Monday, September 27, 2010

Whither the Hippocratic Oath?

A majority of medical doctors in India today are known to resort to unethical, some times illegal and criminal, even murderous, practices to make more money. For them, it is not patients any more, they are just customers, and like any unscrupulous shopkeeper they do not mind short-changing and fleecing their customers. What follows is a long, yet not exhaustive, horror list of these nefarious practices:

# Practicing medicine and surgery without the mandatory degree,

# Unnecessarily prescribing expensive medication at the behest of drug companies who reward them with costly gifts and all-paid foreign jaunts and cruises for them and their families in the name of the doctors attending medical conferences and refresher courses,

# Compelling their patients to undergo a number of diagnostic tests, many of them absolutely unnecessary, and this to earn their cut on each of the tests,

# Demanding extra fee for doing surgery for supposedly freshly discovered diseases after the patient has been cut open on the operation table,

# Delivering babies by Caesarian section even if natural delivery was possible,

# Charging for medical procedures not performed and the doctor’s visits not made,

# Government doctors often attending hospitals and clinics only to net patients for their own private practices or for referring them, for consideration, to a private specialist,

# Doctors in many private hospitals meeting daily targets for expensive medical procedures like angioplasty and cardiac by-pass and also assisting the hospitals in raising the average room occupancy percentage by delaying the patients’ discharge.

# Even after the death of a patient in their care, keeping his or her body hooked to a ventilator and other expensive machines as if making last ditch efforts to save life, and of course making the dead person’s family pay for this through its nose, and

# Even more devilishly, stealing healthy bodily organs while performing surgery and selling them in the black market.

The situation is seemingly hopeless. The Medical Council of India, which was charged with regulating the practice of allopathic medicine in the country and suspending, even canceling, the unethical doctors’ licence to practice medicine, has itself recently been found hugely corrupt and, therefore, disbanded by the government.

In defence of the doctors not living according to the Hippocratic Oath it can be said that they are very much part of the highly corrupt and unconscionable Indian society in which unmitigated greed is the presiding deity and where money earned by whatever means gives a person respectability and fame. That said, the people in ill health can not be just left in the hands of unscrupulous doctors and hospitals out to squeeze the last penny from them. The government can start by doing the following, making new statutes and laws where necessary:

  1. Make it mandatory for the doctors to prescribe medicines by mentioning their generic (or chemical) names, and not brand names,
  2. Make laws to award life imprisonment without parole, if not capital punishment, for doctors and others stealing bodily organs or selling them in the black market,
  3. Severely punish drug companies that reward the doctors for prescribing their products,
  4. Change medical schools’ curriculum to give due importance to the teaching of medical ethics, in each of the five years of undergraduate and two years of graduate studies, by the entirely participatory case study and group discussion methods,
  5. To ensure practice of medicine on ethical lines, form a Medical Ethics Committee, having a two year term, in each State Assembly constituency headed by a judge serving in the local court, the other members being three senior doctors having minimum 20 years of practice, the local MLA, his nearest rival in the last Assembly elections, a lawyer, a journalist and a social worker - care exercised to ensure that none of the eight members was ever punished or charge-sheeted by a court; such committees should also be made at the Parliamentary constituency, State and Central levels,
  6. Create awareness among the people, through repeated publicity over print and electronic media, regarding their rights vis-à-vis the medical community, and
  7. Bring even private hospitals and independent medical practitioners within the ambit of the Right to Information Act, 2005.

1 comment:

  1. i would like to comment on the 7 changes suggested by mr. jaswal as follows :

    1. yes agreed
    2. yes agreed
    3. yes agreed
    4. i dont think it is possible to reform this way. the only way to bring a positive change in this aspect is by privatising all medical colleges. till the day government owned medical colleges exist such deficiencies (such as lack of quality curriculum etc.) will always exist, whether it is indian or usa.
    5. again i dont agree with this method. i feel that once medical institutions and hospitals are privatised, things will automatically come on the right track. i am not saying that private hospitals dont engage in malpractices. even private institutions are involved in wrongdoings but the reason for that is lack of law enforcement. once the law is implemented, no private institution will have the courage to get involved in unethical practice.

    7. this would be not be required i think

    8. at last - mr. jaswal (atleast i agree with you partly on this). what a relief. i only wish you had used the word "only" instead of "even"