Ills of Healthcare in India

Sucheta Dalal 06 January 2017

After Dissenting Diagnosis by Dr Arun Gadre and Dr Abhay Shukla (reviewed in Moneylife, 10 June 2016), The Ethical Doctor is another lucid exposé of the rampant malpractices in the healthcare industry.

The author, Dr Kamal Kumar Mahawar, writes about corrupt practices in India, but from the United Kingdom. This combination of circumstances has many advantages—he writes with empathy for doctors, covers all aspects of the problem, including the clueless and corrupt Medical Council of India (MCI), and is in the happy position of not having his frank writing affect how own career as a consultant general and bariatric surgeon with the National Health Service of the UK.

The book needs to be read, and discussed, widely because we are all potential victims of rapacious hospitals and unscrupulous medical practitioners. But it is even more important that it is read by activists, policy-makers, administrators, investigators and judges. This is because it tackles life and death issues as well as the quality of our lives and of those we care about. The Ethical Doctor is not merely an exposé of a seriously flawed and corrupt healthcare system, but an objective and unbiased analysis of the entire healthcare system, including its socio-political dimensions. More importantly, it offers a clear roadmap for change and improvement.

Dr Mahawar starts with a detailed analysis of MCI and its impractical and legally binding code of ethics. If the code is followed in its totality, every doctor would need to be a saint, he says, and goes on to provide a clause by clause analysis of what is unworkable. He suggests a more practical code for MCI to adopt and exhorts the medical profession to adopt a culture of self-audit.

He goes on to discuss malpractices by various stakeholders in the healthcare industry in separate chapters: the pernicious practice of cuts and commissions to doctors for referrals as well as for diagnostic tests (he says that specialist doctors even pay advance commissions to general practitioners as an incentive to refer more patients and build their practice), the scam of unnecessary tests and treatments, the role of drug companies and appliance manufacturers, how the poor and vulnerable are exploited, role of touts and quacks (where he describes fakes as well as qualified professionals who practice outside their field), etc.

Dr Mahawar points out that the acute shortage of doctors and trained healthcare professionals has meant that people in many parts of the country have no option but to depend on quacks.

An entire chapter is devoted to discussing the trend of doctors burnishing their image through meaningless degrees/diplomas, hiring PR agents, making claims of breakthrough treatments and even buying awards, not to mention constant travelling for conferences that are usually paid for by pharmaceutical companies and equipment manufacturers. The PR agents, reputation-building efforts and commissions ensure that most people have no way of knowing who is a genuinely good doctor and who has simply built up his reputation by dubious means.

This is followed by two detailed chapters on the strengths and weaknesses of public sector and the private sector hospitals, including the role of infrastructure, manpower, and private medical colleges that grant admission based on capitation fees. There is also a long discussion on the need to regulate various stakeholders in the healthcare chain along with relevant comparisons of how other countries handle such issues.

Each of these chapters comes alive with his personal anecdotes and observations as well as examples of abhorrent malpractices reported by the media. The book covers issues like surrogacy, organ donations, medical trials and downright cheating (like the uterus scandal at Samastipur, where a poor woman is asked to get expensive tests and then told to have a hysterectomy to take advantage of a government insurance scheme).

Dr Mahawar ends the book by suggesting radical reform and a series of actions that the government can take to reform the system. The last chapter, aptly titled ‘The Way Forward’, makes some of these suggestions cry out for their immediate incorporation into the National Medical Commission Bill that is proposed by the government. With an estimated 39 million families pushed into poverty every year as a result of mounting healthcare expenses, India simply needs to get its act together on reforming the system.

Comments

User

Abhijit Gosavi

9 years ago

A great article on an important topic. Learning from the experience of my relatives, Iâ€™ve learned that in hospitals, elderly patients are often subjected to needless surgeries that cause additional complications. In fact, I have close relatives in their 60s and 70s who walked to hospitals, on recommendation from doctors, and returned in wheelchairs or dead. In fact, nowadays, I often think going to a doctor itself is risky â€“ though Iâ€™m aware that does not sound like a rational thing to say.

Ralph Rau

9 years ago

Government has its hands in too many pies. It needs to take its hands out of many sectors and leave those to the private sector.

Medical care is NOT one of the sectors to be handed to the private sector.

An interesting and shocking statistic. North America (read USA) with 5% of world population is responsible for 45% of global spend on healthcare.

And even with such high costs the US healthcare industry is also prone to corrupt practices.

Read the story of Tenet Healthcare - once the number 2 hospital operator in te US. Its Chairman was a very high profile gentleman even on the US Presidents advisory committee.

When the FBI investigated THC the truth was exposed. Tenet was submitting fictitious bills to Government funded Medicare and Medicaid. What's even worse, Tenet was subjecting innocent patients to unnecessary cardiac interventions including angioplasty and stents !!!