Scary, real incidents show how unethical Indian doctors have become. But these Doctors tell you just how to figure fake from real

A pregnant woman walks into a hospital complaining of stomach pain, and the doctors immediately conduct sonography. The doctors “manage” her sonography reports and call it an emergency, only to operate her, do unnecessary stitches and extract money. This whole drama of “sonography” and “emergency” was needless and was done only to acquire money. Scary isn’t it?

This is not the only instance in which doctors have manipulated the patient to make money. Likewise, hundreds and thousands of cases happen every day in Indian medical profession, where doctors, on whom patients blindly trust, make fool out of patients.

Be it in urban or rural areas, the malpractices in medical profession in India are rampant and all these have been sized down in one book-‘Dissenting Diagnosis, Voices of conscience from the medical profession’.

Two doctors, Dr Arun Gadre and Dr Abhay Shukla, took the initiative to list down such malpractices in the profession and took interviews of 78 specialist doctors, who told them about the extent to which doctors can go to mint money.

The book, which is published by Random House India, entails how a normal fever is shown as dengue or in worst case scenario, how operations are botched up.

The unscrupulous practices are not only in hospitals but are seeped deep down into diagnostic centres, pharmaceutical companies, asking for cuts from doctors, giving them gifts and throwing parties in return.

The doctors themselves have raised questions on unethical practices in medical profession and demanded regulation of private medical hospitals.

Dr Gadra and Dr Shukla told Business Insider India challenges they faced and what is the need of the hour.

1. After reading this book, people may see every doctor with suspicion. How scared they should really be?

The purpose of the book is obviously not to scare people, but to make them aware of the undeniable realities in the medical sector today, so that they can be alert and assertive as a patient or caregiver. Some of the stories and examples in the book may be a bit shocking, but the purpose is to wake up society, and to shake the medical profession out of denial mode. So rather than being scared, people should become aware about patient’s rights described in the book and should start dialoguing with their doctor, asking for all required information, knowingly choosing the best options, while being alert to possible malpractices.

2. You both have addressed the elephant in the room. What were the challenges you faced while taking down experiences of doctors from across India?

Firstly, it was not very easy to identify ethical doctors across the country, who would be willing to fearlessly speak about the real situation in medical practice and health care, who would call a spade a spade. However, initially through Arun Gadre’s personal contacts among fellow ethical doctors, and further by our contacts in the health movement, the numbers snowballed and we could reach 78 such doctors. Secondly, around half of these doctors were reluctant to have their names mentioned in a public document, although the others boldly offered to be quoted personally. Thirdly, there was some backlash from one powerful body of the ‘medical establishment’, which tried to deny the issues being raised in an earlier vernacular version of the book, and seemed to be more interested in silencing the messenger than heeding the message.

3. You said the private medical sector needs to be regulated. What are the first few steps that should be taken in this direction? How the health sector should be healed?

Three steps must be taken urgently. The Medical Council of India needs major reform – you may call it radical surgery - based on the report of the Parliamentary committee on MCI, and further suggestions by the recently crystallised national coalition of ethical doctors and health activists. Secondly, all states should either adopt the national clinical establishments act or preferably enact a modified and improved act at state level, and ensure prompt implementation of such acts in each state, with provisions to protect patient’s rights and accessible grievance mechanisms. Thirdly, the Health Ministry should conduct a highly visible and effective national awareness campaign through the mass media (similar to media coverage of consumer rights), making people aware about patient’s rights and the need to curb malpractices in the private medical sector. These could be important first steps in the long march to heal the private health care sector in India today.

4. How does one differentiate between a doctor who is adopting malpractices and a doctor who wants your well-being?

Firstly, the doctor would be willing to answer questions and have a dialogue with the patient, explaining about any doubts, logically explaining the rationale for any major procedure, and giving possible options, rather than just dictating the treatment and ordering the patient into silence. A rational doctor does not promise magical results, nor would he / she usually claim to know everything about the patient’s condition in the first encounter. A doctor who claims to know everything about your condition before even going into the details is suspicious. A rational doctor avoids creating panic and would not press for an immediate decision to conduct a major procedure, except in genuine emergencies. He / she would also welcome the patient seeking a second opinion, rather than suppressing such suggestions from the patient or relatives.

5. Often, patients go for second opinion and doctors advise them to take similar tests yet again. What is your advice on this?

Seeking a second opinion is the patient’s right, and should be encouraged especially in cases which are complex, where the diagnosis is unclear, or where major procedures are being recommended. The patient or relatives should encourage dialogue between the first treating doctor and the doctor providing the second opinion, so that unnecessary repeat tests can be minimised. Patients should be wary of doctors who, while providing a second opinion, start by first ordering a full battery of repeat tests, without properly examining the patient, scrutinising the existing reports, and interpreting the available evidence.

6. Medical students pay a hefty amount for completing their degree and charge patients a bomb to recover the costs. Do you think having more government colleges will help the situation?

In our opinion, there should be a moratorium on setting up any new private medical colleges in India for several years, until the entire regulatory system, which is currently centred on MCI, is thoroughly overhauled. Yes, government medical colleges with regulated fee structure should be set up in those regions of the country where genuinely required. However, even government medical colleges must change their emphasis to serve public health rather than the market. We need to shift away from current specialist doctor- driven care, towards a more public health and primary health care based model, so that the focus is on prevention, health promotion and basic health care which could be largely given by paramedics and family doctors.

7. How bad is the situation of Indian medical profession when compared to rest of the world?

India has produced many highly skilled doctors who have worked to provide good quality care to patients both within the country, and in other countries like US and UK. Yet to understand the fate of doctors in India today and compare it with other countries, we need to examine three key elements that are combined in a good doctor. The first is practical, hands-on clinical skills; the second is scientific medicine based rational practice; and the third is medical ethics and sensitivity to patients. Even today there are many ‘good doctors’ in India who combine all three in their person. But due to gross commercialisation of medical education, as well as of the health care system, all three are under massive attack now. The medical profession in India needs to extricate itself from the clutches of the mentioned ‘unholy alliances’, and must get involved in the task of reforming the health care system, pulling its chariot out of the mud. It is still not too late for Indian physicians to lead the way in healing the health care system in the country.

(Image: Indiatimes)