Loss of trust in corporate doctors : The Tribune India

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Loss of trust in corporate doctors

Affordable, public sector healthcare is under threat from an emerging corporate culture, where greed is the driving force and excellence is judged and rewarded by the contribution to the balance sheet.

Loss of trust in corporate doctors

Hand that hurts: In the pursuit of comforts of life the patient-doctor trust has got fractured.



Nirmal Sandhu

Affordable, public sector healthcare is under threat from an emerging corporate culture, where greed is the driving force and excellence is judged and rewarded by the contribution to the balance sheet. If the process is not reversed or slowed, low-priced health services would go beyond the reach of a large majority, and there could be life-threatening consequences. By slashing health budgets, neglecting dispensaries and promoting health insurance, governments are contributing to the proliferation of corporate hospitals and insurance companies while backing out of their commitment to meet a basic need of the less privileged citizens.

One can appreciate that corporate hospitals with their latest equipment and medical talent meet a growing need of a class that can afford to buy their five-star services. It is understandable that doctors too have aspirations, families to support, children’s foreign education to buy and occasional holidays abroad to enjoy. If society itself is in the grip of moral decay and greed, doctors cannot be singled out for finger-pointing. 

However, in the pursuit of comforts of life the patient-doctor trust has got fractured and it is hard to restore the relationship to the levels that existed before an exploitative corporate culture set in. If doctors choose to place profiteering above human values, then they can no longer expect from patients a sense of gratitude which once was a given. Treatment today has become a service like any other that is paid for and the recipient has a right to protest if it is substandard or overcharged.

Lack of trust has raised suspicion about the doctor’s word. Medicine being a specialised field a patient does not know whether the prescribed drug, test or line of treatment is correct. It is only when things go seriously and noticeably wrong that a protest, a police complaint or a consumer court case follows. That is still rare. Most people give the doctor the benefit of the doubt.

The other day over coffee three of us discussed doctors, hospitals and ailments, and each had a horror story to narrate. Instance of medical negligence are legion but the following few immediately came to mind as we recalled with nostalgia a dying social order in which doctors valued human life more and deplored the emerging corporate culture where a dead patient is kept on the ventilator till the family is willing to part with the last rupee it is left with.

A few days ago, on June 21 to be precise, 24-year-old Ravi Rai of Delhi discovered that doctors at the Fortis Hospital in north Delhi’s Shalimar Bagh had operated on his healthy foot, not the one that had got fractured when he slipped on a staircase. His screams attracted media attention, which led to the suspension of the entire operating team. In the hurry to be the first with the breaking news a careless TV channel shocked viewers by saying that Ravi’s leg had to be amputated, which, fortunately, was not the case. Insensitivity, negligence and carelessness seem to have become our national traits.

Those who still believe top established hospitals do not engage in malpractices, or prescribe unnecessary treatment and unwanted tests, here is a recent example. Two months ago, Delhi’s Fortis Escorts Heart Hospital was asked by the State Consumer Commission to pay Rs 75 lakh for “doing unwanted treatment on the patients who are not easily identifiable by the commission”. In another case the consumer commission asked the same hospital to pay Rs 20 lakh (with 12 per cent interest since 2008) as compensation to a septuagenarian whose wife’s leg had to be amputated up to her thigh. The total payout came to Rs 1 crore, a small price for a highly profitable hospital.

The highest-ever compensation in a case of medical negligence in India, however, was awarded on October 25, 2013, when the Supreme Court directed the Kolkata-based AMRI Hospital and three doctors to pay a record Rs 5.96 crore along with interest to a US-based Indian-origin doctor who had lost his 29-year-old wife during their visit to India in 1998. The woman, Anuradha, a child psychologist, had come to her home town Kolkata in March 1998 on vacation. She had complained of skin rashes on April 25 and died on May 28, 1998.

The AMRI (Advanced Medical Research Institute) group has five hospitals—four in Kolkata and one in Bhubaneswar. With over 1,000 beds, 500 doctors and 10,000 surgeries conducted annually, AMRI is one of the biggest in health business in eastern India.  At one of their hospitals in Kolkata a fire broke out in December 2011, killing 92 people. Wiser with experience, the AMRI owners belonging to the famous Emami group have today realised that it was a mistake to venture into hospitals. In a recent interview Emami’s Executive Chairman RS Agarwal said, “You need to be heartless to make money from hospitals.… There may be other ways to make money from hospitals but we aren’t aware”.

In a rare, if not first of its kind, book titled “Dissenting Diagnosis” two doctors have put in writing what most even hesitate to speak about: corporate malpractices. Everyone knows about them and yet few have the courage to admit them or speak on record. In a brave contrarian attempt Dr Arun Gadre and Dr Abhay Shukla have brought to public notice “unwanted investigations, procedures and operations” that members of their fraternity carry on without a fear of the law or a burden on their conscience.

The book quotes a general practitioner: “Corporate hospitals often engage in marketing in a variety of ways. ‘Buy one, get one free’, ‘Discount week’… full-page advertisements, mostly full of falsehoods. They throw parties for general practitioners, and they give them cuts. On top of this, they throw parties and supply liquor to keep politicians in their thrall. Some corporate and large hospitals admit bogus patients under the Rajiv Gandhi Health Scheme (a publicly funded health insurance scheme). They give the admitted person money, and plenty to eat and drink. They prepare records showing that an angioplasty or angiography has been done on that person, when actually nothing has been done. I wonder how the government comes out with such schemes, without first regulating private hospitals. Without regulation, the basic objectives of such schemes are lost, and they become mechanisms for corporate hospitals to loot public funds.”

Failure of regulation is another known secret. The regulator, the Medical Council of India, itself stood discredited after the CBI arrested its former president, Ketan Desai, on April 22, 2010, in a Rs 2 crore bribery case. The bribe was paid for securing permission to enroll students in a Patiala college. Now there is a move to scrap the MCI and replace it with a commission to regulate medical education and practices.

Hospital wrongdoings rarely surface since doctors who are aware of these choose to keep quiet. Even those who are above board become a party to a wrong if they maintain silence. Law enforcers are usually soft towards doctors. No one knows when one may need them. Like other corporate czars, hospital bosses cultivate politicians and whosoever matters. Political patronage has helped hospital business flourish in Punjab and Haryana. For a clean-up job and putting the fear of law in corporate heads, it requires some political maverick like Arvind Kejriwal. Recently he slapped a fine of Rs 600 crore on five Delhi hospitals, which had got land on concessional rates but did not treat the poor as required under the deal.

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