There is a hue and cry from all quarters that the medical profession is no longer “the noble profession” it was but has become a business. People accuse doctors of malpractices, exaggerated expenses, unnecessary operations and of even stealing organs from patients for transplantation. The Supreme Court decision to include doctors under the CPA (Consumer Protection Act) amply confirms the general feeling. Why are these happening and what are are the causes behind this change in the profession? Has it really become a business? Are there no doctors still practising the profession as it was practised in the past?
Today, the expectations of patients and their relatives are high. People are in a hurry and want quick results. They do not wait, and pressure doctors for quicker relief, forgetting that diseases take time to get cured. The request is for powerful medicines, quicker investigations, even surgery. Otherwise, they would like to go to another doctor. And when all is over, they complain about the cost of the investigations and blame doctors for the expenses. Instances are there of patients or relatives asking why not take an X-ray for cough of short duration, an ECG for any chest pain, CT for headache, and of pressing for a Caesarean section because they feel that their daughters cannot bear the labour pains. Diseases like Viral Hepatitis (jaundice), whatever one may do, take 4-6 weeks for total recovery. Patients are so restless over the slow recovery that they change doctors, hospitals and go away to native medicine or even for branding with a hope of quick recovery, which will never come.
Today's doctor is in a predicament. On one side, patients and their relatives are exerting pressure and on the other, specialists and superspecialists are vying with one another to offer consultations. The doctor has to get quick results to keep the patient with him and so uses powerful medicines which are costly, gets investigations done to help diagnosis, and takes the opinion of the specialist or the superspecialist so that he is not accused of negligence. Added to this is his fear of the CPA and court asking him to pay a heavy compensation.
Medicine is a science which has many probabilities and possibilities. The human body is not a laboratory to produce the same result every time. Diseases also vary in their course and complications. A simple viral fever treated or untreated subsides in 3-4 days, leaving the patient a little weak and tired. But the same viral fever can devastate the brain, producing an encephalitis which can cause death or leave the patient crippled. Who is responsible for this or who can predict the nature and course of the disease? If by chance there is an allegation of negligence and the question comes up in court why no investigations were done, the poor doctor is in for trouble. If he investigates every case because of fear, unnecessary expenditure will result for a simple case of fever.
Corporate hospitals and superspeciality hospitals are basically meant to be tertiary care hospitals or for treatment in special situations. They have lots of facilities and unless the case is thoroughly investigated, treatment will not be possible. Critically ill cases should go there. Necessarily, the cost of treatment is high. The mortality rate too is high. But today, many patients go there for minor ailments and then complain about the costly treatment. With so much advancement in knowledge and technical skills, it is not easy for a cardiologist or neurologist to give an opinion without doing many investigations. To assess and analyse a chest pain, a cardiologist has to do an ECG, ECHO, Doppler, treadmill and angiography before an opinion is given. Similarly, a neurologist has to do many tests like Fundus, X-ray and MRI Brain for a case of headache to give an opinion. Once a patient goes for an expert's opinion, how can he bemoan the high expenses?
Medical education has become costly, more so with the capitation fees escalating every year. Even postgraduate seats are available at an exorbitant capitation fee. Any investment made by a person is done with a hope of good returns and necessarily this has an impact on the medical profession. “Today, if there is a decline in the compassion of physicians, its cause may be elsewhere. The fundamental problem lies outside the medical establishment, within the society as a whole. The physician is largely a reflection of the society — basic human character traits are well developed by the time a student enters the medical school.” — Prof. Thomas.
Today's society is run by money, everybody is running after money. The need/greed for money is ever increasing. Doctors being in society are no exception. Yet, they need to have sympathy for patients, take care of the sick and show concern for their suffering; otherwise, the profession will lose its respect. They need to remember the ethical imperatives propounded by Hippocrates, Father of Medicine — choosing the least costly route and the least troublesome investigations, always keeping patient welfare in mind.
(The writer is Professor of Medicine, ASRAM Medical College, Eluru, West Godavri district, Andhra Pradesh. His email ID is: dr_aswinikumar@ rediffmail.com)
