Doctor or mahisasur

Doctors are increasingly being treated as villains with new regulations making medicine more complicated and expensive for patients.

I sit and lament the situation in the practice of medicine today. It is at a strange crossroads which leaves me aghast. What has happened over the decades? I started my career as a young physician treating medicine as a calling and a passion, and like many other physicians of my time, I struggled hard with patients. I sat with those who I knew were dying in the fervent hope that I might be able to pull them back from the brink, like a magician pulls out a rabbit from a hat. In many cases, patients died and the relatives thanked me profusely for the efforts, and I went home heartbroken.

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/ctn_outbrain_ads.cms?adcode=video_ad&msid=60917963&secid=15600667&templateName=articleshowpotime:16 It was a time when one did not charge the dying patient for his last visit. We all followed the norm. I often drove home wondering what more I could have done to help a patient. Often, there was no answer, but whenever an idea developed in my mind, I would chide myself for not thinking of it sooner. This left me with a feeling of guilt, often moving me to tears. This still happens. But after years of practice, I now understand that death is a natural sequel to life and however hard doctors may try it is not always possible to save a patient.

Even today, I tell a critical patient’s relatives that it’s literally a tug of war between the almighty pulling from above and me pulling from below. This often results in enormous cost and we, as doctors, continue to do this despite knowing we are fighting a losing battle. There was a time when patients and relatives respected doctors and often carried their bags up the stairs on home visits.

hese days, I am faced with situations where doctors are attacked and put in the dock, and hospitals are vandalised. In March, resident doctors at Sion Hospital were beaten up by angry relatives. A daily ran an article saying this was due to the health system’s failure. I don’t think that’s the answer. I think now there are multiple, expensive investigations and doctors in desperation order these for critical patients to avoid lawsuits. This costs patients a lot and relatives, left with the loss of a loved one and a large hospital bill, vent their ire on the doctor, the only person available to them.

The hospital is afaceless body. After medical negligence was removed from the purview of medical councils and brought under consumer courts, treatments became more expensive. The medical councils, in my opinion, were doing a great job. Faced with the prospect of being called before a judge with little knowledge of medicine, doctors now order every conceivable test so they are not considered negligent. Who pays for this? The patient obviously. Many doctors started thinking that if they are being treated like a trader, they might as well behave like one.

Another major issue is the doctorspharma industry nexus and the emphasis on using generic drugs. If this is the easy answer, why doesn’t the government ban the pharma industry and only allow the generic sector? I send for my personal medicines every month and my helper got a statin at quarter of the price I usually buy it for. I was delighted until one of my patient’s cardiac problem escalated. The patient had recently exchanged his brand of statin for a cheaper one. To be fair, this may not be the provocating factor, but I didn’t want to take a chance and asked the helper to buy the usual brand.

The thought that went through my mind was that “who is taking a chance here”. There are various substances called excipients added to the molecule to ensure that the drug is well absorbed and reaches a reasonable blood level to be active – the so called bioavailability. I was not willing to take a chance with my own health. Is it fair then that I ask my patient to take a cheaper drug? The question of education by pharma is important and I see no problem of this that if there is no quid pro quo. Fees in India are meagre compared to other countries and this helps doctors to educate themselves without passing on the costs on patients. The question of commission between doctors and labs is now the subject of a new law.

I send my patients to labs I trust. I am well aware of the misery that a wrong report brings. I remember a patient who was diagnosed with prostate cancer. He travelled to the US and found he didn’t have cancer. Such mistakes are not forgivable. They could have been avoided had the tests been conducted at areputed lab. The practice of doctors referring each other has also come under a cloud.

But doctors refer patients only to peers who are knowledgeable and trustworthy. If I had a chance to change my profession I would. But the way doctors are being viewed and treated in the country right now is appalling. I have seen Durga Puja posters in which doctors were portrayed as villains. New laws are being enacted against doctors as if they are hardened criminals. It is almost impossible to make a union of expert doctors, but when the fraternity is driven to the wall, I dread to see the reaction. There have been reports of wrongdoing and collusive behaviour by architects, contractors, lawyers and other professionals, but I see no attempt by the government to regulate them. Every profession has its black sheep, but it’s unfair to punish everyone for the mistakes of a few.

I often went with my investment-banker friend to see his clients in India and abroad. He carried a laptop and entertained his clients with expensive drinks and cigars while advising them on how they should invest their money. Sitting quiet one evening while sipping brandy, I reflected how people pay bankers the top dollar for managing their wealth, but pay much less to doctors who manage their health. There is hardly a chance of full retirement for a physician. Many of us still put in the hours after years of practice. Most physicians die with their boots on.

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