A COLLECTIVE RESPONSIBILITY
To move towards a healthy society, the commercialisation of private healthcare must be undone and a robust doctor-patient relationship must be established.
Expectations from medical professionals have always been steep and, any laxity, inexcusable. While everyone expects professionals, irrespective of their allegiance, to perform to the best of their ability, the expectation is all the more from doctors and medical practitioners. This is because a person comes to the doctor in distress for the alleviation of her/his physical or mental woes. In ancient times, healthcare was in the hands of faith healers who were believed to be blessed with divine powers. As time lapsed, traditional systems of medicine were modified across different parts of the world. With the advent of modern science, the medical system also underwent significant change. The present modern system of medicine bases itself on the human anatomy, physiology and studies any abnormality in them. It looks into the causes of the disease and, if required, accrues more information from diagnostics to reach a conclusion which guides the doctor regarding the course of treatment.
Till a few decades back, doctors were familiar with their patients' families and would often visit them from time to time. This proximity created mutual trust between the doctor and the patient. But, with the passage of time, this relationship has undergone radical change. Changes in the economic environment in the late-1980s brought in a more commercial and consumerist culture that was also reflected in human relationships. This also affected the attitude of both the patients and the doctors.
With the entry of the corporate sector in the field of health, which views healthcare in tandem with any other profit-making business displaying little empathy for the patient, the scenario has drastically changed. Vast sections of the society were marginalised from the reach of modern advanced care because, during this period, most institutions had developed in the private corporate sector. Public funding towards health remains very low, to the tune of 1.04 per cent of the GDP. This has adversely affected the primary healthcare services. The present government further reduced the already low health spending by 20 per cent. The new developments in technological equipment added to the cost of the treatment which further affected the already deprived sections in society from receiving advanced tertiary care. Even the middle classes began feeling the pinch of the high-cost of medical treatment.
During this period, pharmaceutical companies started luring some doctors with expensive freebies which added to the cost of drugs. The dealings among some doctors for cuts and commissions for diagnostics and for referrals presented a serious jolt to the doctor-patient relationship, as the patients begun suspecting doctors, believing they have earned far more than they deserved.
All this created a wedge between the patients and the doctors. The doctors who were till date viewed as second only to God started losing their respectability. People then began viewing them just as any other commercial businessman who would be ruthless and apathetic for undue profits.
It is also during this period that unscrupulous elements began gaining ground in society. They took advantage of the situation and often resorted to violence against the doctors on frivolous grounds. They even started blackmailing the doctors.
The whole situation now demands amelioration. Otherwise, if people lose faith in the person to whom they are offering their body and mind for assistance, medical science will not be successful in passing on its required benefits to society. A concerted effort has to be made by all parties concerned.
The question of ethical healthcare has been seriously considered by a group of doctors and medical organisations. They formed the alliance of doctors for ethical healthcare (ADEH), to work together to bring back the lost glory of the medical profession. In its recently held national conference, ADEH came out with certain suggestions, which include the collective responsibility of governments, drug companies, medical professionals and the society at large. Various sections of the society including the government, the pharmaceutical industry, medical professionals and the civil society have to play a fundamental role in this.
The first and foremost poison is the commercialisation of healthcare, which begins with the entry to medical college. With high tuition fees in the private medical colleges to the tune of nearly one crore rupees, it would be naïve to expect young doctors to behave like saints. The government should take steps to stop the commercialisation of medical education and legally ensure that fees charged in any private medical college are not higher than the amount charged by public medical colleges. Then, provisions must be in place to ensure the effective and comprehensive cost regulation of all necessary medicines, implants and consumables. The trade margin on any medical item should not be unreasonable.
Develop a system of Universal Health Care (UHC) in every state, which enables every resident to access good quality healthcare free of cost at the point of service, which provides secure and satisfying employment and remuneration to all doctors and healthcare professionals; and, eliminate commercial pressures and malpractices. Towards this end, the public health budgets of central and state governments must be substantially increased and public health services must be strengthened in a comprehensive manner. Commercial insurance should not be involved in the proposed UHC and practices of private healthcare providers must be appropriately regulated and rationalised.
It is important that the medical professionals take the initiative of rebuilding their trust with the patients. They must ensure complete transparency in all components of hospital bills charged to patients. The practice of commissions, kickbacks and any unethical inducements to promote the hospital business has to be stopped.
The doctors should abide by the Indian Medical Council (professional conduct, etiquette and ethics) which prohibits them from accepting gifts, sponsorships and any kind of financial or non-financial incentives from drug companies. It also prohibits doctors from advertising themselves. The practice of commissions (cleverly called as an incentive) as referral charges, directly or indirectly, related to any kind of patient referrals must be stopped. They should develop the courage to speak up against the prevalent medical malpractices and promote ethical and rational practices among colleagues and within professional circles.
Patients and citizens should be more open. Do not view the doctor as a person with a tarnished conscience, but consider him as a person with highly-trained skills in healing. It is always better to settle the professional charges before the treatment through mutual dialogue with the health provider. Seek appropriate care, ask the doctor for information relevant to the patient's condition. Do not go by hearsay or advertisements. Whenever major procedures are advised (in non-emergency situations) it is always good to seek a second opinion to allay the anxiety, fear and any other relevant query. Violence is not the answer to any issue. These should be settled as per the law.
Every sector needs to be regulated, including medical care. But no regulation should be corporate driven, as this will decimate the small-scale sector, which, at present, forms the backbone of the healthcare delivery system. The Clinical Establishment Act is a welcome step. It would be better if doctors' bodies, public health activists and civil society organisations are consulted on its ultimate implementation.
(Dr. Arun Mitra is Senior Vice President, Indian Doctors for Peace and Development)