Doctors Vs patients

HEALERS OF A BROKEN SYSTEM

©Dr. Aparna Govil Bhasker

When #Chandrayan 2 fell short of just one more mile, from making history, no "#failure" could be proclaimed to be more "heroic" than that. A true leader, the honourable Prime Minister, went out of his way to support our scientists and said that there is "no failure in science, it is a journey and one or two difficulties must not hold us back". The entire nation stood behind ISRO like never before, and rightly so. It was a perfect example of embracing failure, expressing our solidarity with our scientists and a beautiful lesson in forgiveness. It was humane and graceful and makes me feel proud of my countrymen and women. On a lighter note, it was the hug of the century.

However, in the current times, when it comes to "failure in medicine", it is neither heroic nor graceful. As a profession medicine is one of the most, "failure averse". From our early days in medical school, we doctors are indoctrinated with the mantra that, "failure is not an option". The paradox however is that, in life, failure is inevitable and the medical profession is no exception to this. As doctors we fight the toughest battles with the two of the biggest enemies of mankind- disease and death. To say the least, nothing can be more humbling and as we grow in experience we learn the lessons in humility the hard way.

So, first and foremost, why are we doctors, so hard on ourselves? Most of us have immense difficulty in accepting that despite best efforts, sometimes things may not go our way. Though we are taught lessons in detachment, are we really able to practice them? No one has ever escaped death, but when it happens on our watch, we feel the burden of the lost life on our fragile shoulders. Unfortunately, no amount of money can snatch away a loved one from the clutches of disease and death. As doctors, sometimes even we are guilty of suffering from the God complex. At times we ourselves tend to forget that we are only human at the end of the day.

Doctors and patients are two sides of the same coin. Let's flip the coin and see it from the patient's perspective. From time immemorial patients have reverred doctors next only to God. There is an extremely strong emotional element that is associated with the practice of medicine. Unlike other service industries, healthcare can never be proportionate to the amount of money paid. An x amount of money may guarantee you a business class seat in an airline or the best suite in a seven star hotel, but no amount of money can guarantee getting good health back. Money is just a way to define value for a service, but in case of healthcare it falls severely short. Money is never enough to make up for the loss of a loved one, and  neither is it enough to compensate a doctor for saving a loved one. But until we have another way of valuing the services of doctors and healthcare, money will be the third prong in the wheel. I am not an economist, but I dont need to be one, to know that most people in this country are barely able to make ends meet. We may be close to eradicating polio, but we are nowhere near eradicating poverty in this country. India is a country with a burgeoning population and, in the absence of solid universal health coverage and public health institutes falling severely short, the burden of dealing with a disease and its treatment falls on individuals. A burden they probably cannot carry. I dont feel proud when I say that India has one of the lowest healthcare budgets in the world. Indian citizens are deeply dissatisfied and disappointed when it comes to the basic human right of being provided with good healthcare. Private healthcare is expensive and like all businesses the goal is to make profits. In an emergency, when public healthcare is not an option people turn to private healthcare, which unfortunately is unaffordable for most. And when expectations are not met, it leads to friction and sometimes escalates to violence.

For ages, Indian doctors have held a broken healthcare system together and have done a #stellar job of it. Success stories of everyday never make head line news but what we have achieved in the realm of healthcare with our "#meagre resources" is nothing short of a miracle. However, it certainly is not enough for a country with 1.37 billion people. Doctors are the face of medicine and while they are the foot soldiers who are fighting this battle with minimal support, they are repeatedly facing the ire of dissatisfied masses. Every other day, we hear of doctors being abused and hospitals being vandalized. Impatience has become the hallmark of today's society. While the world becomes smaller and digital, we need to understand that we are still eons away from curing diseases of the complex human body with a click of a button or by using artificial intelligence.

Today, there is increasing dejection and demotivation amongst healthcare practitioners and doctors. Doctors are also citizens of this great country and it might help our morale if we received some grace too. For us, every patient is precious and we succeed more often than we fail. Death is invincible, but doctors are the only ones in this world who dare to fight it. If not a hug, atleast we don't deserve to be chided by our dear Prime Minister time and again and be beaten up for failures that may sometimes be out of our control. It is our sincere appeal to the government to increase the healthcare spends in the upcoming budget and show some positive inclination towards supporting the Indian citizens for this basic human right that is "health".

https://www.aparnagovilbhasker.com/healers-of-a-broken-system/

Why do some doctors charge so much ?

Why do some doctors charge so much ?
Why are some hospitals so expensive ?
Yeah Aamir Khan Rajinikanth should charge the same price as Dino Morea and Uday Chopra
And movie ticket should cost the same in PVR multiplex with a recliner in Mumbai and gallery seat in single screen in jumritalayya
Does it sound crass ?
But it is fact of life
It takes money to Built hospitals will state of art technology and facilities
Good Doctors are a rare species like movie stars
I takes 40-50 years to make a good doctor
And when you buy shares of a hospital you expect returns on it
Govt spends 1.2 percent of budget on healthcare
It is reducing it every year
World average is 5.3 percent
It has washed off its hands from primary health and tertiary Health
74 percent of Indian health care is private money
Most of the tertiary health is done by private players
There is no system like NHS in India
There is no universal health coverage
When u let off the field for private healthcare then don't except Charity from it
But having said that even the most expensive hospital in India is 10 times cheaper than USA or West
But iphone or a Merc  is more pricier in India than in West
Indian healthcare is cheap as our human resources are cheap
You can't employ a doctor by paying ₹40000 (600 dollars) in US
That is the minimum wages for a doctor in India
You can't hire a nurse for ₹15000 in U.K.
Our equipment comes from west
All our CT scans MRI Scans are imported
We pay same price as west in dollars and top of that we pay import duty
Then how we charge 1800 dollars for open heart surgery when it cost 100000 dollars in US
Cos our Doctors and nurses are paid less compared to west
Even the top most doctor in India gets less than an average doctor in NHS
We are happy when Google pays 1 crore to a fresh out of college IIM guy
But if a doctor buys a Merc after 20 years of hard work when his hair is greyed
We feel so upset about it and say look he is earning so much
It is Govt job to give healthcare to us
It is not job of private players or individuals
If Indian govt increases healthcare spend by 1 percent for next five years - we can provide 10 million jobs

Credits : unknown.

Indian health care

The Drama and The Tragedy of Indian Healthcare

(C) Dr. Sachin Landge
Translation:
Dr. Rajas Deshpande

“One doesn’t need to be a doctor to start a hospital, just as one can start a hotel without knowing how to cook”.

Big businessmen and corporates who must invest their money in profitable ventures knew this very well. Up came gigantic buildings under the title ‘advanced / world class healthcare’, where much was invested in the infrastructure and technology, but the quality of doctors was kept to bare minimum necessary: junior most who are willing to accept the atrocious sharing conditions. These new ‘Money Making Machines’ picked up very well, because they gave the  rich class an illusion that they can buy health with money, but also attracted the middle and lower classes under the ever-coveted term ‘cashless’. The fear of illness and death was exploited with aggressive marketing. Many things  started to change after 1992.

When one invests in many hundred crores, the profits must match. To maintain, there must be continuous patient flow, admissions, tests, procedures and surgeries. Indian society is quite vulnerable to advertising as well as corruption. All the marketing strategies and skills were aggressively employed in that direction. To catch patients for paying procedures and surgeries, to develop a patient base, free camps were arranged in the interiors. 'Free' is a universally loved term, most people blindly fall for it.

The idiotic term ‘whole body check up’ was invented to attract the illiterate, ignorant and hyperanxious crowds. Unnecessary tests were suggested and done happily under the false sense of health security.  PROs and marketing teams of various hospitals started visiting private doctors for the obvious: commissions on admission / tests / surgery.

Patients with even simple illnesses that can be treated at primary healthcare center were taken to bigger cities now, and they proudly boasted how much land they sold to get the right treatment.
The perpetual inadequacy or absence of federal / state healthcare infrastructure was never questioned.
Those who had insurance cover started thinking that they now own all the hospitals and doctors. They started behaving as if they are obliging the doctor / hospital by choosing them. ‘Only a good outcome is must because I am paying money’ became a universal expectation, and thanklessness, threats and vandalism started with almost every bad outcome.

Applying the consumer protection act in India, with high illiteracy, poverty and political interference was the final straw. Doctors now could not treat patients based upon only clinical judgement, because the patient and the courts would demand proofs. So tests became necessary, to the point of finding a proof. Evidence based medicine defeated the need for clinical judgement to treat simple conditions without having to do the tests. Doctors and patients both started to suspect each other, and grew apart.

Still some really patriotic doctors, clinics, smaller nursing homes and hospitals continued what was essential for the society, giving excellent healthcare at the lowest cost, based upon their patient base generated over decades of faith and trust. The ‘Clinical Establishment Act” broke the very spine of such hospitals, because it made western standards blindly mandatory for Indian hospitals. More licensing, over 30 permissions (bribes everywhere), and so much paperwork and infrastructure investment, that it was now impossible to keep healthcare low cost. The only thing that was excluded from such westernization was costing. As the doctor is the only face of healthcare for the patient, the ultimate blame for higher costs was conveniently placed upon his/ her shoulder. All doctors turned villains now.

The hidden plans to eradicate small hospitals and private practitioners are being successful now, given the hardships involved in running one’s own hospital. Thousands of small hospitals / clinics have closed down. Doctors now must join corporate hospitals if they want to continue as specialists. They have no control over billing and hospital policies, and are thrown out if they question anything.  Most people do not know that a doctor’s payment is less than 10 percent of most hospital bills, a standard corporate protocol all over India, and if the doctor wants to help the patient, it is his own bill that he/ she will have to sacrifice.

Mediclaim (Medical Insurance) is still at a fraudulent stage in India, with many deserving patients being denied insurance, while many patients being allowed to misuse it. Mediclaim companies now have two fatal policies; to encourage the accreditation business, thereby making it difficult for smaller hospitals to survive, and to dictate lowest healthcare costs for hospitals and doctor’s fees, whereby their own profit margin stays high. In such a scenario, the corporates either must inflate the bills or cut down on the quality of healthcare provided.

The big corporates required specialists who worked at the lowest salaries and accepted all their conditions. Those who had passed out without much merits from less academic medical colleges, those who had lower confidence and / or experience became easily available.  Instead of increasing govt medical colleges and seats, private medical education was encouraged, because the highest in the land prifited from that policy. The society never objected, because the dream of ‘buying a medical seat and ability of becoming a doctor even without merit’  had become a reality. Only a few exceptional students benefit from private medical education.

To pay for electricity and water and land and building with commercial rates, to get no subsidies, to pay full taxes, and then to be told to “subsidise”  patient bills for charity (whereas the govt hospitals keep on increasing it regularly), is atrocious. At every stage a hospital / doctor must bribe for permissions. Very few exceptions. In fact, people expect doctors to pay higher bribes.  Doctors belong to the same society as you, and mirror the same good and bad that the society has, there cannot be one-way blame game here. This does not mean there weren't greedy doctors, in fact the corporate policies helped some such doctors  flourish too.

There indeed were days when doctors earned too much money, some with good and some with deceptive means. Gone are those days. Now in each specialty there are a few who do well, and some who don’t. Most doctors struggle to maintain the incomes to continue offering good healthcare. Many have quit the profession. 

Even patients are mostly not happy with only honest and good treatment. They want multiple facilities and luxuries,  trained staff, accreditations, cashless facility, no marketing/ referral/ cut practice, but still the lowest rates. How will smaller hospitals compete in such a scenario with the giant corporates?

In a few months / years, small hospitals and private medical practice will have been completely eradicated, the only healthcare options will be government or corporate. After defaming the entire medical profession and creating wide rifts between the society and doctors, the marketeers of health and life corporates and insurance companies, will  keep on freely filling their coffers while providing compromised healthcare at all stages.

© Dr. Sachin Landge, Anaesthesiologist, Ahmednagar.
Translation: Dr. Rajas Deshpande

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