Erosion of medical ethics
Satya Pal Dang
The medical profession is getting more and more cornmercialised. There has been a continuous erosion of medical ethics not only in the private sector but also in the Government sector. I give some examples from my own experience in Punjab.
Illegal private practice
Government doctors once had a justified grievance. They demanded adequate non-practising allowence (NPA) if they were to be disallowed private practice. However, even after adequate NPA was granted, illegal private practice did not disappear. In fact it grew along with NPA. In our unofficial survey of practices in the Government Medical College, Amritsar, we found only three professors who were not indulging in private practice. Two of them – husband and wife – have since retired. The third resigned after he suffered repeated victimisation at the hands of the Government of Punjab.
Those indulging in illegal private practice fall into two categories. There are those who charge reasonable private fees and also do not neglect patients who do not pay any illegal fee. In the second category are those who fleece patients and neglect those who do not pay the private fee. The situation is particularly troublesome for patients unable or unwilling to pay when they need surgery. A junior doctor had told one such patient: “If you want to get the operation done properly, you have to pay.” She could not afford this amount and came to me for help. I spoke to the Medical Superintendent saying: “Even the Devil spares the occasional home.” This helped.
The Medical College, Amritsar, once enjoyed a reputation that extended beyond the borders of the State of Punjab. Even today it has some very good and humane doctors but they are in a minority. The majority indulge in misconduct. A very common malpractice is to get all tests done from private laboratories which pay commission to the referring doctor. If somebody is bold enough to question this practice he is told that tests by the hospital laboratory are not reliable. Scanning machines in the hospital are out of order most of the time. This suits the unscrupulous doctors. Senior doctors divert patients to private hospitals being run by their wives. There are others who help their sons in pharmaceutical companies to get orders. In a particular instance the drugs so sup plied were allegedly sub-standard.
Examination by proxy and other horrors in the public sector
A fairly popular doctor told me: ‘One feels ashamed to have to work here.’ Not long ago, a pregnant candidate ‘appeared’ for the M.D. examination and delivered the next day. She was a relation of the then principal. A newspaper made it known, through a prominently displayed report, that the lady had taken the exam through a proxy. It was never denied. A member of the legislative assembly (MLA) wrote to the Minister demanding an enquiry. Nothing happened.
About a year and a half ago, a daily reported on a new-born child having been taken away by a cat from the maternity ward of the Guru Teg Bahadur Hospital, run by the Government in Amritsar, and left in a bathroom of the hospital with one eye damaged and bleeding.
Vimla Dang, MLA, immediately visited the Hospital and pursued the case to the end. Here are some parts of the story. In response to her query “Can a cat carry a human child?” the doctor replied, “There is one very big male cat in our hospital.” The explanation for the child being on the floor with the attendant and not with the mother on the bed was that it was a Caesarean delivery and there were no pangooras in the hospital. The mother was told to take her child with the damaged eye to the children’s ward on foot. From there she was directed to the eye hospital. There the head of the department examined the child and sent them to the plastic surgery ward. He asked one of his junior colleagues to accompany them. In the surgical ward, Rs. 600/-had to be shelled out just for preparing the file.
Vimla Dang issued a statement to the press disbelieveing the story about the cat and demanding an enquiry. Some leaders of the local doctors association issued a rejoinder accusing Mrs Dang of making a mountain out of a molehill for political purposes. This writer discussed the case with a key office bearer of the association of doctors. The latter characterised the incident as shameful but frankly stated that his association would remain silent, lacking the courage to take a stand. In the hospital file, the blood group of the child stood changed. Later investigation showed that a doctor of this very hospital was conducting deliveries in private at his home. Forceps were used in one case. One eye got damaged. The parents were rich and influential. The healthy child on the floor was taken away. Lights had gone off when this switch was effected. It has been established that the door of the bathroom in which the child had been found was bolted at the time. No doctor has claimed the presence in the hospital of a cat trained to bolt doors.
This case was taken to the High Court. The judges passed strong strictures against the hospital and awarded Rs.100,000 for the child with parents getting the interest to be used for its upbringing. These are just two of several instances.
The private sector
Charging exorbitant fees and room/bed rents, keeping patients in clinics for weeks when the need is only for a few days, subjecting patients to unnecessary costly tests, doing Caesarean operations when these are not necessary and other similar practices are becoming more and more common. I know of many reputed private hospitals which engage untrained girls as nurses. One such hospital in Amritsar was also doing business in paid kidney transplants without testing donors or recipients for AIDS.
Doctors were once treated as gods. There are some in the profession even today who are god-like, but the apt description for most in the profession is that of gods that have failed.
Dare we hope?
As there are some god-like doctors even today and as there is some idealism in young doctors who make it to medical college on merit without paying heavy capitation fees, the situation is not irreversible. Good in human nature is sure to assert itself given the necessary encouragement. Societies for Medical Ethics such as those in Bombay and Delhi, if formed all over the country, will surely help reverse the present trend.