Delhi Belly————— Physician Heal Thyself !

I have a feeling that many would agree with me that the medical profession has now become the most venal and unscrupulous of professions in India. Patients in All  hospitals – government or private – are like cattle being led to slaughter – and in private hospitals they are being made to pay for it too! Each of us knows a horror story or two but two recent cases posted on social media plumb new depths in depravity and commercialisation of health care.

Both relate to a high end private hospital in Gurgaon; The two online stories that carried the titles:  Money Minded Doctors – Medanta  City & Daughter Lost Mother – Medanta Gurgaon and had appeared at   http://fantoosy.com/money-minded-doctors-medanta-medicity/ and  http://fantoosy.com/daughter-lost-mother-medanta-gurgaon/ have now been removed from the website.

Government hospitals are bad enough, treating patients like cattle, but the burgeoning new crop of private hospitals and nursing homes are like Dante’s Hell: “Abandon Hope, All Ye Who Enter Here.” The arrogance of the Doctors there is matched only by their rapacious skill in extracting your life savings through unnecessary “consultations”, superfluous “investigations” and extended stays in exorbitantly priced ICUs, sometimes even when the patient is dead! They will not deign to explain anything to you. Sometime back my son was being treated at a leading hospital in Delhi and the urologist prescribed a particular test which cost ten thousand rupees. He had undergone this same test just three months ago and the results were fine, so I asked the Doctor the need for repeating it so soon. His haughty response was that I wouldn’t understand since I did not have an MBBS degree! I politely disagreed, pointing out that I had an MA and a diploma in Management, had taught in a University for two years and then spent 35 years in government service, had published a book and written more than one hundred articles: in other words, I was reasonably literate and not as stupid as I looked, and therefore he could try explaining to me the answer to my query. His response: “I am a very busy man, I don’t have the time.  I’ll ask my nurse to explain it to you”! I gently reminded him that I had just paid Rs. 1200/ for his time and that if he didn’t have it (the time) he could refund my money and I would be happy to go elsewhere. The session ended with a joint decision that the test was not necessary. I have not gone to that Doctor again and my son is none the worse off for not having gone through the test,

But that is no cure, because most other doctors would behave exactly the same way.

How have things come to such a sorry pass? Here are a few reasons:

One, the government has created space for the rapacious private sector by completing abdicating its responsibility to provide good quality health care to its citizens. India spends only 1.3% of its GDP on health, and 80% of that is spent by the private sector. The global average is 6.5%. Our per capita spend is US$ 39, as against 203 and 483 for China and Brazil, respectively . The government has no money for improving public health infrastructure even as it doles out thousands of crores to subsidize Air India and publicise its own achievements. The deplorable state of public health services is reflected further in the following figures: bed intensity is 1.3 beds per thousand pop. against the WHO norm of 3.5; there are only 0.7 doctors and 1.71 nurses per thousand population, and to reach the WHO norm we need an additional 1.5 million doctors and 2.4 million nurses( we produce only 50000 doctors every year!), and 1.8 million beds. This requires an investment of Rupees 1.65 trillion, about 2% of GDP over and above the current provisions. The imbalance between urban and rural areas is even more telling: 70% of all available beds are in the top 20 cities!

Two. This historical neglect has led to a warped and unhealthy surge in private hospitals whose sole aim is to make money. Health care has thus become corporatised and hospitals are no longer run by doctors but by management graduates who are more concerned about the bottom line than the oxygen line. Stories are now emerging from whistle blowers about how doctors are expected to ” convert” 40% of their OPD patients into in-patients, how they are forced to generate a minimum revenue for the hospital every month, how revenues from everything- medicines, lab tests,ultra sounds, MRIs- are shared with the prescribing doctor, how unnecessary operations and procedures are carried out simply to inflate bills. Health is no longer about CARE, it is now about BUSINESS with all the attendant decline in human values that goes with commerce. Even that would be acceptable if the poor patient at least received the succour he is paying for: as the two Medanta stories indicate, however, even that is not forthcoming. How deep the rot has set in is best illustrated by the Delhi government’s order last week imposing a fine of Rupees 600 crores (US $ 100 million) on five Delhi private hospitals for not providing free treatment / hospital beds to EWS patients as they are required to do as a condition of getting land at concessional rates. It is to Mr. Kejriwal’s credit that he has taken this bold step. The order will of course be challenged in the courts. The government should insist that, while the matter is being heard, 50% of the revenue of these five hospitals should go into an escrow account, to be accessed/drawn only on the conclusion of the case: this will ensure that the fine amount is secure( not fly away like Mallya’s millions), and also that the hospitals don’t spin out the litigation endlessly.

Three. There is no regulatory framework to discipline or punish erring doctors and negligent hospitals. The MCI ( Medical Council of India) is supposed to do so but rarely, if ever, does so. It has become such a moribund and corrupt body that the Supreme Court was recently forced to appoint a three member panel, headed by Justice( Retd.) Lodha to oversee its functioning. The aggrieved patient, if he survives, has no option but to take recourse to the courts where he rarely gets justice, given the absence of a strong law on Torts and the infamous delays that mark our judicial system. Sooner or later he runs out of either patience, or money or life itself and the corporates win every time. There is an urgent need to legislate an independent Regulator for the Health sector, with powers to fine, punish, disqualify, award compensation  and cancel licences. After all, if there can be regulators for telecom and real estate ( which are not life and death issues), then surely there is a greater need to have a similar statutory authority for hospitals and doctors. The MCI’s role should be downgraded to just registration of doctors and over-seeing medical education.

Finally, medical education in India is too narrow and tunnel-visioned. Medicine is not just a science, it is also an art that encompasses humanities: the art of communicating with patients, the understanding of his or her psychological state of mind, empathy, the ability to comfort, if not cure, compassion. All these humane traits are missing in medical education, leading to the complete disregard of moral and ethical values. The humble GP ( General Practitioner) of my childhood has sadly become extinct, but he epitomised what a real doctor is expected to be- a friend of the family, available at all hours, treating more with love than medicines, a soothing presence at one’s bedside. Today’s doctors have the bed side manners and behaviour of a chamber pot. It is the lack of these humane and compassionate elements in modern medical education that partly explains why doctors today are the uncaring, for-profit robots that most patients perceive them to be.
I sometimes wonder– who is the sick one here: the doctor or the patient ?

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English is a wonderful language and I am always fascinated by its endless possibilities- its words can be turned and twisted to convey a myriad of meanings: changing just one letter in a word can confer an entirely new meaning to it and open up a whole new vista of humour and wit. Here are a few puns I seem to have come up with during my deepest moments of unemployment:

*  CONDOMINIUM–a service apartment providing free condoms.
*  NON-PLUS——— minus.
*  OUTSKIRT——— dress better than the other ladies.
*  DESERTATION— a Phd thesis by a Bedouin.
*  INTERCOARSE—- rough sex.
*  SINTHESIS——— a scholarly paper on Evil.
*  DISSENTRY——– the habit of always disagreeing.
*  COOPULATION—- consensual sex.
*  AIRLYING———- an airline not giving correct departure time.
*  DUMBOCRACY— rule of the masses.
*  DICKTATORSHIP– a patriarchal or male dominated society.
*  PLOOTOCRACY— the looting of a country by the elite, as in India.
*  ARSEWHOLE—— a complete arsehole.

Avay Shukla

The author retired from the IAS in December 2010. A keen environmentalist and trekker he has published a book on high altitude trekking in the Himachal Himalayas: THE TRAILS LESS TRAVELLED. His second book- SPECTRE OF CHOOR DHAR is a collection of short stories based in Himachal and was published in July 2019. His third book was released in August 2020: POLYTICKS, DEMOCKRAZY AND MUMBO JUMBO is a compilation of satirical and humorous articles on the state of our nation. His fourth book was published on 6th July 2021. Titled INDIA: THE WASTED YEARS , the book is a chronicle of missed opportunities in the last nine years. Shukla’s fifth book – THE DEPUTY COMMISSIONER’S DOG AND OTHER COLLEAGUES- was released on 12th September 2023. It portrays the lighter side of life in the IAS and in Himachal. He writes for various publications and websites on the environment, governance and social issues. He divides his time between Delhi and his cottage in a small village above Shimla. He blogs at http://avayshukla.blogspot.in/