Of truth, half-truths and lies

The recent show by Aamir Khan on “Satyamev Jayate” has brought the spotlight bang back on the medical professional. To hear of doctors being described as “ Maut ka Saudagar” was shocking, to say the least, coming as it does from one of India’s respected actors. What are the facts and fiction in this case?

The first patient on the show showed a toe amputation, without it being mentioned whether it was a diabetic case or not, in which the chance of gangrene and amputation increases manifold. Any information, Mr.Khan?

Next up, “forcible” attempts at liver transplantation. Can we have the medical facts of the patient examined in public, please, and before a proper, impartial medical panel? I think no doctor would be imbecile enough to try such a cameo attempt. Let’s examine the case in public, with hospital/ doctor defending itself. Same for Major Rai, with his allegation of surgery without consent. If proved, let the hospital and doctor be served with permanent suspension. If not, let Aamir Khan issue a public apology. Does he even have the guts to do that, away from his limelight and TRPs?

Let us not even go into the career problems, uncertainties, vagaries of the medical profession. These are certainly no determinants of medical ethics, as a well-to-do doctor can still be an unethical one, whereas one finds many medical practitioners not doing spectacularly well, but still leading a life of dignity. My mother has done this in her own home-based paediatric practice for the last 30 years, and no, she does not take cuts and commissions. But she strongly believes that doctors, just like any other human beings, have a right to prosperity, dignity and happiness. Then where does this simplistic notion of “doctors must work selflessly without consideration of money” come in? Did Aamir Khan sponsor my medical education? No, my parents paid for it. Did the government give me a subsidy? No, I studied in a private medical college .Looking at the ramshackle public health infrastructure, I am damned right glad that I did so.Do I earn well as many other professions? Again, no, but that is the least of my concerns. What I enjoy is that I can connect with people, every single working day, and be respected as a professional who does his work well. If a doctor can do charity, that is well and fine. Otherwise, just let him do his work well, which no doubt, thousands of doctors across the country are doing, day in and day out. Without prodding from Mr.Khan.

Has Mr. Khan heard of the CPA (Consumer Protection Act) which was extended to the medical profession quite some time back? If patients are consumers, where does the concept of “selfless service” come in? Can we ask what is so intrinsically wrong about charging for healthcare? Do people not pay for their childrens’ education, despite teaching being a "noble" profession? Hospitals are business houses because, we were thrust into the CPA (Consumer Protection Act), not because we asked for it.

Where there must be no compromise is on the question of medical ethics. A zero tolerance policy is required. That is where the entire gamut of doctors, society, government, politicians, bureaucrats come in. Why is the Regulation of Clinical Establishments Act taking such a long time? Why not quiz the government on why it spends only 1.5% of the GDP on public healthcare? Why did we see the NRHM (National Rural Health Mission) scam in Uttar Pradesh? Did we see the presence of a single bureaucrat / politician on the TV/ TRP show to answer these questions? Obviously no! It is easier to turn scapegoats out of the private medical establishment.

Oversimplifying issues comes with its own set of problems. Does blanket use of generics assure quality? Whose responsibility is it to check the quality of generic medication? Has Aamir Khan ever heard of issues such as drug potency and efficacy? The issue of generic usage is a laudable one, but the larger issue of drug quality had to feature if Aamir Khan had to rake this up. Does he know that for the same drug molecule, bioavailability (the amount of drug actually available to the body) differs widely? So who takes up the onus for ensuring the quality of generics? Simply amplifying the cost difference does not help, definitely for higher medications at least where efficacy is important.

One agrees that there are problems in the medical system, resolve to improve these issues and take actions for the same. One of the reasons why many doctors feel frustrated today is the overcommercialisation of the medical system. The issues depicted in the show are genuine, however the presentation and some of the remedies suggested ( such as selfless service ) , are too simplistic and non-viable. Why target medical professionals only?

This particular show treated the problem in a rather simplistic way. Sensationalism is the best way to grab attention, hence the ridiculous figures of 40-50 % commission quoted (while it is an undisputed fact that the commission system exists, this figure is untrue in most cases) . Hence the intense cajoling of Dr.KK Talwar, Chairman of Board of Governors (BOG) of MCI, hence the putting of words in peoples’ mouths to gain cheap TRPs. May I add that Dr.Shetty himself was on the BOG of MCI , made some positive contribution, and that things have changed considerably after the end of the days of Dr.Desai? The medical establishment is understanding these issues, and carrying out changes.

I do agree with the Yeshaswini (Narayana Hrudayalaya) model. This needs to be replicated across the country. The Yeshaswini Scheme has done wonders in Karnataka, despite some flaws. This is a model which I deeply admire, like the Rajiv Gandhi Aarogyashri Scheme started in Andhra Pradesh under the late chief minister Dr.YS Rajashekhara Reddy( who incidentally passed from a private medical college). All graduates of private medical colleges do not start out with the mentality of fleecing people, Mr. Khan- a large number of them come from business families and NRI backgrounds, and do not even need to think of this. If people can afford private medical education, which is intrinsically costly, who are you to moralise? What must be stopped is the selling of seats to sub-standard candidates, not private medical colleges themselves. And for your kind knowledge, most private medical colleges run a system of cross-subsidy, where the private candidates’ fees offset the cost of providing education for the government candidates. This was the case in my medical college, too. Did you bother to check with the representatives of these colleges by calling them to your show? Most conveniently not!

It is to be noted that the opening of medical colleges has got nothing to do with medical professionals, as most of these are opened by businessmen/ politicians who think they can make a quick buck. They are aided by the political establishment in lien of huge returns, no doubts also aided by some rogue medical professionals, who, as Dr.Talwar correctly points out, are a shame to the profession. Point to note is that not all private medical colleges are bad. I studied in one myself and can testify to the superior quality of education, which I contrasted in my clinical years with the public medical education system (no donations- I went through an entrance test, and I certainly did not spend Rs. 50 lakhs).

Privatization of healthcare is a worldwide phenomenon, even in the UK, the epitome of the public healthcare system. However, it is much on the higher side in India, which needs to be addressed, and the balance corrected. There is enough scope for the public and private sectors to exist side by side. The government needs to increase its healthcare spending- please let’s not end up blaming doctors if it doesn’t.

There are many medical professionals who are making a difference. Why only Narayana Hrudayalaya? There's the example of Dr.Binayak Sen who has devoted his life selflessly to the people of Chhattisgarh (and was imprisoned as a " Maoist" in return). Why was he not interviewed? Because he is not media savvy? Because the Indian government (whom no doubt the organizers of the show would be anxious not to offend) would be displeased? Why no mention of Christian missionary hospitals such as CMC and St.Stephens , who are doing yeoman service to the community? Because they cannot generate TRPs on a television show?

The way to deal with this issue is not sensationalism but an examination of the facts. How many cases of medical malpractice are reported statistically vis-a-vis the number of cases treated? Has he come out with these figures? He talks of 30% commission for medicines? Pharma companies would close down if they paid 30%. Has he examined facts and figures before airing them on a public forum?

Being a medical professional myself, even I have been a victim of commercial mentality of certain doctors. But I still maintain that the vast majority of doctors are ethical and true to their profession. If they charge for their services ethically, even high charges, they have a right to do so- we do not need moral lessons from an overpayed actor to remind us of our duty in life. At the same time, we need to weed out the rogue elements, combined with an effort in improving the conditions of doctors. Let us not compare ourselves to UK when we are in a fundamentally different milieu.

What I disagree with are not the facts, but the presentation, in a rather unilateral manner, passing grandiose judgements on a profession which, if it has wronged on some aspects, has also been often wronged against, especially in our country. This eyeball- grabbing attitude is so typical of actors and self-proclaimed messiahs of society, and reminds me of the TV Anchor on Star Ananda channel who, after the AMRI fire in Kolkata, standing on the smouldering pyre of 92 human lives, never failed to remind us how he was the “ first” to reach the scene and provide “ exclusive coverage.” The same “ Star” media group which never fails to sensationalize issues. One fails to understand from what high moral ground people like Aamir Khan project themselves as the saviours of humanity. This issue of medical corruption should be dealt with by saner people committed to society, rather than self- aggrandizing actors. That would provide it the credibility which it currently lacks. There is an increasing deficit of trust towards the medical establishment these days.  Cameo attempts like these, dancing superficially on the surface while not going deeper, with the intention of increasing TRPs but not doing anything to solve the problem, will simply increase that trust deficit and do more harm than good. Call it “ Asatyamev Jayate” if you will.

-          Aggrieved, a member of your condemned medical community. Guilty as accused,Mr.Khan.