DOCTORS: YESTERDAY, TODAY, TOMORROW

Following the publication of the news item titled "Human values missing among doctors" (SOM dated Feb. 29), one of our readers Dr. (Lt. Col.) Y.N.I. Anand gives an account of the evolution of the current day doctor, old or young:

Most of us who graduated nearly four decades ago entered the profession mainly because we wanted to serve the patients and mitigate their sufferings to some extent. We had seen several doctors during our childhood and how popular they were with the patients. I knew personally of an LMP, who had earned lakhs in the fifties. Yet he never overcharged any patient. For that matter, he treated many patients free of cost.

Private clinics were very few, and private laboratories and X-ray clinics were unheard of. Taking an x-ray for any ailment was a big thing! Government doctors treated the patients with empathy and efficiency. Since there were no scans and other hi-fi gadgets, doctors were thorough in their clinical assessment and invariably made correct diagnosis and gave proper treatment.

All the top students of PUC went into this profession. Time was when even PCM students could get into a medical college provided they had the capacity to pay a huge annual fee of Rs. 400, buy books worth a few hundred rupees and maintain the standard of a medical student! Most importantly, they had to slog for at least 15 to 18 hours a day.

Most of our teachers in the medical colleges were excellent teachers as well as clinicians, like for example Prof. K.G. Das, the late Dr. M.V. Govindappa and Dr. C.B. Murthy. Even those professors who had roaring private practice were punctual and taught us well. Some were not inclined to be employed by the government — Dr. C.D.Srinivas Murthy, Dr. B.V. Rajagopal and Dr. C.G. Narasimhan to mention a few. They enrolled themselves as honorary clinicians and wor-ked in the hos-pital, taught us well and looked after patients.

Dr. Kannan was first among the pathologists to start private laboratory and Dr. N.M. Srinivas, to start an X-ray unit. We wondered as to how they will earn, since most of the tests that they were doing were available in the K.R. Hospital itself. However, since there were a few private clinicians in the city, they would have had no problems in attracting patients. They came up by sheer hard work, ethical practice and sincerity. Dr. Kannan used to perform several investigations absolutely free especially if the patient was poor.

Several Nursing Homes had come up in the city in keeping with the growing demand for medical care. Dr. Raman and Dr. Kamala Raman were the popular doctors owning "Ashoka Clinic" in Krishnamurthypuram. In fact, Dr. Kamala Raman did her condensed MBBS course with us since she was not happy with a mere LMP.

Similarly there were a few other nursing homes in the city, like the Chaya Nursing Home and the Vinayaka Nursing Home. A few other doctors in government service rendered yeomen service to the patients, earned popularity as well as money, quit government service and opened nursing homes or small clinics.

All these while, barring a miniscule minority, all the doctors were fair and ethical in their deals with their patients. Cuts, euphemistically called, "Referral Charges" today, were unknown those days. Lab investigations or X-rays were asked for because the patient "needed them". Where was the question of collecting part of the amount charged to the patient as "cut", when the term itself was unknown?

During the later part of the eighties and the early part of nineties, there was a real explosion as far as private medical care was concerned. By this time, many sophisticated lab investigations, Ultrasound, CT and MRI scans and private medical care had taken firm roots since many patients who could afford, wanted special and better quality medical care.

Then came the so-called "Corporate Hospitals", who started treating the medical profession just like any other business. One of the medical corporate giants went on to the extent of telling his team of doctors that they were there to make money by treating patients. The question was how to attract patients for admission and performance of investigations! He simplified the matter by asking his administrators to pay a small percentage of the fee collected from the patients to the doctor who was referring the patient. Thus the evil practice of offering "cuts" was born and we named him as the "Father of Medical Malpractice".

Initially there was some hesitancy amongst the doctors to accept cuts but gradually they got used to the idea and found that they had some more money, albeit unaccounted, to spare! After establishing well, our corporate giants started thinking that they should generate "their own cases". Hence they instructed each department to send a certain minimum number of patients to the Lab and X-ray/scans everyday. Thus were born the high numbers of "unnecessary" investigations.

As the hospital charges were high, many patients used to get the investigations done elsewhere and the report to the hospital. Since the hospital authorities did not like this, they told the patients that they won't consider the outside test results as reliable and hence the same will be repeated in the hospital. This was a clear blackmail but the patients had no choice.

It became increasingly difficult for the smaller laboratories to survive and hence they started offering "higher cuts" to the re-ferral doctors as a means of attracting patients. I know of scan centers offering more than 50% of the amount charged to the patient as cuts to the referral doctors. I know of famous physicians taking home more "cut amount" than their own "practice amount"!

The "fame" of the doctor was directly proportional to the "cut amount" he earned daily. He would recommend only a certain scan centre or a lab to his patients and would not accept results from elsewhere. There are other super specialists and those who "care for the poor" who demand a higher percentage than the rest for their referrals and get them too. There were some intelligent patients who thought the services offered by the private doctors/labs should be commensurate with the charges they levied on them. This led to the consumer movement and the intervention of the govt. in the matter.

The doctors were rightly bro-ught under the control of the "Consumer Courts" by law. The doctors resisted this tooth and nail but failed miserably, since by this time they had lost most of the sympathisers. The same Presidents of IMAs and other medical leaders/politicians, who would go on strike at the drop of a hat, had no courage, moral or otherwise, to tell their own professional colleagues to desist from accepting the cuts, since they themselves were resorting to unethical practice.

In the meantime, there was mushrooming of private medical colleges who were the money making machines for their owners. Students had to offer high capitation fees, to the tune of Rs. 25 to Rs. 30 lakh for an MBBS seat and Rs. 50 lakh and above for a PG seat. After paying so much money, how could one expect the doctor to serve the poor and the needy in remote villages? His first mission after graduation/post-graduation would be to recover the costs he has incurred!

Hence, a combination of privatisation of medical education, corporatisation of medical profession and mushrooming private medical establishments, laboratories and scan centres have led us to the mess that we are in today. There seems to be no solution since most of the doctors look at the other departments of the government where they have to pay bribes to get their jobs done. Hence the thinking is, "When I have to pay someone illegally, why not I also get something as compensation"?

Unless the whole society recognises this evil practice prevalent all over the country and the governmental authorities take some drastic steps, the future appears bleak to all.