Saturday, October 06, 2018

4. "Who are you to take decisions on our behalf?"

 "Who are you to take decisions on our behalf?"
What do you want us to do doctor? was a question I used to get asked all the time when I was practising surgery In India in the 80s and 90s. Families wanted me to make  decisions  for them.They had  an unshakable faith in me to make the correct decision for their  patient based on their circumstances.
 but now the  tables are turned  and  doctors are asked "Who are you to take decisions on our behalf?"
 A rampant malpractice is in the area of prescribing vaccines—it is organized, and takes place on a large-scale in planned fashion. The practitioner gets a cut on the Maximum Retail Price (MRP) The more expensive the vaccine, the higher the  commision.
Once it  is marketed to them, the patients definitely take them. But it places a big burden on their budgets. And if I don't recommend vaccinations, they will certainly ask me, "Who are you to take decisions on our behalf?"

 All vaccines should be manufactured and supplied by the government. There should be no involvement of private companies.' 

As Dr Arjun Rajagopalan, the surgeon from Chennai, pointed out, 'Even in the case of some ordinary business or trade, there is a clear distinction between business conducted ethically and business conducted unethically. Even that sense no longer exists in the medical profession. The practice of cuts/commissions is now routine. As the patients do not have the necessary knowledge, it is the duty of the doctor to look out for the patients' best interests. Taking a cut/commission that is even more than the fee charged for the consultation is totally wrong. But I feel sad when I see that there is no transparency whatsoever left in the private medical sector. 'Every week I come across two to three elderly persons who only need proper spectacles,' said an ophthalmologist working in one of the country's metropolises. 'But they have been told to get operated for cataract (which they don't even have), and they are told the charge is Rs 30,000—40,000. Those who have insurance fall into the trap and go in for the surgery. Those who don't have insurance come to me for a second opinion, and they are saved! 'Every month I get at least two to three cases where the patient has all

opinion, and they are saved! 'Every month I get at least two to three cases where the patient has all the paperwork ready. They have been told by some other ophthalmologist to have a cataract surgery, and they have come to me with the required money because someone has recommended me. I examine them and tell them that they have no cataract! This confuses them. They don't know whom to trust. They even harbour the suspicion that I don't understand the issue properly, or that I am scared to perform surgeries. They pressurize me to perform a surgery. But I refuse.' Patients from the economically weaker sections are specially prone to exploitation, as public health expert, Dr Rajib Dasgupta of Jawaharlal Nehru University, observes, 'Under the Rashtriya Swasthya Bima Yojana (RSBY, a scheme under which the government purchases the services of private hospitals for poor patients), private doctors diagnose a complicated hernia even when it is a simple hernia, since this fetches them a higher claim. Caesareans help them to earn more money than normal deliveries. And they claim they are forced to do this, because the fees that the government pays are very low! In the case of some surgical procedures, what these doctors claim is true. But missionary hospitals and some other service-oriented hospitals happily implement this scheme. The scheme is a support for them; which also means that the fees are adequate and costs involved to hospitals are affordable. '

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