Monday, 7 July 2014

Fate of doctors in India:;;;;;;;;;;May God guide me to always do good to my patient.

Copy paste of a what's app message.. May not agree with all the points yet worth giving a thought


Fate of doctors in India:


This article is also a test of how our society tolerates truth.
Recently read a flash news about Eminent Doctors taking
cuts / referral fees. There cannot be any justification. But
if a whole system based upon corruption, a whole society
facing inflation expects only one of its components to be
sane, it’s insanity. Hence these thoughts. I apologise in
advance if this hurts some feelings. This isn’t a placebo
though. For the “Nautanki” people who appear so shocked
to hear about corruption in the Medical field, here’s the
naked truth: There is corruption in every aspect of every
field including religion, law and judiciary, government,
politics, police, press, military, film industry, YOUR FIELD,
and also medicine, as the doctor is a part of this very
same society, not from Mars. 

There is corruption in every
aspect of medical field: referring a patient, lab tests, CT/
MRI, Surgeries, Cross referrals, almost everything. But as
in every field, there are people who do it by choice, there
are some who have to be a part of the system to survive in
India, and some who refuse to be a part of it all, facing
many other problems including a perpetually low income.
Think Simple: why would a person with highest of merit,
hardest of hard work, tendency for helping others want to
become corrupt? Not by choice. No one becomes a doctor
for greed (Someone might attempt, but these people drop
out in the first six months or a year: Those not dedicated
to a hard life cannot endure medical education in India).

Every doctor wants to do good to his patient and also live
a decent life. After a lifelong meritorious career, why
should he be expected to toil in villages / rural areas
without any rewards for it? Why should he not want his
kids to go to the best schools? Why should he not want a
decent lifestyle? Why should one give up a lucrative career
in the west and return to the homeland feeling patriotic, to
just be told that in your own country you are doomed to a
life of sacrifices just because the society expects so?

“Someone who wants money should not become a doctor”
said a dropout actor who is seen doing all immoral things
(from peeing openly in a garden for press in real life to
cruel crimes and revengeful murders on film: while running
a show to change India to an ideal country.. I hope he and
his family only use Indian things, medicines etc.). Why?
Why should a doctor not want money for a decent life?
Why should he endure the humiliation of so many non-
meritorious people from his class livin in luxury because
they chose not to be a doctor, while he chose the noble
profession? Listening day-in and day-out to patient’s
problems, tears, cries, allegations, threats, and
expectations, not ever having a peaceful sleep for a week
at a stretch, not eating in time, not having enough time for
family, why should a Doctor NOT want to earn well? We
are not supposed to refuse a case in emergency. Do the
Judiciary or Police or Politicians do that? We are fined
crores for medical negligence. What if the Judge is wrong?
What if the police are wrong? What if the politician is
wrong? What do they pay even when proven wrong? Why
the presumption that the negligent doctor’s intention was
bad? Negligence is possible in all fields (reactors/ bridges/
buildings/ food/ trains/ public transport), can cost life in
many, how come the doctor alone pays in crores for a life
that he was attempting to save, while in all other cases the
motive was profit, not saving life…? How come the judges
decide the amount of fine? In a recent case, the fine was in
crores. If the patient had survived, would the court have
ordered the same payment for the doctors? 

Doctors save
millions of lives. Some through heroic / exceptional efforts,
without thinking of rewards. If a young patient is saved,
shall we charge according to all the income he can make
all his remaining future? Than why this criteria for fines?
World has become a global village. People travel to the
developed world often. Highly specialised doctors in India
are expected to be at par with their western counterparts.
They often are, because half the world travels to India for
medical advice. But the Indian community is yet to awaken
to the Doctor’s fees. An average specialist in the
developed world charges between 10,000 to 30,000 INR for
the first consult. Appointments are very difficult to get.
They don’t work out of 8 am -4 pm slots except in
emergencies (some honourable exceptions). And yet they
get so many benefits from the hospitals they work at, and
also from the government. THEY SEE NO FREE PATIENTS.
Most doctors live in luxury in the western world. An Indian
doctor on an average charges 200-1000 rupees for an OPD
patient. Sees many free patients (almost 40-50%)
everyday. 

Continuously has to be occupied with: 
1.
Patient’s health and benefit 
2. Relative’s expectations,
their anger (many think that every patient must get well
irrespective of his / her health status). Many hold the
doctor responsible for their illness / failure to improve/
complications. 
3. Continuous suspicion: Many patients
think Doctors are out to loot! Every investigation is with an
intention to get more profit out of the patient. They want
the best, but like “sabji”, they want to bargain. 
4. There is
also a widespread belief that pharma industry is actually
serving the doctors, not patients. 
5. Google searchers who
think they know better medicine just because of what they
recently read about a tiny drop in the ocean of medicine.
They eat up a lot of time, but don’t want to pay for that
additional time.
 6. The very relatives who shout at the
doctor seldom know what medicines the patient is taking:
it is all supposed to be the doc’s responsibility. 7. So many
Toms, Dicks and Harrys coming over and threatening: this
is everyday nuisance in ALL casualties in India. There is
no sensible Director in Bollywood to have realised a
Doctor’s plight while working under threat in casualty.
Everyone loves the populist “Doctor-Threatening” hero!
Then the seemingly innocent weapon (The secret bleeding
wound in many a Doctor’s heart!!) “But Doctor, You are
like God / Next to God. The whole society respects you”
That respect is divine for us, that respect and the
satisfaction of doing something godly by saving lives,
helping people live better lives alone keeps us from going
on and not quitting the profession for better incomes.
Don’t you think we had the options of making more money
had we used our talents elsewhere, especially in today’s IT
world? But that respect does not substitute for our
children’s fees. Not for our rents, electricity, travel ANY
expense. Almost all doctors and their family members end
up paying full bills for themselves at the very hospitals that
they work in… some minor exceptions. 

Everywhere a
doctor goes, he pays the same money that any other
citizen. There isn’t a separate queue for a doctor anywhere
in any office just because he / she has patients waiting.
There is no pension. There is no security. I can show you
some highly successful (in patient care) ethical doctors
who can’t pay for their own treatment TODAY!! If a doctor
is sick, his / her income is zero as long as he does not
work: No one cares if he has treated hundreds for free. The
respect does not substitute for the stress a doctor bears:
of years of listening to and attending pain and tragedy,
years of sleepless life, fasting days, lost precious time with
dear ones.. as with anyone else, the DOCTOR ALSO HAS
ONLY ONE LIFE… WHICH HE CHOOSES TO SPEND
HELPING OTHERS.. is it a crime to be living well for such a
person? And if Doctors are next to God, very respectable,
how come their mistakes become villainous immediately
when something goes wrong? As for the other side: There
are corrupt doctors, corrupt practices. But please
understand, a single doctor did not create them, nor did a
group plan them These developed over time as the system
evolved. One had to fall in line or quit the profession in
want of better life. Like in every field, there are greedy
among doctors. They ruin the reputation. But a single
doctor cannot do anything. Those who try to change the
system are boycott, thrown away, maligned. There are
some continuously fighting this. 

Every doctor cannot
afford to start a hospital of his own. He has to choose a
specialty hospital which has all the facilities to practice his
specialty. These come at a price. I appeal the people who
feel bad about investigation prices to just enquire the rates
of the machines/ skills/ licences/ manpower/ maintenance
required to make these facilities available. The government
makes it compulsory to attend many of its employees
free / at subsidized rates, and never pays.. who will pay
for them? So hospitals have their systems. A single doctor
cannot change them. Also, not all hospitals are corrupt.
The Medical councils do not have any protocol / system to
protect a doctor who faces vindictive attitude from
hospitals if he / she wants to argue. 

Many specialists DO
NOT RETURN TO INDIA OR HAVE ALREADY LEFT INDIA
AFTER RETURNING due to this one reason. Because
specialist practice is based upon referrals, and where most
of the referral system itself is corrupt, one has little hope
of survival especially in a decent city / town. Doctors who
want to run their own hospitals face same bribery, same
licencing scams, same corrupt government practices that
any other business does. The rates are probably higher,
and the regulations stricter. Doctors are a weak vote
bank., hence not on priority of any party. It is more
practical for the politicians to openly criticize the doctor /
profession in hope of gaining public sympathy / attention.
No one wants to attend to their problems, which are many.
The medical council never protected any doctor against
court cases or hospital victimising them for fighting
against corruption. The regulations made are ancient,
primitive. When a whole medical system is corrupt in
almost every step, they have taken the approach of
superficial actions against individual cases: typically
populist and sensationalist. 

The medical councils KNOW
every aspect of corruption, but have opted to fit in some
screws where the whole building needs extensive repairs.
One’s degree and education of fifteen years becomes
meaningless in the eyes of medical council just because
there is delay in renewal of licences. How can rules be
applied only partially in a system? While many people
practice without degrees or knowledge, the councils
choose to target the qualified for not renewing their
licences: a process that involves acquiring CME points, the
money for most such events, travel etc comes from
pharmaceuticals, the patient pays. They do not have the
online option of CME / licence renewal like most western
countries, even in this advanced age! So a doctor is
expected to leave his town and practice, get involved in
events sponsored by pharmaceuticals, travel with help
from pharma companies, stay in hotels with their money
so as to renew his licence. But not online. And there is no
compulsion that he has to attend the event for his
specialty. So a Neurologist could attend a gynaecology
event just for CME points and its ok for the renewal of his
Neurology licence!! One can easily get such CME credits
without attending the event! There has to be an online
option, or a rethinking of this whole business. And an
option to do it without involving pharmaceuticals. The
whole Mediclaim business in India is a fraud: they don’t
pay for 1. OPD consultation / investigations of a patient:
even if serious. 2. Patients with genuine illness, but
without injectables or surgery. 3. When they do not
understand the diagnosis or the fact that some cases do
not have a proper diagnosis. 4. Emergency / Critical care /
Specialist charges etc. 5. Even when they pay, it is their
choice how much. 

This results in many a wrong practices,
or the patients can't afford treatment at all. So in a
mediclaim case, no one benefits except the company:
Patients, Hospitals, Doctors all lose. Still, the Medical
councils do not want to do anything. In fact, they don’t
have a say. Add to these: Incessant calls / emails/ wtsapp
messages for any enquiries that pop up in the patient’s or
relatives (usually the cousin in America) mind at any time
of the day or night: and bitter words to follow if reply is
delayed. (That doctor has advised so so… what is your
opinion?... I just read on google about stem cell therapy to
improve my anger… what say? Etc. etc.). Then there are
sons and daughters who stay in US / UK etc., but leave
their parents back in India. They expect the same care but
at a low price, and also a daily update by the treating
doctor. 
NO WESTERN DOCTOR GIVES OUT HIS
CELLPHONE or EMAIL ID TO PATIENTS, THEY KNOW
THIS, but they talk from there as if from the top of a
mountain..They don’t want to come and attend their dying
parents, but vent out this guilt in form of anger towards
the treating doctor: Do everything doctor, don’t worry
about the money.. I am unable to come to attend my MOM
because of business meetings/ no tickets / kid’s exams
etc. I lose my patience here often. If a Judge / lawyer is
ever reading this article, Your Honours, please consider
these when you next fine crores to a doctor (even if
insured, he has to pay huge): A doctor should not be held
negligent if 1. The patient does not follow advice as written
2. Patient continues to drink / smoke / eat tobacco/ or
does anything that the doctor has prohibited. 3. Does not
follow up as directed (most patients miss their follow up
dates: doctors are supposed to jump from illness to
illness). 4. Does not show the same care towards his own
life that the doctor is expected to take. 5. Has not given all
correct information about himself / herself / his/ her
illness 6. Hidden some information from the treating
doctor. 7. Has lost treatment details. 8. Self medication /
cross consultation without knowledge of the earlier doctor,
resulting in multiple medications. 9. Has had unknown
allergies / reactions in the past. 
There should be a doctor’s
board for each specialty which opines about every
particular medicolegal case before the court makes its final
decision. I always wanted to be a good doctor, like most
other colleagues I know. I have always heard the courts of
justice demand that one speaks the truth. Here it is. Hope
I am not punished for speaking the truth. I am not always
correct, I am sure some of my friends will correct me. I will
keep learning too. A warning. If the whole medical system
becomes non corrupt, patients will end up paying far
higher consultation / surgical fees than what is paid now.
This is inevitable. Add the legalities to everything, and
many specialists will become non-affordable / non
available to most. The many many who get free treatment
now will be denied that. Or the next generations will see
less and less specialists opting to settle in India. I love my
profession. I Love my country. I love my patients too. But I
also deserve a good life. It is time I stop thinking I am God
because the society has presumed so. May God confer
best of health upon all humanity. May God guide me to
always do good to my patient.
- Darshan Mahegowda

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