Picture this scenario. A ward boy/sweeper performs a surgical procedure on a patient with the medical chief of a government hospital watching it. Later he supports his conduct, in the media. The medical profession is getting highly commercialized what with the doctors prescribing expensive diagnostic modalities and receiving a major ‘cut’ from the diagnostic centres. What happened to the Hippocratic Oath that they had taken before they start their practice?
Dr. Ashok Shetty, Medical Director of Bhaktivedanta Hospital had a lot to say about the rapid commercialization of the medical profession and the health care industry. He started with, “In general, we will talk about why this is happening in health care industry. First of all, whatever you have said about getting commercialized, unethical thing, insensitive feeling, or negligence, this is not happening only in the health care industry, it is happening in all professions. You talk about law, education and other industries, everywhere. But when it comes to the health care industry, the issue becomes sensitive since we are dealing with the life of a person. It is a noble profession. But we should go back to find out why it is happening.”
Does the Indian get a fair deal in terms of health care, today?
There is definitely a doubt about the person who is providing the health care. When there is a doubt about the person’s character then definitely this cannot be a fair deal.
A friend’s mother was admitted in another expensive hospital here due to knee injury. She being a diabetes patient has her food at 8.30 PM, not later than that. My friend was not allowed to stay with her. When the patient insisted about the food, she was scolded by the nurse on duty. Finally, someone came and at 10.30 and she was given a big bowl of highly sweet kheer and all food that remained after others had consumed! When they complained, though the hospital said they will look into it, nothing seems to have happened. What would you like to say about this? (This is the same hospital, where recently when a small boy got his hand cut off due to an elevator accident, was not attended to and surgery done, until the relatives deposited an exorbitant amount. After surgery the attached hand developed gangrene and not only they lost the money but also the boy lost his hand. I got to know from a mutual friend. Many of these incidents do not leak out also.)
The doctors are getting commercialized. It goes down to the nurses, attendants, etc. also. When your work becomes a burden, your patient becomes a burden, then naturally care, love, compassion, everything goes away. Then you become insensitive to the patients. Your tone becomes harsh. If you are not up to the mark in your profession, you don’t have the necessary qualifications. All types of training should be there. There has to be sensitivity, human touch among others. What your friend experienced is very natural, now-a-days. The nurse will not smile. She is not concerned about you. She is doing her work in a mechanical manner. This is because she is not putting her heart into her work. Patient becomes a commodity. If there has to be a change, it should come from within. That can happen only through proper education.
Recently a ward boy attended to a patient while the doctor looked on. Sweepers have bandaged wounds and given injections. There have also been deaths of infants in hospitals. An unqualified woman recently performed caesarian operation and the patient died. The woman maintains that so what if she is not qualified, she has experience! What would you like to say about this?
I will not be able to comment on this because this is a little strange for me. Why would a ward boy give injections? I mean a ward boy is not qualified to give an injection. If it has happened, it has to be condemned and strict action should be taken on the authorities of the hospital.
The good news is that guidelines are coming to accredit a hospital. We are also in the process of getting national accreditation. In another one year we will be an accredited hospital. One of the guidelines is that there should be qualified doctors, nurses and trained attendants. Then there are guidelines for surgery, bandaging wounds, etc. Assessment will be done every year. If they do not follow the guidelines, they will not be accredited. If a patient goes to a non-accredited hospital, it will be at his own risk.
Today, medical education has become expensive what with huge donations paid. The result: predominant commercial motive among doctors. What would you like to say about this?
First of all our education itself is commercialized. We are talking about health care education. A person who studies there has to come and work. He has paid a lot of money for his education. So when he comes out of medical college he is already motivated to get that money back. So when he comes out he comes with all the skills with that motivation with the aim to get back the money. What type of ethics is expected from him? The beginning itself is wrong.
We will go one step further. This is the profession of a doctor. We have gone wrong somewhere. The person should have the qualification before he takes up the profession. Qualifications are not measured by marks. Now-a-days, education is based only on marks. Parents are pressurizing the children to get good marks so that they get admission into a good college. Good college admission means a good job. A good job means more money. More money means more comforts and happy life. This is not true.
In school, we were taught, “When wealth is lost nothing is lost. When health is lost something is lost. When character is lost everything is lost.” Because of rapid materialization, the whole civilization is based on the dictum “the more you possess, the more you have comforts, power, prestige and influence and that translates to happiness.” In that type of scenario, this sutra that we heard is turned on its head. Now it has become, “When wealth is lost everything is lost. When health is lost something is lost. When character is lost nothing is lost.”
Now we have to go back to this fact that when a person selects a profession is he qualified for that profession? No doubt his profession has a lot of prestige. It is noble. But the bottom line is that, is he qualified? If he has good marks that may mean that he may be a good businessman by nature. But if he becomes a doctor how is he going to behave? He is going to see the patients as a commodity. How much he can buy and sell? Where is the question of care and compassion?
In ancient days, this profession was called vaidhya. Also it was free of cost. At the same time, Shiksha or education was free of cost. Knowledge was free of cost. Also Nyaya or justice was free of cost. Now, all the three are highly commercialized. In this state of affairs, now we are talking about health, the doctor will see it as a business. There is no question of care and compassion here. I am not saying that everyone is like that. But some percentage of this faculty has spoiled the name of this profession. Now who is to be blamed for that? The whole system has to be blamed. Blame the medical education, which asks for donation.
So nyaya, chikitsa and shiksha should be free. But is it possible? I am also a doctor. Will I be able to treat patients free of cost? Not possible, because this is my livelihood and have to maintain my family. But, where to draw a line?
It has been seen that there is often a nexus between diagnostic centres and doctors and the resultant ‘cut’ which the doctors receive for recommending tests to patients. What would you like to say about it?
Everything boils down to greed. The person thinks that if I make more money I will be happy. But the truth is if he does not have the basic qualification, he should not be taking up this profession. He should take a profession he is more adapted to like business. But as a doctor the person should be responsible, truthful, compassionate, kind and contented in life. He should not be over ambitious. Of course there is scope of having an ambition to some extent. But he should be able to balance it. Only in that stage can he help others. If he is satisfied from within, he can satisfy the others. He can be composed. He can speak kind words. But he has the pressure of the loan he had taken for his education. Do you think such a person will be very ethical in his practice?
What would you like to say about the Munde couple scandal of foeticide in Beed, Maharashtra?
It is an inhuman act. What is driving them to do it? They are doctors-gynaecologists. It is money and the greed for it. It is our livelihood. We should make money. But there should not be too much greed. When greed dominates and ethics are sidelined, it becomes a crime. So ultimately it is the doctor’s attitude, his intention which matters. You cannot blame just anyone for negligence. Mistakes can happen to anyone. The best of doctors can make mistakes. But more important is, what is his attitude? If the intention itself is unethical, he is doing something very wrong and that cannot be pardoned.
The commitment of doctors towards their profession and patients is dwindling. Why is this so?
The person does not have the basic qualification. He is not taking it as a responsibility. If there is the sense of responsibility, the commitment has to be followed.
Many doctors insist on tests, procedures and unwarranted surgeries with a commercial motive. Your comments.
The character has gone. Money has taken more importance. With that he can get power, prestige, material things and comforts. That will come with money. Money has the purchasing power. There is greed for money. Where is this greed coming from? The modern civilization is teaching it to them right from school. The parents are teaching it to them. “You should get good marks. Study hard.” In this way, the parents are pushing their children.
There is no proper leadership. The leaders themselves are corrupt. Everywhere corruption is there. It is also there in the health care industry, because we are a part of the whole system.
You are asking is there an answer. Yes, there is an answer. But you have to educate the children properly since school. The education should include spirituality and be properly value-based.
How is the health care accessibility to the poor and the rural folks in India?
Unfortunately, wealth is distributed in our country in such a way that there are a few, who have much more than the others. If the rich people have this understanding to share their wealth properly, then the poor and the rural folks will have easier accessibility of health care. In the rural areas, the health is not good. They have poor sanitation problem and no proper water. While in the rural areas there is the problem of communicable diseases, in urban areas there are non-communicable diseases or lifestyle diseases like diabetes, cancer, etc. (laughs).
Industrialist Arvind Mafatlal had a vision that each industrialist should adopt 2 villages and give them health care. It becomes a social responsibility. If everyone thinks of this as a social responsibility, then only the poor people can get proper health care. But the question is that are the rich willing to share their wealth? No. They should get the feeling that the wealth is God-given and they have to share it. And I am sure they have more wealth than they can spend. Of course, the government should solve this problem, which. At the same time, if the industrialists come forward, this can be done.
How according to you can we create value oriented medical professionals such that no citizen is taken for a ride and subjected to tests, treatment and medicines that are not warranted?
This dream can come true if there is balance in our society. We, in Bhaktivedanta Hospital, have adopted communities. There is a small very poor village near Nashik and one village near Wada. For them, all medical facilities are free here. We organize rural camps. If an elderly person has cataract, they are brought here in our vehicle, the operation is performed and we send them back in our vehicle, all free of cost. We are one hospital, in a very humble way in our own capacity, trying to do it. But what are others doing? Our hospital has also come under Rajiv Gandhi Jeevandayee Arogya Yojana. People under the poverty level are treated free of cost here.
There is another scheme which is in planning stages. We plan to adopt a large village. People there will contribute a nominal amount monthly. Then if someone is ill they can come here and take the treatment without the anxiety of payment of bills because others will be paying for them. It will be like an insurance policy between the hospital and the village. If the hospital can cover a large population for this, then it can afford to treat them free of cost. This is already being implemented in Bangalore by Narayan Hrudayalay. There could be others. This is just one example.
Universal health care, why is it still a distant dream? What can be done to achieve this?
Universal health care will be a distant dream unless we stop commercialization and too much dependence on technology. There are such expensive diagnostic and treatment modalities like CT scan, MRI, Laparoscopy, laboratory tests, etc., which the poor people cannot afford. Treatment itself has become so complex. There is so much investment in technology needed. Some companies are coming forward to help. But this is still a small percentage.
How is sale of generic medicines at affordable rates to the public possible?
Generic medicines are also expensive. The only way their cost can be reduced is by getting them in bulk in big containers and dispensing them.
Would you like to add something?
Bhaktivedanta is a semi-charitable hospital. Various discounts like for senior citizens in consultation, diagnostics and medicines already being implemented. Also this hospital is different in the sense it takes care of not just the body, but also mind and soul. We have a holistic approach. The knowledge is coming from Vedic wisdom. If you only take care of the body and not bother about the mind and the soul you are not completely healthy. We have the spiritual care department which talks to the patients individually to discuss with them why they are suffering. When they leave this hospital they are not the same people. They leave with a satisfied feeling. Fever comes down, stones are removed and pain is less. But at the same time, their anxiety is taken care of. That is the holistic approach, which is the need of the day. The doctor also has to go through a proper training for this. There are prayer meetings, discourses, etc. But since this is a hospital and they are appointed for their professional skills, we haven’t made it compulsory. It is voluntary.
This article was previously published in Eve’s Times magazine. It has been reproduced here with the permission of the editor, Swati Amar.