"patients are now going without care and suffering on a scale that has not been seen since before the Independence all for the sake of the alleged gains to be had from "market efficiency". Across the country the public is protesting, but the voices go unheard and unanswered in new Delhi."
Question: There is a growing demand from society for effective regulation of the private medical sector. What is your opinion on this subject?
Dr Ajgaonkar: There are no two ways about it. Regulation of medical practice is of course necessary because we have collectively not been able to maintain the ethics of our profession and we have let it become a business! That is the state of affairs today. Why should doctors work? To serve the people. Now any person who says to himself, 'This "service" stuff is too much, I can't do it,' should not come to study medicine. The nature of our profession earlier was service-oriented. What were the medicines that were used in earlier times? They were often placebos ... Let me explain about placebos to your readers. They are tablets without any effective ingredient in them— but they are given as treatment anyway, so that the patient feels better, since they feel that have received some kind of care. People used to feel better even with those placebos. The reason was because there was a relationship of trust between doctor and patient. Now under the onslaught of technology, we have lost our clinical
Now under the onslaught of technology, we have lost our clinical sense. Do you understand the seriousness? We doctors used to rely on our skill to pick up signs. As we grew older we used to develop that marvellous sixth sense. Now we have lost it thanks to our dependence on investigations. Often, an illness has psychological origins. I myself have often seen cases where just a few minutes of sympathetic conversation with a patient has resulted in a dramatic decrease in blood sugar levels. But see what is happening—American fads or I would rather say commercial fads are now getting established here. Like doing full body investigations routinely without any indication. Just fling a set of statistics in the patient's face. 'The prognosis is ... 97 per cent mortality!' So is it really like this? First, ninety-seven patients will die, and onl after that will three be saved? No it's not like that is it? Are mortality!' So is it really like this? First, ninety-seven patients will die, and only after that will three be saved? No, it's not like that, is it? Are doctors some kind of gods? No? Then they should boost that patient's morale. A patient's will to live can be strong ... and if the doctor builds up his morale and these [factors] come together, people live on, casting aside all kinds of gloomy prognoses. I have seen such cases myself. We can't say which patient fits into this pattern. Medicines alone do not help; the doctor-patient relationship is tremendously important. We seem to have forgotten these principles nowadays. What we treat are figures for blood pressure and blood sugar, X-rays, MRIs and CT Scans. We don't treat human beings. Even during our medical training, we dissect parts of the body... we never look at a person as a whole. Now everything in medicine has become mechanical. Doctors too have changed. I will tell you about doctors in earlier days. Dr Modi was forty years my senior. But he used to come to Chembur to examine my patients. He charged just Rs 50 and what did he tell the patient? 'The medicines given by Dr Ajgaonkar are all appropriate and I am not going
change even one.' Dr Wadia would make a diagnosis just based on the patient's detailed case history, and would decide the course of treatment after examining the patient. It was only rarely that he would order investigations. Now our greed has increased to the extent that when a patient of one consultant goes to another consultant, the second one prescribes the same medicine, but merely changes the brand to show that he is doing something different. And it is true that this profession has now become a completely commercial business. If you look at the issue objectively, it is not our role to make money by taking advantage of another person's illness. But that is exactly what is happening. They put terminally ill seventy- to eighty-year-olds on ventilators, keeping the hospital meter running by unnecessarily using the ICU and ventilator. Come on, just let the patient go home. Let him die in peace at home amidst his family members. In the ICU there are tubes in the mouth and nose ... the patient can't speak even if he wishes to. Of course, when the patient is young, and the disease is reversible .. , certainly you should use the ventilator. But what is the point in pushing forward for a short while an old man's death—that too while you ruin him financially and increase his sufferings? Doctors angrily question why there is no regulation on builders and property developers. In the first place, we are not builders but doctors. We deal with issues of life and death! That is not the case with the
property developers. In the first place, we are not builders but doctors. We deal with issues of life and death! That is not the case with the builders and developers. And then, if we ourselves start behaving like builders, people will also treat us as such. Have we ever imposed any self-discipline on ourselves? No. If we ourselves do not keep ourselves well dressed and start dancing in the nude, why would other people tolerate our behaviour? They will take steps to cover us decently. How can we then complain, 'You are interfering with our work?' How dare we complain? You tell me, do we have any right to do that? And what a terrible state we have reached! The pharmaceutical companies have tried to entice us with big temptations, and we have fallen prey to them. Simply because it's free ... just because pharmaceutical companies give [doctors] free alcohol, senior, eminent doctors get drunk in public programmes ... when one sees this, one is disgusted, ashamed. Drink if you want. But go to your room and drink, not in public with the free liquor given by drug companies. Once you are in the pharmaceutical companies' debt, then you have to prescribe unnecessary medicines produced by them. And as to pharmaceutical companies ... yes, some new molecules are useful. But what about the price? Just see ... insulin was available at Rs 30 or so per dose, now it costs around Rs 150. How is that? The research costs on the medicine have been recovered—should the medicine become cheaper or more expensive over time? No medicine ever becomes cheaper. How is that? I for one never attend pharmaceutical company-sponsored meetings, and if I do go, I never eat anything other than a salad. Often, largely useless medicines—medicines that have no additional benefit compared to existing cheaper variants—are palmed off. And even if any defects come up in the post-marketing survey ... the companies don't disclose this information and continue to market the same medicines. And now huge corporate hospitals and multi-speciality hospitals are growing. These hospitals put pressure on all the doctors linked to the hospital, and on their full-time doctor employees. They demand that they must send a certain quantum of business to the labs and the radiologists.
There is no doubt that this practice has become commonplace. Unnecessary investigations are then forced upon the patients. The unfortunate patients are trapped. They keep running from one big hospital to the other. This is what is going on today. KEM Hospital, Nair Hospital, JJ Hospitali are all teaching hospitals, and procedures like angioplasty are performed there too. If well supported, these teaching hospitals can easily do better than all these corporate and multi-speciality hospitals. In that case, we should increase the facilities in these government hospitals. But our elected representatives ... have now become self-representatives.
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