Who do doctors turn to when they get sick? And do they take the same medications and tests they prescribe for us? Answering these questions can help heal the delicate doctor-patient relationship that suffered another setback last week. It all started with the new Mumbai Police Commissioner, Sanjay Pandey, warning doctors not to order unnecessary tests on behalf of a commission of diagnostic laboratories. “The person who comes to you has a serious problem, you can’t treat them like a commodity,” he said in his weekly social media post. The Association of Medical Consultants responded to him asking that he retract his remarks. Other doctors called his statement an outright attack on the medical profession.
As usual, the truth is somewhere in the middle. And it is up to the medical profession to take care of it. Pandey, a public-spirited bureaucrat, was just articulating people’s feelings in his usual blunt way. While there are devoted physicians, there are also those who exploit a patient’s faith in the noble profession. To complicate the equation, some unscrupulous private hospitals treat the patient as well as the doctor, but more on that later. The fundamental problem is with the doctor-patient relationship. Patients feel that doctors don’t have time to listen to them, that they lack empathy and that they just prescribe a plethora of drugs and give them a whole range of tests instead of listen to them and examine them in detail. In short, the doctor has no patience. Also, doctors never admit that some conditions can be better treated with alternative therapy.
Unfortunately, this happens in all professions, there are simply too many anecdotal cases to dismiss it as deviant behavior. I can relate a few personal cases, but allow me to relate only one concerning my late father. After his retirement, he hiked to Chhota Kailash during which he once felt a sharp pain in his chest. Attributing it to exhaustion, he left after resting for a day or two. On returning home to Mumbai about a month later, he saw the family doctor who performed an ECG which showed he had suffered a minor heart attack. The doctor advised him to be admitted immediately to the intensive care unit of a particular hospital. My father ignored him, reckoning that if he could survive two months in the hills and a long train ride home, he wasn’t going to die in a day. He took his time and a second opinion and lived for two decades without any signs of heart trouble. Now, each case is different from the other but knowing both parties, I’m inclined to believe that in this case it was a “different” doctor.
On behalf of doctors, who are often poor communicators, it can be said that patients expect a pill for every disease and believe that an injection is a better option. Over the years, patients have been conditioned to believe that doctors who don’t write long prescriptions aren’t qualified enough.
Patients can be so hypochondriac that they Google symptoms and want the doctor to confirm their diagnosis! Given their busy schedules, the doctors do not willingly put up with these fools. It is also irrational for the patient to attribute every death to physician negligence. This could be one of the reasons doctors prescribe a battery of tests as defensive medicine. However, the existence of the pernicious practice of “cutting” cannot be denied. Most experts agree that healthcare fraud is endemic in India, with recent corruption scandals engulfing everyone from doctors to pharmaceutical companies and healthcare regulators. In 2013, Dr HS Bawaskar, who runs a hospital in Raigad, filed a complaint with the Maharashtra Medical Council with documentary evidence of a diagnostic center sending him a ‘cut’ for referring his patients there for CT scans. .
Dr. Arun Gadre, a gynecologist turned health activist, says three types of malpractice are particularly common: kickbacks for referrals, irrational prescribing of drugs, and unnecessary interventions. One of 78 doctors he interviewed told him that doctors usually received 30,000 to 40,000 rupees for referring patients for angioplasty. And that was ten years ago. This is what Sanjay Pandey was referring to when he said that in the time of Covid diagnostics companies have made staggering sums from tests prescribed by doctors. Here it should also be mentioned that up to 67 doctors have died due to COVID-19 in Maharashtra.
The medical profession gets a bad rap mainly because of corporate hospitals, where doctors are given targets and patients are overcharged. If the doctors do not reach the targets, they are punished and if they exceed the targets, they are rewarded. A few years ago, Kokilaben Dhirubhai Ambani Hospital in Mumbai was harassed for proposing an “Elite Forum for Doctors” where doctors would be rewarded with money for referring patients to the hospital. During Covid, these hospitals forgot all humanity and robbed patients. on complaints from patients, the Maharashtra government reviewed thousands of bills and reimbursed them over Rs. 35 crores.
The responsibility for improving the doctor-patient relationship ultimately rests with individuals. Dr Behram Pardiwala, a consultant to leading hospitals in Mumbai, has some advice for young doctors: “Always look at a patient as a doctor would if it were a member of his family. It is important to understand the suffering of the patient and then move forward with the treatment, but young doctors don’t have that, they just see a patient as a job for which they are paid a certain amount of money.
He was only repeating the 17th century Italian physician Giorgio Baglivi: “Let young people know that they will never find a more interesting and instructive book than the patient himself.”
(The author is a Mumbai-based freelance journalist and writes about civil society, law enforcement, the environment and urban development. He tweets at @anilsingh703.)
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Published on: Saturday 09 April 2022, 08:30 IST