#VinitasPune: The Doctor’s Dilemma-Critical Perspectives

Violence on Doctors
Image used for representation only.

Quite justifiable that the medical fraternity is demanding safety at work, considering the regular episodes of facing the wrath of patients’ relatives, across India.

What is the issue ? Let’s take a balanced look at the scenario that prevails today in our country…

The credibility of several professions is being questioned these days; but when it comes to the medical fraternity, the stakes of disrepute are high as it is directly connected with the physical and mental well-being of man – at times a see-saw between life and death.

That, patients’ relatives should indulge in beating up the doctors in case of what they perceive as failure of treatment leading to death of their loved one, is highly condemnable.

It is, therefore, absolutely justifiable for the doctors to finally demand a central law to protect their safety while at work. That, the campaign has received huge response from doctors from across the cities including Pune shows the seriousness with which they are looking at the issue.

This reminds me of a recently released Marathi Play `Zara Samjhun ghya’ (Just try to understand) with Mohan Agashe in the lead role of a patient whose father has died due to alleged medical negligence, during surgery.

He seeks legal intervention and runs from pillar to post for justice. On the other side, the doctor’s dilemma has also been highlighted. The Play is centred around a primetime debate on a national television, with the anchor being the Protagonist, grilling Agashe, the hospital staff with news bits from her reporter. The play is an apt reflection of the changing relationship between a doctor and patient and the lack of trust of the latter in the former’s diagnosis, prescription and treatment.

And therein lies the crux of the issue.

Medical care is of very high quality in Pune, with some brilliant doctors in every branch. However, it is the industrialisation/corporatisation and the entrepreneurial ambition of the owners of the hospitals and the management team that gives it a business twist.

Doctors, in anonymity, confirm that they are asked to meet targets of hospital room occupancy, operation theatre occupancy as well as ICU occupancy. When I was writing a series of articles on the mandatory need of the head gear (helmets) while working for a leading national newspaper, a senior neurologist of a prominent hospital told me how nearly 90% of the beds in the ICU are occupied by head injury patients. When I told him, if this matter is so serious, why don’t the hospitals come together to spread public awareness of helmets? He quipped that it would lead to dip in business as the ICU beds would go unoccupied.

The nexus between hospitals and diagnostic centres is even more startling.

One of my close friends whose husband in a well-known specialist of a particular mentioned the 30-40% cut for general practitioners/specialist doctors who advice tests like MRI and other diagnostics from particular pathological laboratories. Recently, after the suicide of Dr Payal at the Nair Hospital in Mumbai, a former senior doctor circulated a video in which she said that commercialisation of medical colleges and hospitals is largely responsible for young medical students taking such drastic steps.

For she said, there is no senior to hear out the young interns; doctors are mechanically churned out from colleges and all that the young doctors are interested in are cuts and commissions. There is no essence of humanity or compassion left in the younger breed of the medical fraternity.

That, operation theatres need to spin money was amply portrayed by one of the orthopaedic surgeons who is best known for microscopic surgeries of the hands and legs that receive multi-trauma injuries due to accidents on roads or in industrial units. Such surgeries take hours on end as they are intricate, dealing with nerves and blood vessels. He was asked either to abnormally hike his fees so that the hospital is at an advantage or go find some other hospital for his modest (financial) approach.

As far as cashless treatment is concerned, where you have a medical insurance, hospitals are known to indulge in more than necessary treatment.

In their book Dissenting Diagnosis, Dr Abhay Shukla and Dr  Arun Gadre  write about the shocking commercialisation in the medical field. They write that a young heart specialist was warned that unless he convinced 40% of his patients to undergo surgical intervention, he would lose his shop. They write, quoting a medical expert that, to find a white sheep has become difficult amongst most who are the black sheep of the profession. An instance has been given wherein a pathologist got no recommendation to his laboratory for tests, as he refused to give commission to doctors. The book speaks about how, due to the greed of doctors and hospital management, people are unable to get medical care at affordable rates. In cases of cancer, heart and kidney ailments, often, the entire fortune of a middle-class family is lost to the treatment of the disease, afflicting the near and dear one.

On the other side, patients and their families from the educated class, flaunt their knowledge, which they consider as more superior than the doctor they are going to.

Their guru is the Google and they almost do an incisive research on the subject of the illness. If the doctor, does not advocate a battery of tests, then they feel he is not doing his best and so seek second opinion.

Also, in case, something adverse happens to the patient, due to some tests that were not prescribed, again the doctor is bad-mouthed by the family members. So, the doctors too hesitate to use their own professional and intuitive skills in their diagnosis. It is the machines which master-mind the diagnosis. 

Hence, incidents of violence against doctors are on the rise as the family insinuates that the doctor fell short of treatment to the patient.

On the other hand, exorbitant donations required for entry into medical colleges, particularly in the post-graduation level, leads to the moneyed scoring over students who may have a high intellect and inclination for this profession. An expert remarked, “such students then aim to open private hospitals to recover the big fat sum that their parents paid for, to get admission. So, form day one profit drives them; not the patients’ recovery.’’

Truly, this excerpt from the Hippocrates Oath has been buried deep: `I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure.’’


#All views expressed in this column are the Authors and Pune365 does not necessarily subscribe to them. 

Vinita Deshmukh

Vinita Deshmukh

Passion for the written word that comes alive, not only to tell a story, but to speak out loud about all that's good, bad and the ugly in society...

That's Vinita Deshmukh, Senior journalist and RTI activist who believes in journalism that reflects the views and needs of the common man.

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Vinita Deshmukh