IS IT TIME TO PACK OUR BAGS?? (Part II)

No doctor deliberately causes a patient harm or death. The best way not be accused of medical negligence is NOT TO PRACTICE MEDICINE. This would be like discontinuing driving to never be pulled over by a traffic policeman. It is one thing to be accountable for ones actions it is quite another to work under a steady threat of such claims. A sword hanging over a doctor’s head can never ensure steady hands.

There is repeated injustice to doctors by equating them with all kinds of commercial and institutional establishments by government agencies. They are charged commercial, non residential, institutional rates for water, electricity, property tax. This is done even when doctors are earning their livelihood professionally in part of their residential premises. The administration considers a doctor’s clinic in the same category as a petrol pump, a coal depot, cinema houses and clubs, charging property tax from them. This again is nowhere done in case of other professionals like advocates or chartered accountants.

Another wound has been caused by the acceptance of a gross devaluation of the economic value of a doctor’s work. Be it any scheme of the government or the private sector, the reimbursement from the insurer, which is frequently delayed and with unjustified deductions, does not even cover the cost of the treatment. Doctors are routinely and without objection doing massive amount of work for which payment is frequently not made by the insurers. The administrators also at times dictate the course of treatment to be followed, and which hospital a patient should visit, depending on whether hospital has signed their Preferred Provider terms and conditions.

The overt and covert promotion of indigenous systems of medicine by the State and proliferation of quackery without any fear of law is another formidable bane of modern medicine. From a chemist, an RMP to a layman, everyone knows and freely advises modern medicines. Whenever some attempt is made by doctors to improve the state of affairs regarding quackery, there are always those who scuttle the process by talk of introspection. The next generation of doctors will blame the current one for not having done what we should have, letting the profession degenerate.

There is no doubt that there is commercialization of medical profession. Solutions to this have to start with reform in medical education, and regulatory mechanisms of medical practice.

Now there is another notification that MBBS doctors will have to serve 1 year in rural areas before appearing for postgraduate entrance exams. Already with charm of medicine fading among youngsters, an increased duration for postgraduate degree will further dampen any remaining enthusiasm. Also, the government does not have sufficient rural primary health centers or jobs in them to accommodate 43,000 MBBS graduates passing out each year. A fresh MBBS doctor has no exposure of treating independently. In rural areas treating patients unsupervised would expose them to danger. According to a survey, 88.1 % of doctors have faced the wrath of patients or their relatives more than once in their career. Leaving untrained fresh graduates loose on rural population will definitely not earn any kudos for the government.

Adding insult to injury, seats for specialization and super specialization courses are sold openly at exorbitant prices to the highest bidder with approval of statutory bodies like the Medical Council of India (MCI). Medical education is now available to either the beneficiaries of social justice or to the super rich. Merit has no role to play in this scenario and this is approved and promoted by the State.

Final nail in the coffin is provided by the Clinical Establishment Act, which provides total control of medical practice in the hands of bureaucracy. An eye specialist under the act can be forced to conduct delivery for a woman in labor, part-time medical practice cannot be done without providing round the clock emergency services, a registered clinic can be inspected any time of the day. Ironically, to inspect the premises of unregistered quacks, a notice has to be given to the quack before inspecting the premises at an appropriate time.

The profession that has long held the esteem and trust of the public is experiencing a transformation unlike any ever seen in the country’s history. Today, doctors feel squeezed from multiple fronts. The investment and hassles required to run a sustainable medical practice have become too great. A wedge has been driven between the doctors and patients by third parties. The diagnostic and treatment regimen of patients, once individualized to each patient’s physical, mental, spiritual, financial and cultural needs, is now dictated to them and enforced with threats of reimbursement cuts and malpractice litigations. This confluence of economic and regulatory pressures is driving some physicians to early retirement and others out of the medical profession altogether. The time does not seem too far when the emerging generation of talent starts avoiding the debt and risks inherent in becoming doctors, unless, of course, something is done, and that too, promptly.