Millennium Post

Self-denial as a cardinal trait

The Indian establishment is in a perpetual state of denial. Self-denial has almost become a state policy, except that it has not been written into the Constitution's directive principles. One may argue that there is nothing wrong with complacency as long as it gives a sense of contentment and security. But when it is a false sense of safety, it lands us in a dangerous situation. A good part of India's problems stems from this self-denial mode that we have placed ourselves. The first step towards solving any problem is recognising that it exists. But we are adept at dealing with a problem, not only by ignoring it but by vehemently denying that anything like that exists at all.
And the worst part is that we don't stop there. We go on to establish how those who complain about a problem are the real issue, and deal with them accordingly. In fact, shooting the messenger has become the hallmark of Indian governance. To say that it is only a problem with the contemporary society would be another instance of self-denial as the trait has evolved across generations into a fine art.

It was such sophistication on show when in the 1980s a reporter from Indian Express claimed to have bought a young woman named Kamla from Dholpur in Madhya Pradesh for a price of Rs 2000 or less under a sting operation, if it could be called one, because the term and the practice were entirely alien to the brand of journalism practiced in those days. Instead of taking steps to ameliorate the conditions that made the 'purchase' possible, our government booked Ashwini Sarin, the journalist who exposed the scam, under the laws against human trafficking! In pretty much the same way the law took its course when MPs presented note bundles at the Parliament Hall in the infamous notes for votes episodes during Narasimha Rao's and later Manmohan Singh's governments.

Now we hear that the Indian Medical Association has moved against renowned cardiac surgeon Dr Ramakant Panda, who owns Mumbai's Asian Heart Institute, for putting up a hoarding saying 'Honest Opinion. No Commission to Doctors'. According to a report in Times of India, IMA's Hospital Board of India has written to Dr Panda asking for the billboard to be pulled down. Further, the IMA fellows are planning to move to higher authorities to bring him in line if he resists. The IMA president is very upset that the contents of the billboard suggest that the other hospitals are dishonest.

"What is being claimed on the billboard is the basic work of a doctor. It's like banks saying we don't rob people. Moreover, it indirectly alleges that others are unethical", the IMA president told the newspaper.

Who in India does not know how kickbacks and commissions oil every wheel of the country's healthcare machinery, except our venerable IMA president? It is most unlikely that he is not aware of what is going on through the length and breadth of the country's healthcare industry because his office is not located in any ivory tower but a very modest structure built with brick, mortar and steel. It is a different matter that his thoughts seem to be made of ivory tower stuff.

What is, however, certain is that he has no sense of shame, unlike a distinguished colleague of his, who went on record to say he was ashamed of his country and his chosen profession for whatever has been going on. The reaction was triggered by an article in the British Medical Journal in 2014 titled 'Corruption ruins the doctor-patient relationship in India'. The article, written by an Australian doctor who had volunteered to work for a charity hospital, referred to the practice by a heart clinic offering 10-15 per cent as a kickback to any doctor who referred a patient for an ECG.

In an article in the same issue of the magazine, Dr Samiran Nundy, chairman of the department of surgical gastroenterology and organ transplantation at Delhi's Sri Ganga Ram Hospital, wrote that corruption was all pervasive in the healthcare delivery system in India.

Referring to cash-filled envelopes that land up on doctors' tables from imaging centres and laboratories, Dr Nundy said: "In many of our five-star corporate hospitals, where the primary motive seems to be profit, there is an institutionalized system of so-called 'facilitation charges' or fees for 'diagnostic help' given to physicians who refer patients regularly for expensive procedures like organ transplants which may reach Rs 1-2 lakh."

"The temptation to do unnecessary investigations like CT scans (1500 rupees cut) and MRIs and perform unnecessary procedures in the form of caesarean sections, hysterectomies, appendicectomies and other operations for cash payments must be difficult to resist," he further observed.

The ethics debate set off by the article had prompted Union Health Minister Dr Harsh Vardhan to decry the 'cartelization' among diagnostic centres and pathological laboratories while participating in a discussion in the Parliament. He also expressed grave concern that patients were being subjected to unnecessary tests by doctors who were guided by the 'lure of commission' offered by diagnostic centres. It is this realisation that has led to the government announcing several measures, including, a proposed ban on the prescription of branded medicines by doctors instead of their chemical names, and the capping of the price of stents used in heart surgeries so that doctors do not insist on high-cost devices for the sake of higher commissions. No one has any clue as to what happened to the ban.

The least that the IMA president can now do, instead of following up on his complaint to the Medical Council, is to apologise to the people of India and send his organisation to the ultimate state of self-denial, which will start a process of its self-annihilation. As a good beginning, he can probably use his influence to replace the two snakes in the IMA logo with Ouroboros, the 8-shaped Greek symbol depicting a snake eating its own tail.

(The views expressed are strictly personal.)
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