Public perception and state propaganda against doctors

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Doctors in India (meaning only those of modern scientific medicine) are victims of massive state-sponsored propaganda for the last few decades. The constant and persistent high-decibel hammering from every pulpit recognisable has had its effect on the general public, which is gullible enough not to differentiate propaganda from fact. Gradually, the public sentiment too has turned negative, especially when in our country saving for daughter’s marriage is ingrained but there is no concept of saving for the old age or health-related emergency. Hence in illness, the disappointment with the government services and financial burden of the private sector healthcare results in an already negative sentiment against the face of healthcare services that the doctor represents.

DOCTORS’ POSTS NOT INCREASED IN VILLAGES

The first major propaganda aired constantly is that “there is a dearth of doctors (1 doct.or for every 1,700 patients)” and these doctors do not go and work in villages. Along with this is tagged the line that the government spends crores in training doctors. In my earlier articles, I have already elaborated on this point. If AYUSH doctors are not recognised doctors, then why spend money on promoting AYUSH. If they are doctors, then the ratio is 1:946 and not 1:1,700. As regards rural posts, since there are only 1,750 vacancies for the MBBS doctors to work in villages and India produces about 67,000 doctors yearly, this figure simply reflects government’s own incompetence. The posts for MBBS doctors in villages have not been increased in past three decades despite substantial increase in population.

The question whether “government spends crores in training doctors” is also debatable. About ₹1,200 crore is spent yearly on the Postgraduate Institute of Medical Education and Research (PGIMER), which treats 25 lakh patients yearly. So, on whom has the ₹4,800 per patient been spent? In training doctors or on treating patients? The doctors who are under training are used as bonded labourers and made to work more than 90 hours per week. Taking into consideration the working hours put in by doctors for which they are grossly underpaid, they actually pay the government in crores in the name of being trained specially in government institutes.

GOVT REGULATION ON PHARMA INDUSTRY

“Doctors write expensive medicines because they are sponsored by the pharmaceutical Industry to go to Singapore and Dubai”. In my 27 years of private practice in a Tier-1 city, somehow I missed these Singapore trips. Unlike cosmetics, clothes, and other consumables, the pharmaceutical industry is very zealously regulated by the government and its agencies who decide what the selling price of a drug will be. It is these government agencies that permit one company to market one drug with two or three brand names with different prices. Such corruption at the government level or its agencies needs to be obfuscated by somehow putting blame doctors’ shoulder.

“Doctors place stents unnecessarily, doctors steal kidneys, doctors put dead patients on ventilators to make money”. Innumerable similar allegations resonate across the spectrum of social electronic and print media. A stent placement is a life-saving procedure and I for one have lived these last 13 years of life only because a stent was placed in me without me first questioning the cardiologist on the need, type or cost of the stent. The only way to really know would be for no stents to be placed for next two years and then compare the mortality and morbidity with preceding years. We can start this study by introducing the “no-stent policy” for the parliamentarians, bureaucrats through central government health scheme and other captive populations (spare the army/ex-servicemen contributory health scheme please).

GANGS DEFRAUDING DOCTORS

Stealing kidney is a popular storyline for B-grade movies. How exactly do you steal a kidney since it is not exactly a pickpocket’s job. The place where this happened maybe is like in Gurgaon where a quack was running an illegal unauthorised kidney transplant centre. He and his accomplices had been arrested in four different states, got bail and had restarted their business instantly through their network of touts, corrupt officials who prepared documents and had infrastructure and patients and donors ready for him to restart the moment he escaped from prison or got bail. This, however, is a criminal who poses as a doctor and uses some qualified doctors with or without their knowledge of the criminal activity. Law currently leaves about 1 lakh chronic renal failure patients to die every year if they do not have a legally acceptable donor. There are gangs who defraud doctors and hospitals by getting paid donors who initially give video consent as close relative and later demand more money from touts failing which they make allegations against hospitals. This has, however, also given rise to ludicrous allegations of stealing kidney against civil hospitals, nursing homes etc, which have no facility for kidney transplantation. Change in law and its judicious but rigorous application can easily eliminate the gangs operating in the kidney transplant arena. Accusing doctors gains more TRPs and sells more newspapers but glosses over a very serious problem.

CLARITY OF THOUGHT IS NEEDED

“Doing a Caesarean unnecessarily” is another frequent allegation made. The government in fact has come up with a policy that to do a Caesarean for which government will pay princely ₹9,000 under Ayushman Bharat – NHPS the private hospital will need permission from government hospital. This brilliant notification is the brainchild of probably the most incompetent bureaucrat on orders of those with a compartment in 5th standard as their highest qualification. Sir, by the time a Caesarean will be done for foetal distress following provisions of this order the foetus, the mother and later the gynaecologist (from violence) all will be dead. The NCDRC in case of Dr Indu Sharma awarded ₹1.1 crore against a Delhi hospital doctors for not doing Caesarean in time resulting in brain damage to the foetus. A clarity of thought is needed at the highest level whether we want doctors to do their duty or to do what the judiciary, police, bureaucrats or politicians demand that they do all of who may be contradictory to each other.

Despite the propaganda, medical profession in India is still the most ethical profession which charges most reasonably its so-called “consumers” despite the difficulties faced.

Above editorial was published in Hindustan Times Chandigarh on 01/17/2018 here. It was written by  DR NEERAJ NAGPAL The writer is convener, Medicos Legal Action Group and ex­president of IMA, Chandigarh. The views expressed are personal.

 

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