Is India at war with its Doctors ? August 19, 2013
Having been in clinical practice for 28 years I have had the opportunity to have witnessed the ‘glory days’ of medicine when a patient with normal gall bladder operated erroneously with diagnosis of acute cholecystitis / cholelithiasis would still touch the surgeons feet on discharge. Those were the days when ultrasound was science fiction and oral cholecystograms used to be done to diagnose cholecystitis. Since then situation has come when one in 4 MBBS, MD, DM, MCh doctors have faced allegations of medical negligence in courts and consumer forum. 88% MBBS and specialist doctors have faced anger or violence of patients or relatives in their professional career at least once.
Over the years I have listened to doctors complaining, griping and moping over the problems facing them. They feel hemmed from all sides, victimized and perceived as being soft targets. Many doctors specially youngsters seeing their previous generation unhappy with the state of affairs have started leaving clinical practice. Some move into administration, others business, some go abroad, some simply retire. I cannot blame them because India has been at war with its doctors for the past 2 decades and doctors feel defeated. The doctors do not have supportive work environment, professional autonomy or fair pay.
The first blow was when medical profession was covered under Consumer Protection Act. Doctors were equated with traders, barbers, bankers, building contractors, insurance companies, transport, suppliers of electricity, board & lodging and the like. Other professionals like advocates though originally envisaged to be covered under the Act have been spared the aftermath due to deft legal maneuvering. SC in IMA vs V P Shantha & ors included doctors only for outright cases of negligence but unfortunately now this has extended to the level where courts are deciding what a doctor is to do in a complex medical situation. A cardiovascular surgeon operating on a chest tumor should not have proceeded with surgery if neurosurgeon was not available. In another case honorable SC opines If on operating it is found that an additional procedure is needed, it should not be done even with relatives consent. Patient should instead allowed to come out of anesthesia give consent for second procedure and then reoperated. Professional autonomy of doctors has been subjugated to judicial, and administrative control and interference.
This was followed by repeated injustice to doctors by equating them with all kinds of commercial and institutional establishments by government agencies. They are charged commercial , non residential, institutional rates for water, electricity, property tax. This is done even when doctors are earning their livelihood professionally in part of their residential premises. Chandigarh Administration and Municipal Corporation consider a doctors clinic in the same category as a petrol pump, a coal depot, cinema houses, clubs godowns and baraat ghars and charges property tax from them. This again is not done in case of other professionals like advocates.
Another wound has been caused by the acceptance of a gross devaluation of the economic value of their work. Whether it is Bhai Kanhaiya Scheme, or CGHS, or ECHS or even Third Party Administrators who decide what will be paid for life and death work. Often the reimbursement from the insurer (frequently delayed and with unjustified deductions) does not even cover the cost of the treatment. Doctors are routinely and without objection doing massive amount of work for which payment is frequently not made by the insurers. The administrators also at times dictate the course of treatment to be followed which hospital a patient should go to depending on whether hospital has signed their Preferred Provider terms and conditions.
Adding insult to injury MBBS degree , specialization and super specializations are sold openly at exorbitant prices to the highest bidder with approval of statutory bodies like MCI & NBE. Medical education is now available to either the beneficiaries of social justice or to the super rich. Merit has no role to play in this scenario and this is approved and promoted by the State.
PCPNDT Act shifted the onus of poor social development from the Government to the radiologists very conveniently. If women do not have their well deserved position in the society how does filling form ‘F’ properly, and displaying notice about sex determination in requisite color and dimension in a doctors clinic rectify it.
The overt and covert promotion of indigenous systems of medicine by the State and proliferation of quackery without any fear of law is another formidable bane of modern medicine. From chemists to RMPs everyone in India has a birth right to prescribe modern medicine in India. Now another category of non MBBS prescribers of modern medicine in form of BSc Community health is being added by the Government. Besides devaluating of the MBBS degree it will be sold with a ‘rural doctor’ tag in the great private medical education Bazaar. Its value being enhanced because it is to be approved by MCI / NBE. All this obviously puts the qualified doctors at a disadvantage.
Recently GOI has instructed various States to amend their laws to permit registration of AYUSH doctors in the State Medical Register so that they can prescribe allopathic medicines. Reason for this has been given that MBBS doctors do not go to villages.
Final nail in the coffin is provided by the Clinical Establishment ACT which provides total control of medical practice in the hands of bureaucracy. An eye specialist under the Act is forced to conduct delivery for a woman in labor. Part time medical practice cannot be done without providing round the clock emergency services. A registered clinic can be inspected any time of the day. But to inspect a unregistered quacks premises a notice has to be given to the quack before inspecting the premises at an appropriate time.
Now there is another notification that MBBS doctors will have to serve 1 year in rural areas before appearing for postgraduate entrance exams. Already with charm of medicine fading among youngsters. Increased duration for postgraduate degree will further dampen any remaining enthusiasm. Also Govt does not have sufficient rural Primary Health Centres or Jobs in them to accommodate 43000 MBBS graduates passing out each year. This again means corruption.
It of course is the internal strife among physicians which created the conditions ripe for their defeat in this war and they cannot blame outside forces entirely for their loss. Defeating its doctors in this unilateral undeclared war that Indian Government is waging cannot however be good for the country.
Dr Neeraj Nagpal
Convenor and Founder Trustee
Medicos Legal Action Group.