A common man will fight for one or two rupee with a vegetable /fruit vendor but will never confront a doctor on treatment pricing.
Street Talk
Expert Opinion
National Doctors’ Day is celebrated on July 1st every year in India since 1991.The Day is observedto recognize the invaluable contributions of doctors to society. This day not only honors the dedication and hard work of medical professionals but also serves as a reminder of the critical role doctors play in human lives. Precisely, this day holds importance for acknowledging personal sacrifices of doctors to ensure the health and well-being of their patients; to highlight advancements in medical science and the achievements of doctors; to serve as a reminder of the importance of health and regular medical check-ups; and to reinforce the importance of doctor-patient relationship.
Let’s take this opportunity to deliberate upon the issues confronting doctors as well as patients in our region (J&K) which have adversely impacted the performance of the health sector.
Incidents of unhealthy developments trapping our doctors’ community on the wrong foot are not new in our region. These incidents trigger dual anger among masses. First, the majority of opinions gather against the ‘unholy’ practices of our medical doctors. Second, groups in defense of these holy professionals vomit anger against those who expose their ‘unethical’ deeds. Amid these developments, the sacrosanct chord in doctor-patient relationship has only weakened over a period of time, which has adversely impacted the performance of our human savings institutes.
Today, the public is losing fast their trust in doctors. There is a common and growing feeling among the masses that their health concerns are not seriously taken care of despite paying treatment expenses through their nose.
Does all this sum up thatdoctor-patient relationship is no more sacred?
Here I am reminded of an old proverb that “Doctor is the second God on this Earth”. Genuinely so. For a patient, it’s the doctor who can rescue him from the clutches of death. This unflinching faith on doctors has never challenged their status as ‘second God’. We observe that a common man will fight for one or two rupee with a vegetable /fruit vendor but will never confront a doctor on treatment pricing. The reason is simple: For him this ‘second God’ is the only fervent hope to save him from getting consumed by a disease.
But do our ‘holy’ professionals (doctors) fit this adage? Over a period of time, this holy profession has been witnessing unholy trends at our place. These ‘holy men’, of course not all of them, have engaged themselves in trading politics rather than treating patients. Besides, they have developed an attitude to look upon a patient as a money generating machine and don’t hesitate to employ all strategies to make money. Most of them, unfortunately, only focus on the pocket of the patient. It makes them no difference whether the condition of the patient improves or worsens. Whatever they value is just money, not anything else!
International Journal of Community Medicine and Public Health has defined the doctor-patient relationship as “a consensual relationship in which the patient knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person as a patient. Quoting Emanuel and Dubler, the Journal has suggested that the ideal doctor–patient relationship consists of the six C‟s: Choice, competence, communication, compassion, continuity, and (no) conflict of interest.
If we slightly peep into the past, we find no questions were raised about this noble service. A doctor would always remain in commanding position while dealing with the patients and patients or his attendants would never dare to argue with them. There would never be an iota of doubt on the integrity and treatment capability of a doctor.
Why has the trust in doctor-patient relationship faded away to such miserable levels? This is a million dollar question, especially in the context of our own hospitals. Ask any junior doctor, senior resident or a doctor who is discharging duties as registrar in the hospital, they in one voice say that patients hardly trust them and their treatment capabilities. “If we find a patient with minor ailment, we prescribe treatment and ask him to go home. But most of the patients lose cool, thinking that we have not shown interest in his ailment. At the same time, when we find a patient seriously sick, we prescribe medicine as per the protocol of his ailment. This time the patient calls the agent of a pharmaceutical company for prescribing medicines which are not available in the hospital and are a bit expensive. In both situations we are at the receiving end,” a group of doctors while describing their plight narrated this.
We have many times come across attendants manhandling a doctor if the patient is asked to be in a queue for consultation or the medico’s treatment fails to provide a relief to the patients. A common thread in such incidents is that the doctors (JRs/SRs/Registrars) at the operational front have been the victims as the consultants or head of departments (HoDs) very rarely come across the patients in hospital chambers for the public. Here I don’t think it would be unjust to blame these senior medicos for the kind of deterioration we have been witnessing in the doctor-patient relationship. Most of the time, these consultants/HoDs are busy striking deals with pharma companies to run a product across patients. This aspect of these senior doctors is not hidden and many times fingers were raised at them for acting as medico marketers – an extended arm of pharmaceutical companies. Generally speaking, this behavior of senior medicos who are responsible for running a human saving institute have been actually responsible for shaking the trust factor in doctor-patient relationship. Patients have been forced to doubt the treatment protocol of such medicos. Since these senior medicos are not in direct contact with mass patients, the doctors down the line like JR/SRs and Registrars who are mostly out of touch from such deals are left to face the fury of the public for none of their faults.
It’s a common notion in public that in the name of curing kidney pain, stomach pain, gall bladder disorder etc., some of the money-minded doctors perform surgery when such disorders are normally treated with oral medication. The style of functioning of most of the doctors in the valley which includes some leading doctors reflects the opposite of Hippocrates’ oath. They seem to have vowed to prescribe unnecessary medicines and tests to the patients; prescribe lethal drugs, like antiretroviral, chemotherapy, or give ECT to their patients and frighten them with unnecessary comments, opinions or advice. These groups of doctors don’t believe what Hippocrate said, “Let diet be your medicine” and it never comes to their mind to prescribe fresh fruits, vegetables and a good diet to their patients, rather than tonics, syrups, synthetic multi-vitamins, especially to children.
Take the case of spurious drugs. It’s a huge concern confronting us on the health front. Our doctors’ community has been very vocal on spurious drugs flooding our hospitals and markets. They have been blaming administrative authorities for allowing a spurious drug to enter into the J&K markets. But who is responsible for making these drugs to reach the patient? Obviously, it’s this breed of ‘holy men’ playing a key role in spreading this menace. They are influenced to prescribe these spurious drugs. So they are one among key players to legalise the entry of these drugs into the markets and even into the government institutions like hospitals and dispensaries. Here the doctors as marketing agents of pharma companies act more as business functionaries.
Let me reiterate a few important questions: Why can’t there be treatment guidelines issued by the government for the doctors in terms of prescribing medicines and conducting periodic prescription audits? Can’t we end this nexus between the doctors and the pharmaceutical companies by invoking a regulation wherein the companies are asked to follow disclosure norms stating expenses incurred on gifts to doctors? Why can’t we have a ‘Sunshine Act’ where disclosure of all financial transactions and transfers of value between manufacturers of pharmaceutical / biologic products or medical devices and physicians, hospitals and covered recipients are made mandatory?
‘Sunshine Act’ will reveal actual pharmaceutical-marketing expenditures of individual drug companies. If the expenditure is found contributing disproportionately to the total expenses of the company, the regulators can immediately put strictures and force the company to stop unethical influencing of doctors. It can also have a huge impact on the medical expenses of patients as the controlled marketing costs will bring down the prices of medicines.
There is a need to frame comprehensive legislation to make not only these holy but all health care professionals accountable to the system. This alone will help to strengthen the trust in doctor-patient relationship. More importantly, it will restore the credibility of the holy profession in the region.
(The author is a veteran journalist/columnist. He is former Head of Corporate Communication & CSR and Internal Communication & Knowledge Management Departments of J&K Bank)