In recent times there has been much change in all walks of life. Medicine is no exception. Over the past four decades in this field we have seen vast changes in the attitude of doctors, hospitals, patients and the media. First and foremost, patient expectations have changed.
The earlier generations depended on family doctors and there was a bond between doctor and patient. Money was only incidental. Today, with the media and the Internet proliferating and generating new expectations, patients want quick-fix solutions. The same attitude is found in the younger generation of doctors. The sea change in medical treatment regimes came in the mid-1980s with the founding of corporate hospitals and nursing homes.
Today there is a trust deficit between doctor and patient. The communication between them is at a low. We may be in a digital world, but in patient-care there should be a personal touch and communication to solve most problems. That’s often not there today.
Once, all the top specialists were in major government general hospitals. Corporate hospitals changed that. The investors built the best hospitals with state-of-the-art technology and paid well to hire the best medical talent from across the globe.
Virtually overnight, in Chennai for example, we had the best treatment available in the country, with specialists on a par with those anywhere in the world. For such care, there is a price to be paid.
Investors and managements expect returns. We should not think government hospitals are doing free service — salaries and running costs come from the taxpayer; it is only returns that are not expected. Today there is no denying that private hospitals and private medical colleges have a significant role in healthcare delivery. If private medical colleges don’t have the standards stipulated by various accreditation bodies, they will disappear, as many engineering colleges have. But unlike engineering colleges, the cost of running private medical colleges and hospitals is considerably more. They also need an adequate patient load to make possible teaching, training, and research publishing. And looking after hospitalised patients has a cost too.
Today every patient wants American standard medical care at local cost. We are not doing too badly on that.
India at present is a destination for patients from a large number of neighbouring countries. In the next decade it will be a major medical destination for patients from other countries as well, a development similar to it having become a destination for information technology services since the 1980s. This is because we have the best of doctors, nurses and technicians. And we still offer caring treatment at comparatively reasonable costs.
One of my patients, in spite of having medical insurance in the United States, came to me to have his treatment done instead of getting it done in the U.S. When I asked him why, he told me that in the ICU there the nurses and doctors don’t communicate with parents and are more bothered with their charts and records.
American medical care is driven by lawyers, insurance and medical administrators. In such a situation, charts and records become more important than personal involvement with patients.
Let’s look at another issue. When a doctor operates in an emergency case or has to deal with a very serious case, he or she is doing his best, based on the knowledge and experience. They have to take spot decisions in critical situations. They don’t have the luxury of adjournment or a higher court. For a doctor to act in an emergency situation, he or she should have freedom from fear of litigation and physical assault.
If there is gross medical negligence, let the law take its course. If hostile relatives and rowdy elements take centre stage, the poor doctor is a sitting duck. No other profession comes in contact with the public as a doctor’s profession does.
Defensive mode
If doctors are to fear litigation, then they will get into a defensive mode. They will think twice before doing complex procedures, not because of any medical problem but the fear of the courts and, possibly, being asked to pay huge compensation. Today most doctors take medical indemnity bonds, only adding to the cost for the patient. This was something unheard of in the past in India.
A doctor will be close to 40 years of age when he becomes a specialist or super-specialist. From there it takes a decade more of hard work day and night, Sundays and holidays, to get recognised. No other profession has such a long incubation period. Surely he or she is entitled to respect — and understanding if there is medical error. He is, after all, human. Every doctor is doing his or her best for the patient. Don’t shoot the doctor; he or she is helpless. It cannot happen to lawyers, bureaucrats, industrialists or politicians because there will be repercussions.
The times have changed. With greater scientific progress, people’s expectations have increased. Who will bear the cost? Healthcare cost cannot be the complete responsibility of the government alone with just 2.5% being the share of the GDP for health care. It is the responsibility of individuals, institutions and philanthropic bodies to fill the gap to attain the goal of a healthy nation. Private participation is needed in numerous ways. Please don’t shoot the doctor.
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