In defence of good doctors

Sudha Vidyasagar

IN THE past few weeks, a lot has been written about how the noble medical profession has been corrupted by business interests and how doctors no more consider the profession a calling. As a practising physician for the past 20 years, I wish to share my views on why this situation exists, and what can be done to reverse the trend.

The medical course as such is a demanding, long drawn 10-year programme of study, if one wants to specialise in any field. Most doctors are in their 30s before they can even stabilise, and in the case of those who want to be super specialists, add another three years to this learning period. At the end of it all, it is a good seven years after any engineering graduate begins to earn that the doctor sees his first salary.

People feel doctors are earning a lot, but it is not known that most doctors who are fresh graduates start out with a low salary. When they enter private practice, patients hesitate to pay even Rs. 50 for consultation even to an experienced doctor, which they would gladly part with for a TV/car repair technician. Add to this the fact that patients are quite willing to pay for blood tests and scans and value them more than a doctor's opinion. So what does the medical specialist do? Send the patient up for a scan, which gives him a cut!

Let me give you a simple personal example. On a holiday, I happened to see a cook who complained of pain in the upper abdomen. As an act of goodwill, I examined her and diagnosed her to have gastritis, and gave her medicines. Two days later, she came to me guiltily with a scan report of her abdomen which said she had a cyst in the ovary (many times an innocent finding), and asked me what she should do. She obviously was not happy with my diagnosis (not charged), spent Rs. 400 on a scan, detected a cyst which was in no way the cause of her trouble, and came back to me, only because some one told her she should get operated!

This is the scenario: a patient pool which does not know enough to understand which investigation will show what, and is willing to spend on a test, a doctor/nursing home population which is willing to cash in on this over enthusiasm to get investigated. In the middle of all this, an honest doctor can hardly survive, as the private hospital where he works may consider him a failure if he dose not generate money from patients!

The second problem is the educated classes' craze for medicines. I have had mothers bringing their 17 year olds to me saying they are weak and need blood tests which are invariably normal, and will not go away without the inevitable vitamins. Any fever that lasts more than a day is treated as a dangerous event demanding antibiotics. In a world where nobody has time to spend on any illness, instant cures are demanded, pushing the doctor's pen to write medicines which will work on more than one illness. In my younger days I used to fight it out with patients and insist on no drugs. Now I sometimes give up as I realise talking to patients who have fixed ideas is a waste of time.

Quacks thrive as patients seek one-shot cure for chronic diseases like diabetes, and spend enormous amounts of money on unproven treatment prescribed by unqualified personnel.

So how do we protect gullible patients from getting over investigated, and over drugged? In this scenario if we doctors play along with the patient's wishes, all are happy: patients, hospitals, and doctors. Can we avoid this comfort zone of least resistance?

I am not here to defend any corrupt practice. I myself have spent all my life in an academic institution, having shied away from survival in private practice.

But I know of enough private doctors who are trying to do an honest job and practising their profession with high ethics. I salute these brave good men and women who are not protected by an academic institution like me, and are battling it out in the cut throat world of private practice clutching on to their principles. As in all other professions we too may have our black sheep, but that does not mean there are no good practitioners of the art of healing. The general public must allow these good doctors to flourish by recognising their inherent sincerity and worth.

The interpreter of the tests is always more important than the test itself. So it is most important to find a good knowledgeable doctor. Allow the doctor to decide what tests are needed, and what medicines should be taken. Do not underestimate the value of such an opinion.