

    Due to the hopeless mismatch between demand and supply, even the merit seats are often 'sold' surreptitiously. In my home state, Kerala, an expose by a TV channel last year revealed how successive govts., (both of the left and right varieties) had 'sold off' merit seats in a cooperative Medical college. Their justification was that there was no other way they could have raised the funds to run the college.

    Problems do not end there. An MBBS degree doesn't take you anywhere. A young doctor once told me that he had made a huge mistake in opting for medicine. He was the brightest of his batch. And when he cracked the then much coveted medical entrance, there was much rejoicing and celebration. Today he rues his decision, because his less gifted companions are much better off than him. He tried a stint abroad and came back disappointed; nurses are more in demand abroad than doctors. His only hope is to marry into a rich family and get his in-laws to open a hospital.

    Govt pays a pittance to the doctors and promotions are slow. Things are even worse in the private sector. And if the doctors have to maintain 'the status' expected of them, they have no choice but to resort to unscrupulous practices.

    Setting up hundreds of govt. run colleges, as suggested by Zephyr, isn't a practical solution. Where are we going to find the faculty? The proliferation of engineering colleges has led to a dangerous deterioration of standards. If this happens in the medical sector, consequences will be disastrous.
  • Zephyr
    By
    Zephyr
    12.09.12 06:57 PM
    One of the solutions to this is to set up hundreds of government run medical colleges where one can get admission solely though merit and throw it open to everyone regardless of whether they are rich students or not. As it is, medical education is so expensive that a doctor who comes out of college is intent on making good the money spent on his or her education. where is the commitment to serve under such circumstances? Look at the number of engineering colleges! There are so many today that anyone can get admission into one. Why not medical colleges?
  • indu chhibber
    By
    indu chhibber
    12.09.12 09:53 AM
    There is an overall degeneration of ethics & principles & the once noble professions like teaching & medicine are no exception.
  • Sonal Mehta
    By
    Sonal Mehta
    12.09.12 01:50 AM
    Joseph, I dont agree with you on several counts there. First and foremost, medical education in India is actually much cheaper than in other countries, specifically in the government run-colleges. While the affluent are certainly advantaged in having more access to better preparation and coaching classes etc, there were several classmates of mine who were not so fortunate but still made it through. So while the prospect of 'buying' one's way into med school and subsequently into residency exists, the number of people who actually do that is much lower than those who actually work their way through the super competitive exams to get in.

    I agree with the other point you make about how this is a huge problem with no solution in sight.
  • Joseph James
    By
    Joseph James
    11.09.12 08:20 PM
    There is much that is wrong with the Indian Medical system. The problem begins with Medical education. It has priced itself out of an ordinary person's hands. Most of those who come into the profession these days hail from an affluent background and invest a fortune to bag a medical degree. Since graduation has little value in the medical bazaar, they try to 'buy' a postgraduate degree. And that certainly doesn't come cheap!! So when they finally begin their practice, their primary concern is to recover their investment. So what if some of the ways adopted by them are rather 'unethical'? In the given scenario, there will always be medical practitioners who would resort to questionable methods of making that extra buck - be it abortions, Sex Determination Tests, harvesting human organs or an unholy alliance with the drug suppliers. Recently, a widespread abortion racket was exposed in Maharashtra. It won't be long before another takes its place. The rot runs really deep! And what's really depressing is that there are no clear solutions in sight.
  • Sonal Mehta
    By
    Sonal Mehta
    10.09.12 11:53 PM
    Claudia, I haven't come across any such policy in the US. However, if you are from a foreign country visiting the US and don't have health insurance the amounts you would be charged (and would have to pay out of pocket) are substantially higher than what you would be charged if you had insurance, but it would be no different than what a person from this country without insurance would be charged. I don't think that's fair at all and agree with runningit on perhaps contacting a consumer court as I seriously doubt the legality of such a policy
  • runningit
    By
    runningit
    10.09.12 10:43 PM
    @Claudia

    That is a disgusting policy. Have you tried contacting a consumer court about this?
  • Khadija Ejaz
    By
    Khadija Ejaz
    10.09.12 06:31 PM
    Another episode showed hidden camera videos of doctors and nurses very happily giving patients options to abort their female foetuses like it ain't no thang. They were even telling them how they'd dispose of the foetuses. It's scary how easy it is for human beings to get desensitised to anything. Anything at all.
  • Jyoti
    By
    Jyoti
    10.09.12 01:58 PM
    The series of unfortunate experiences that every patient in India have faced at some point of his/her life is enough to create bitterness towards the medical profession. I especially hate it when doctors don't accept test reports that are not conducted in their labs.

    I am not saying that every person in the profession is bad. But the ratio of good versus bad is very small.
  • Claudia
    By
    Claudia
    10.09.12 10:45 AM
    Hi there,
    I am a German married to an Indian living in Mumbai. When I needed a small operation done some days back I was to be admitted to a Hospital in Mumbai. Their policy is to charge foreigners 25% more on all fees and procedures. I tried to argue, that I am a resident of Mumbai, to no avail. Have you ever come across something like this abroad (You are a Indian, by policy we will charge you 25% more) and would you like to write on this!?
    Regards
    Claudia

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