But in all honesty, we, the Doctors have our scopes and limitations as well, just like any other human being. There could be and there do exist amongst us a handful of people with corrupt morals and degenerated sense of responsibility. Those selfish practitioners, who cannot handle the pressure and prestige of the profession, resort to unethical practices, scandalous treatment procedure; they breach the codes of medical conduct and stigmatize the nobility of the profession. There cannot be any defence and justification for these kinds of practices. These people should be subjected to stringent legal action and punishment. But I can proudly claim that the fraction of such dark sheep is so low that they could never be the representatives of our white coat profession. A few dark deeds by a few people cannot outshine the nobility and sincerity of the mass medical world and put it under scrutiny on a huge public platform.
I am talking about the medico episode of Satyamev Jayate, where, in a fair attempt of spreading awareness and pointing out the malpractices in the medical world, a sweeping generalization was used. I didn’t find the mockery of the profession and its practices any appealing or informative, rather offensive and disgraceful to the profession and its integrity. It only tarnished the image of the doctors and portrayed their practices negatively to a billion people across the country instead of educating them. Thus failing the prime purpose of the show. I can still feel agitated on how Aamir Khan was raising his brows, widening his eyes, turning his lips in whistling position, laughing on the least funny incidents and making dialogues like “mera toh ab India mein ilaaz hone nahi wala”, “aj toh mai studio se bahar nahi ja paunga”, “saare doctors mujhse gussa honge ke kya kya dikha raha hai” and blah blah. It was a unilateral representation of the facts and the doctor’s side in the reference cases was never presented. I think they should also have called the involved doctors in the show and should have given them a fair chance to put their side of the story.
One partially irresponsible episode with a man of influence like Aamir Khan could have major negative impact on a doctor-patient relationship which is pivotal in the treatment of a patient. Faith is the cornerstone of this relationship which is bound to be affected if the patient is apprehensive of the doctor’s intentions in any regard. Medicines just correct the pathology; it is this faith which heals the patient. That is why I disprove anything which might dampen this faith between a doctor and a patient.
We are well aware of the lacunae in the functionality of all the systems in our country. There are admission scandals, kidney rackets, misuse of funds and powers and all those political interferences and corruption at various levels in the medical system too. Unleash it. Reveal it. Talk about it. Question it. Condemn it. But for heaven’s sake, SPARE OUR WORK TACTICS! Spare the way we handle cases. When we sit to see patients we DO NOT HAVE ANY BAD INTENTIONS but the one and only thought of bringing him to recovery as soon as possible. You really think at the time when a person is bleeding in front of us, or a child is losing breath, or a lady is screaming with pains, we are actually thinking of making profits? Or getting commissions? Or the business with MRs and laboratories? HELL NO! We are doing what we deem appropriate and in the best interest of the patient at that moment. In our brains we are shuffling those many thousand pages of the elephant sized medical books to find out that one sentence which could relieve the person of all the sufferings. There is no scope of other considerations whatsoever. Such is the intensity and the pressure of the medical profession. The slightest misjudgement on the doctor’s part can make the difference of life and death and we understand it more than anyone else can.
Questioning a doctor’s opinion and calling it right or wrong: Medicine is not an absolute science like maths where two plus two always make a four. Given the vastness of the diseases and infinite combinations and permutations of them, two doctors can have different opinions about the same case. But that does not mean that one of them is right and the other one is wrong. I myself have seen a case where three different consultants gave three different opinions about the feasibility of an operative procedure. One of them advised the operation. The second one said it was high risk and better be avoided. The third one thought the medicinal management should be continued for the time being. All three of them are the most renowned in their field of expertise. And none of them was wrong. I could understand their points of view, being a doctor, but obviously, I don’t expect that from a common man and he might jump on to saying that the other doctor advised him wrong and forced an operation which was not needed. That is not true. The opinion of a doctor is always in the best interest of the patient and is based on his knowledge and experience. It is tough to explain medical pathology to a patient. So we use the simplest terms to explain it to them, while we are not intending to misinform or misguide him. For example we tell a patient that he has “jaundice and liver enlargement”, instead of telling him that he has “hepatocellular carcinoma, Hepatitis or Thrombosis of the Hepatic vein”. If the patient goes to another doctor and he uses these terms, he might accuse the previous doctor of cheating him, whereas that was not his intention.
The case of uterus removal in the village of Andhra Pradesh: The episode showed a village where hysterectomy operation was performed on most of the women and their uteri (the uterus is the internal organ that carries a foetus) were removed. This case definitely sounds too fishy and demands immediate investigations into the matter. We could have two outcomes:
- There is a possibility of a particular disease being rampantly prevalent in this demographic area. If that be the case, the region could be taken for epidemiological studies further.
- There seems to be a greater possibility of finding a big racket being active in the area which should be exposed and punished as soon as possible.
Laboratory Investigations and Diagnostic Procedure: SMJ raised many doubts about the diagnostic and lab investigation procedures in the medical field and their futility in many cases. Investigations are done for the purpose of finding out the cause of the disease, starting up the treatment, following it up in future, to assess the improvement with time and for the final prognosis of the case in hand. Let me give an example of a common symptom of headache. Out of the hundreds of the causes this could be due to as simple a cause as stress and does not need any lab investigation. But it could be due to as fatal a condition as brain tumour or an internal haemorrhage (bleeding) which needs costly investigations like CT scan and MRI. So what do we do now to find out? We give a provisional diagnosis on the basis of clinical observation and assessment. And then we go by a stepwise protocol and call for required investigations at each step to reach the final diagnosis. If one investigation gives a negative result, a common person might say, “Doctor ne faaltu mein karaya ye test”. But that is not how it is. We cannot run a risk of not doing it and face the fatal repercussions. If there is slight possibility of getting a cause, we would better go with it than not. We are not dealing with machines and it is not only money and resources we have to be cautious about. You have to do everything that it takes when your subjects can breathe and bleed. When we have access to the technologies, both the doctor and the patient want the accurate diagnosis and treatment. It is the bilateral satisfaction involved here; not only doctor’s intentions.
Medicines, their costs, medical representatives, and doctors: India has a big pharmaceutical industry which manufactures the medicines. These companies employ exhaustive marketing strategies, apparently ethical and legal, to promote their products. Meetings of a doctor and marketing representatives of these companies are just as much a part of the entire strategy. Their job is to influence and convince the doctor about the superiority of their product over the others of the same class. They give free “Physician’s samples” to the doctors. And believe you me, it’s all legal and ethical and done under white light.
Now let me tell you where the crux of the problem lies. The cost is decided by the manufacturers and is under the governmental regulatory policies. Nearly all manufacturers are engaged in a fierce competition to sell the medicines of their brand and take the lead over others. Ethics take a backseat at the level of the companies itself. Wrong practices like expanding the indications of a drug, exaggerating the efficacies, ignoring the contradictions, underplaying the adverse effects, creating unnecessary combinations of drugs, flashy presentations of the drug covers and finally directly influencing and dealing with the pharmacies to sell their products. This is what causes the vast differences in the prices of the same medicine from different brands. This is the failure of the vigilance and control by the regulatory authorities and not by the doctor. The doctor is just the last link who prescribes the medicines whose MRP is pre-decided and duly sanctioned by these authorities. When there are so many loopholes at the production level pointing the sword towards the doctors is not acceptable.
Trust me, howsoever an MR tries to influence us, we still advise an economically poor patient to eat “gud aur chana” for anaemia instead of those costly iron tablets.
Professionalism: Hard it may be to appreciate and accept, but the truth is, gone are the days when people would choose medical field with the only intention of healing and serving the humanity. The youth today is much more versatile and takes medicine as a “PROFESSION” and seeks better opportunities for livelihood and personal growth. While “serving” always remains the prime principle, we cannot go without “earning”. Doctors today do not merely prescribe, but have multiple roles to play hand in hand. In a much more advanced world where patients are much more knowledgeable, much more informed, much more expecting and much more enthusiastic to spend money on their health aspects, a doctor has to be much more professionally braced in many aspects. And there comes the practical aspects of being a doctor. Today the health care services are coming under the arena of corporate world and business has become an inevitable part of the modern medical practices. While a doctor is working for an institute/organisation established purely with business orientation, he becomes a part of a business unit and is bound to follow the standards set by it. Now this unit has all the management mantras of sharing, maximizing the profit, buying, selling merging, partnerships, cuts, rebates, commissions and everything with other medical related units. And directly or indirectly the doctor becomes an integral part of this business. Now you tell me, where does the fault lie? And is it the doctor to be blamed for such a set up? It is hard to say what is right and what is wrong here, I leave these questions open to the reader and let them draw their own conclusions about this professionalism in the medical world.
Ah! Mr Aamir Khan! Satyamev Jayate had left many nerves flickering by its partial showcasing of the story and it resulted in this vent of thoughts. While the show’s intentions were honest, so are of our profession and these should not be disgraced by revelations of petty facts without understanding their impact. This kind of mal-representation is not expected from a responsible celebrity like you whose words are absorbed by the audience like that of a religious preacher. Thank you but no thanks for such a blinding eye-opener episode on medical world. We don’t want to be bracketed with God but to be duly respected as humans and be spared from such monster-like portrayals.
If at all one needs to see the real face of the profession, they should visit some government hospital and see the senior-most doctors handling the patients in the scorching heat of rooms without electricity and sweating with the patients. See a cardiologist operating a heart while his own wife died of a heart disease. Look at a doctor trying to make a call to his daughter stuck in some jammed and mobbed area while he chooses to see his patients instead of going to fetch her. One would know what dedication and intentions are. Mr Khan, you could keep your apologies to yourself but make sure that the next time you don’t end up delivering a wrong message to the society.
The views expressed in this article are the author’s personal views.