THE LOOT OF PRIVATE HEALTHCARE- HOW ESSENTIAL IS MORALITY TO HEALTHCARE?

THE LOOT OF PRIVATE HEALTHCARE- HOW ESSENTIAL IS MORALITY TO HEALTHCARE? THE LOOT OF PRIVATE HEALTHCARE-gawah expree jan 29 2023 HOW ESSENTIAL IS MORALITY TO HEALTHCARE? Lifesaver tainted by unholy nexus. Over centuries, the medical profession has maintained ethical standards. Their magnificent contributions and landmark discoveries in medical sciences and innovations in diagnostic and therapeutic techniques have revolutionized patient care, saved countless lives, and significantly improved longevity and the quality of human life. Beyond its scientific and technical contributions, medicine is uniquely fulfilling as a ‘Noble profession’. In return, it has been accorded the respect of society, of other professions as a noble profession imbued with eminence, dignity, high ideals, and ethical values. In the recent past, unfortunately, there has been a sharp decline in the ethical conduct of some of the medical practitioners, lifesavers are accused of an unholy nexus with private hospitals, diagnostic centres and-pharmaceutical-companies by getting kickbacks. Materialistic influence has produced a highly greediest mentality; and while engaging in professional activities at times they lose sight of the ethical, human, and noble values of their profession. Here are some things people have said about us that baffled me? Doctors get commissions from pharma companies, Private hospitals (nursing homes) and diagnostic centres? If yes, How-much? Agreeably, some of them do indulge in unhealthy commission business. Some doctors will suggest certain tests to be done at particular labs, or diagnostic centres especially from those they get commission from. Sadly, it is a common notion in public, If a doctor prescribed you for tests, please go to Government undertaking labs the cost will be 30% to 50% less than the private labs. If a doctor needs the report of the same lab as he/she suggests, then avoid that doctor or try a reputed laboratory known to be running “not for profit. A private laboratory owner (not for profit ) told me privately the actual cost of the test in a private lab is about 40% to 30% less than you paid. Another problem in our private medical care which frequently patients complain to me is that if a doctor prescribes some medicine, it will only be available only in his/her shop attached to his/her clinic, or in the nearest medical shop or the shop of his/her choice. What does that mean? The Medical field is now a business so beware of fraudsters. Well, some doctors do indulge in cuts, commissions for referrals .When confronted, all the people inline involved (the doctors, diagnostic centres, ,private hospitals) initially refused to me about the presence of any such clandestine arrangement but when we took some of these into confidence and discussed with them the gravity of issue with clear examples of persona A BC and places XYZ involved, showed some samples of inflated bills or of unnecessary tests and interventions, prescriptions of costly or unnecessary drugs, medicines prescribed only from xxx company, referrals to diagnostic centre’s or nursing homes , the existence of commission book they cooperated and admitted that they are paying the doctor or, staff, or middlemen for bringing patients to them. Some of these involved even confessed ,that they had to start doing so as others had started the practice and they did not want to lose competition(business) due to the cut-throat competition between various hospitals and diagnostic centres ,and they have to by bank loans So how does it work actually? Suppose I wrote medicines worth 10 thousand of a company, the company’s representative comes to thank me for the confidence I have shown in their product and they offer to help us with something in exchange. For example, academics (sponsoring conferences, CMES or getting books etc. It is a common understanding among the medical fraternity that legally we are allowed to take their help with academics. When I say that, I don't mean that sponsoring is restricted to conferences, tickets abroad ,or showering me or my family with costly gifts only. There is an outcry in the society about doctors accepting huge favours from pharma companies. Let me clear that for you, not every doctor accepts favours from companies. I personally know many who strictly have instructed medical representatives to not offer anything at all. What is my defence on resisting the temptation of commission beyond my moral principles? If I am new in my practice, to survive in the competition I have to give results. Which means my patients have to improve better and faster which requires two things, one accurate diagnosis and second good quality medicines. If I prescribe medicines of a substandard company which is not effective, I may get the commission they are offering but my patient will not improve and I will not survive in practice. Hence, no doctor will prefer prescribing substandard medicines just for the sake of commission. So, the ultimate point is…some doctors might be accepting those gifts. There are good and bad people in every profession. But not all doctors do that. And for our own survival also, we do want our patients to get better, so no question of compromising on quality of treatment for small favours. For some time , people have started exaggerating the nexus between companies and doctors, and blame doctors for everything. Government launched generic medicines under Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) with an objective of making quality generic medicines available at affordable prices to all, to prevent the so-called bribe doctors were taking but prescribing generic medicine is not without hassles. Suppose I prescribe paracetamol (generic name) to a patient for fever. I know a certain brand of molecule is effective and so I write let’s say brand “DOLO ,”you go to the medical store he says it’s a brand name but we have generic medicines, do you want those? You take them. But then do generic medicines have no brand at all? Who produces them then? It’s just that the shop owner will give you the cheaper drug from some local company which may or may not be effective…blame comes on the doctor not treating well. Whilst we can’t say don’t take it, I give my patients options and ask them to buy any one of those. If they choose to go generic, I tell them it’s their decision and then the efficacy of treatment can’t be guaranteed by me and most of the patients trust my opinion. Golden card under PMJY scheme would have proved game changer in this direction, unfortunately it has also run into scams and is exploited by many dirtbags.The principles and responsibilities of medical professionalism must be clearly understood by both the professionals and the society. Essential to this contract is public trust in Doctors which depends on the integrity of both individual physicians and the whole profession. I know, and many people in society will acknowledge that most physicians are good and the sacred relationship between patient and doctors which has existed since ages will not perish with certain aberrations here or there. This doesn’t mean all doctors are noble, as with any profession, we do have many bad apples that need appropriate treatment – some physicians are greedy. We all agree medicine arose out of primary sympathy of humankind and a desire to help those in sickness. This relationship arises out of the pain and suffering of one person and an offer of hope by another and, factually, most of the doctors are fulfilling this obligation. It is unfortunate that we have begun calling the Medical professionals as “businessmen in an industry” – it somehow undermines and discourages the dedication of the majority of Medical professionals involved in care of the patients, and denigrates the “noble profession”. Society in general and patients in particular may also play a part in this discontent. Physicians are constantly faced with patients and their relatives who have begun to respond in high tech ways. Amidst the menace of dangerous practice of self- medication prevailing in the valley, some patients after going through the web acquire some knowledge of disease and required tests and feel that if a practitioner does not prescribe a fancy new test, he or she is not updated. The medical profession everywhere is embedded in diverse cultures and local constraints. Market forces, societal pressures, and administrative exigencies must not compromise this principle. I am confident that the medical profession is still a noble profession and the sacred bond between patients and practitioners will endure despite new storms. Even in these uncertain times I continue to believe in the innate moral strength and humanity of my profession. Some years ago, I was participating in a panel discussion on the future of healthcare, at a leading institute of health management. I heard many of the panellists affirming that healthcare and public health must absorb and apply the efficiency-enhancing practices of business management. I agreed, but only partially. I said, “the mantra of healthcare business management is, efficiency and profit, while the mantra of healthcare and public health management must be accessibility affordability, efficiency and equity.” While underscoring this vital difference in the goals of these two practice disciplines, I should have added ethics too alongside equity. I politely let it be assumed that healthcare management would ideally be bound by ethics, even as it pursued efficiency and profit. Where things go wrong? the way some private hospitals were being ruthlessly run by management graduates who had no medical background. They lacked empathy and their only objective was to maximise profits for the investors who owned the hospital. The situation is worsening, with foreign investors gaining control of established Indian hospitals. Their representatives are squeezing the doctors to generate more and more revenues, often through unnecessary tests and procedures as well as over-billing. These complaints were not new, but to hear it from a leading doctor of my status in a private hospital who felt oppressed and revolted by the unethical practices revealed to me the extent to which mercenary management had derailed value based medical practice. India’s mixed health system has evolved by default, not by design. We need to make the best use of all our healthcare providers and avoid exploitation of vulnerable patients. To improve access, affordability, and quality of healthcare, we need the public sector to be more responsive, the private sector to be more responsible and the voluntary sector to be more resourceful. More funds diverted towards healthcare expenditure above current 2. 0% GDP .At present, the medical profession is confronted by an explosion of‘technicalization’, specialization and commercialization. Despite initiatives by authorities’ health care remains as an over-promised, over-burdened, over-spent, but not “overhauled sector. At times we are facing shortage of resources due to dearth of beds, or expertise of care providers (Specialists and paramedics)or modern machinery. In such an atmosphere dedicated physicians find it increasingly difficult to meet the expectations of patients from giving the standard care they need. These challenges centre on increasing disparities among the legitimate needs of patients, the available resources to meet those needs, the increasing dependence on market forces to transform health care systems, and the temptation for physicians to forsake their traditional commitment to the primacy of patients’ interests. In these circumstances, reaffirming the fundamental and universal principles of primacy of patient welfare and values of medical professionalism, which remain ideals to be pursued by all physicians, becomes even more important. This principle is based on a dedication to serving the interest of the patient. (DR Fiaz Fazili Is Sr Consultant Surgery, and Expert on Health care Policy planning and Quality control(improvement ) can be reached at drfiazfazili@gmail.com