The backdrop to this situation is that in the past few decades, under the influence of privatization- and liberalization-oriented policies, public health services have been left underfunded. They are also often prone to corruption and not adequately responsive to ordinary patients. Not only does the middle class keep well away, but in many places even the poor are abandoning public health services and turning to private services. The chilling reality is that in order to cover the costs of using private medical services, the poor are forced to sell their homes and land. According to the World Health Organization, in the past few years approximately 3.5 per cent of the population per annum (amounting to nearly four crore people) have been pushed below the poverty line in )Yfish
The public at large is probably unaware of the helplessness felt by such doctors who are deeply troubled about the entire scenario. The public sees the insistent and self-congratulatory posture of certain doctors' associations, or newspaper reports about attacks on hospitals, and the cases that are brought before the consumer courts, as well as sensational media reports on deaths in private hospitals caused by negligence. If, for instance, a healthy thirty-year-old dies during a simple operation, the doctor's negligence may not be a factor. But the perception of society is that many doctors today exploit patients, putting them through investigations, surgeries and procedures which are not needed. Even a suspicion of negligence can lead to a public reaction which can all too easily flare up into violence, which, however deplorable, has to be understood in the context in which such extreme reactions arise. There has been a decline of transparency in the medical sector, and the overall position of many doctors and their associations has been one of complicit silence or active support of the guilty.
How These Doctors Were Selected The doctors to be interviewed were identified through personal contacts, and then through a further chain of doctor contacts.2 This is not a representative sample, and we make no claim that the views of these seventy-eight doctors reflect the views of the entire medical profession. In fact, it is an oft expressed opinion that it is relatively difficult to locate ethically practising doctors, who may be regarded as 'exceptions' within their profession, hence this specific method had to be adopted. The initial circle of doctors was from among those whom the first author, Dr Arun Gadre, knew personally, and who were known to be practising ethically. Other doctors, especially outside Maharashtra, were located through the contacts of ethical doctors, or contacts of colleagues in SATHI, who had personally experienced these doctors' ethical and rational practice.
" These twelve doctors relate intensively with the private medical sector, and either treat patients coming from the private sector or have studied the private sector in some form. Many private doctors often send patients with complicated illnesses or terminal diseases to a premier government hospital like AllMS as a dumping ground. Apart from that, poor people come to such hospitals when private doctors recommend a course of treatment they cannot afford. For these reasons, doctors working in hospitals like AllMS have significant knowledge of the workings of the private medical sector."
"Thirty-seven doctors who participated in the study gave permission to use their names, and their names have therefore been mentioned in this book. Both authors have been in private practice themselves and know the pitfalls. For instance, there is the ever-present anxiety that even without a mistake on their part, a patient under their care may die or develop serious complications. In such a situation, there is no effective mechanism that can help them, while there is a tendency among doctors in the private sector to point fingers at other doctors. There are increasing incidences of attacks on private doctors and hence individually practising doctors feel quite vulnerable. The incidences can happen in publichospitals too, but the mighty arm of the government is available to back up doctors in public hospitals. In the private set-up, the doctor has to fight on his or her own. Secondly, no doctor in private practice ever wants a scuffle on the premises as his or her reputation is at stake. Hence many honest doctors in private practice are apprehensive about alienating their colleagues while exposing malpractices in the private medical sector. Therefore, the names and locations of those doctors in the sample have been kept confidential at their request. The interviews given by these doctors who are currently engaged in private practice, all point towards an important and serious reality. This reality is the deplorable decline in ethical standards in private medical services, and also the highly commercialized form that such practice has acquired. But even more than this, they make it clear that in our midst there is still a group of doctors, albeit a small one, who, just like most patients, feel suffocated by this gross commercialization and are deeply disturbed by the unethical practices that are rampant. Barring a few very senior, well-established doctors, the majority of these young and middle
disturbed by the unethical practices that are rampant. Barring a few ven senior, well-established doctors, the majority of these young and middl( aged doctors are engaged in a tough day-to-day struggle to avoid compromise and keep themselves out of the jaws of unethical, commercially-driven practice, which has become the dominant norm. It is a genuine fear among many that such doctors may, soon, like some endangered species, become extinct. If we are to avoid this, then society must rapidly identify structures and mechanisms that would ensure protection of rational practice and provide safeguards against unethical practices. All doctors were asked nine common questions: I. Are you satisfied with the private medical sector as it functions today? 2. If not satisfied, then tell us the areas in which standards have gone down and problems have arisen. 3. From your experience, can you give us some examples of medical malpractice?
4. 5. 6. 7. 8. 9. fish medical malpractice? Give some examples from your own experience of irrational practices which cause harm to patients. Can you give some example of inflated rates being charged for medical services? What is the impact of the growth of corporate and multi- speciality hospitals on the medical profession? What is the impact that insurance has on the functioning of hospitals? What is the influence of pharmaceutical companies on the functioning of hospitals? What suggestions do you have to improve the current situation?
'public hearing' on the private medical sector, conducted by a section of private doctors themselves. We hope that the searing testimonies will help awaken the general public, citizens' groups, social movements, and political representatives to the urgent need for regulation in the private medical sector in India. We hope that with social pressure and political attention, this sector, that has remained largely unregulated until now, will be subjected to participatory and social regulation in the interests of ordinary patients, as well as rational health care professionals. That would be the best response we could give to the anguished voices of ethical doctors that are reflected in this book.
The public at large is probably unaware of the helplessness felt by such doctors who are deeply troubled about the entire scenario. The public sees the insistent and self-congratulatory posture of certain doctors' associations, or newspaper reports about attacks on hospitals, and the cases that are brought before the consumer courts, as well as sensational media reports on deaths in private hospitals caused by negligence. If, for instance, a healthy thirty-year-old dies during a simple operation, the doctor's negligence may not be a factor. But the perception of society is that many doctors today exploit patients, putting them through investigations, surgeries and procedures which are not needed. Even a suspicion of negligence can lead to a public reaction which can all too easily flare up into violence, which, however deplorable, has to be understood in the context in which such extreme reactions arise. There has been a decline of transparency in the medical sector, and the overall position of many doctors and their associations has been one of complicit silence or active support of the guilty.
How These Doctors Were Selected The doctors to be interviewed were identified through personal contacts, and then through a further chain of doctor contacts.2 This is not a representative sample, and we make no claim that the views of these seventy-eight doctors reflect the views of the entire medical profession. In fact, it is an oft expressed opinion that it is relatively difficult to locate ethically practising doctors, who may be regarded as 'exceptions' within their profession, hence this specific method had to be adopted. The initial circle of doctors was from among those whom the first author, Dr Arun Gadre, knew personally, and who were known to be practising ethically. Other doctors, especially outside Maharashtra, were located through the contacts of ethical doctors, or contacts of colleagues in SATHI, who had personally experienced these doctors' ethical and rational practice.
" These twelve doctors relate intensively with the private medical sector, and either treat patients coming from the private sector or have studied the private sector in some form. Many private doctors often send patients with complicated illnesses or terminal diseases to a premier government hospital like AllMS as a dumping ground. Apart from that, poor people come to such hospitals when private doctors recommend a course of treatment they cannot afford. For these reasons, doctors working in hospitals like AllMS have significant knowledge of the workings of the private medical sector."
"Thirty-seven doctors who participated in the study gave permission to use their names, and their names have therefore been mentioned in this book. Both authors have been in private practice themselves and know the pitfalls. For instance, there is the ever-present anxiety that even without a mistake on their part, a patient under their care may die or develop serious complications. In such a situation, there is no effective mechanism that can help them, while there is a tendency among doctors in the private sector to point fingers at other doctors. There are increasing incidences of attacks on private doctors and hence individually practising doctors feel quite vulnerable. The incidences can happen in publichospitals too, but the mighty arm of the government is available to back up doctors in public hospitals. In the private set-up, the doctor has to fight on his or her own. Secondly, no doctor in private practice ever wants a scuffle on the premises as his or her reputation is at stake. Hence many honest doctors in private practice are apprehensive about alienating their colleagues while exposing malpractices in the private medical sector. Therefore, the names and locations of those doctors in the sample have been kept confidential at their request. The interviews given by these doctors who are currently engaged in private practice, all point towards an important and serious reality. This reality is the deplorable decline in ethical standards in private medical services, and also the highly commercialized form that such practice has acquired. But even more than this, they make it clear that in our midst there is still a group of doctors, albeit a small one, who, just like most patients, feel suffocated by this gross commercialization and are deeply disturbed by the unethical practices that are rampant. Barring a few very senior, well-established doctors, the majority of these young and middle
disturbed by the unethical practices that are rampant. Barring a few ven senior, well-established doctors, the majority of these young and middl( aged doctors are engaged in a tough day-to-day struggle to avoid compromise and keep themselves out of the jaws of unethical, commercially-driven practice, which has become the dominant norm. It is a genuine fear among many that such doctors may, soon, like some endangered species, become extinct. If we are to avoid this, then society must rapidly identify structures and mechanisms that would ensure protection of rational practice and provide safeguards against unethical practices. All doctors were asked nine common questions: I. Are you satisfied with the private medical sector as it functions today? 2. If not satisfied, then tell us the areas in which standards have gone down and problems have arisen. 3. From your experience, can you give us some examples of medical malpractice?
4. 5. 6. 7. 8. 9. fish medical malpractice? Give some examples from your own experience of irrational practices which cause harm to patients. Can you give some example of inflated rates being charged for medical services? What is the impact of the growth of corporate and multi- speciality hospitals on the medical profession? What is the impact that insurance has on the functioning of hospitals? What is the influence of pharmaceutical companies on the functioning of hospitals? What suggestions do you have to improve the current situation?
'public hearing' on the private medical sector, conducted by a section of private doctors themselves. We hope that the searing testimonies will help awaken the general public, citizens' groups, social movements, and political representatives to the urgent need for regulation in the private medical sector in India. We hope that with social pressure and political attention, this sector, that has remained largely unregulated until now, will be subjected to participatory and social regulation in the interests of ordinary patients, as well as rational health care professionals. That would be the best response we could give to the anguished voices of ethical doctors that are reflected in this book.
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