Healthcare doesn’t really care!

Vijay Tankha

What everyone already knew and was simply waiting, patiently, to hear is now in print. Private medical practice is deeply duplicitous, driven by base motives of profit and self-interest rather than the noble ideals of the Hippocratic Oath (which incidentally says nothing about over charging). But now not only medical professionals but also the entire fraternity of diagnostic clinics, multinational companies, specialty hospitals and an array of service providers have joined together to transform healthcare into big business, designed to squeeze profit from misery and disease. Healthcare professionals are complicit in what is a lax (and often criminal) ethical environment where the customer always pays, sometimes with her life(savings).

Gadre and Shukla have done a yeoman’s service to the profession if not to the nexus of doctors and hospital managements, pharma companies and their agents whose confessed aim is not cure but profit: Needless testing, over prescription usually of expensive branded drugs rather than cheaper generic alternatives; even the so-called ‘sink’ tests, (no actual test done, the pathologist doctors a report); are all part of the stock in trade of private practitioners, while hospitals ‘pressure’ their employees to lead the sick into the operation theatre. In some cases, even fake operations are conducted. This book should be made mandatory in medical schools.

The responses of 77 ‘ethical’ doctors working in a variety of medical fields, in cities, all over the country form the first part of the book. This is entirely anecdotal (though believable). All fault seems to be laid at the door of private practice and for-profit hospitals. Greater analysis of the cost of setting up and the mechanics of running these would have given the reader a better grasp of the intricacies of the healthcare system, where both the sick and the healthy are routinely milked.

However, more than griping, the authors have serious recommendations to make about how the situation can be rectified or modulated. This forms the second part of the book and is a valuable eye-opener, even if the recommendations and corrections seem simple and obvious. There is need for greater regulation of medical services by a calibrated cap on procedures; standardised treatment protocols; patients made aware of their rights and doctors of their duties. The cosy relationship between pharma companies and doctors (freebies of all kinds) is nixed. The ultimate aim, the authors recognise, despite the enormous obstacles that many despair of, is a system of universal healthcare (which means that health is not a commodity available to all, but a right that each can demand). Here many point to the UK model approvingly.

However, the functioning of private hospitals is only a symptom. It is not as if there is something wrong with making money, only that there are unethical ways of doing so (most criminals are businessmen ) and regulation is what is required, not criminalisation. The authors, with a healthcare NGO offer a variety of possible solutions.

All cures, as good doctors will tell you, are risky. Nor are the possible side effects of many of these proposals entirely known. That both medical education and practice and the regulator of these, the Indian Medical Council, need to be reformed is not in doubt (a recent report from a Parliamentary Standing Committee says as much). What is required is also often known, like a single entrance test for medical colleges, long proposed and now mandated: preventing huge capitation fees, which burdens future doctors with debts that they have to recover from by hook or crook.

The demand for healthcare is a demand for life. That said, we recognise that all progress is piecemeal. The book is indeed a wake-up call, though some are not sure whether the bodies it wants to rouse are not already dead.