Samiran Nundy
A recent article in the British Medical Journal entitled “Corruption ruins the doctor-patient relationship in India” made me feel quite ashamed for my country and my chosen profession.
The author, David Berger, a district medical officer in Australia, recounted his experiences as a volunteer physician in a small charitable hospital in the Himalayas and concluded that “kickbacks and bribes oil every part of the healthcare machinery”, and suggested that the will to reform it promptly from within the country seems to be lacking.
After working here for 38 years, both in the public as well as in the private sector, I could not, unfortunately, agree with him more. The process of individual corruption starts early, with the capitation fees for entry for the MBBS course in many of the now ubiquitous private substandard medical colleges, which are mainly owned by politicians. There, the student encounters poorly qualified and disinterested teachers and, worse still, few patients from whom to learn. He or she then appears in the final examinations, where there may have been pressure put on examiners to pass him and his colleagues, who hardly then deserve to be called doctors. It is not surprising that the end result is a practitioner who not only lacks adequate knowledge but is also deeply in debt and has at his mercy a poor, ill-informed and trusting patient.
Can we expect him to be ethical when, to survive, he has to compete against colleagues who are giving kickbacks or “cuts” for referrals and receiving them in cash-filled envelopes from imaging centres and laboratories? The temptation to do unnecessary investigations, like CT scans (Rs1,500 cut) and MRIs and perform unnecessary procedures in the form of Caesarean sections, hysterectomies, appendicectomies and other operations for cash payments, must be difficult to resist.
Talking with colleagues in the public sector, it seems that to get selected and promoted or avoid being transferred from a comfortable job to a less “lucrative” post is almost impossible if one doesn’t use the influence of politicians and bureaucrats before the actual day of decision.
We can create national watchdogs like Britain’s National Fraud Authority, which has brought down corrupt practices in the National Health Service. Finally, once he or she is caught, the corrupt doctor or health worker should be subjected to exemplary punishment.
The new government in India has been elected mainly because people are disgusted with the all-pervasive corruption in this country. There is now hope that we can get out of this current morass, but we must act soon.
(The writer, a gastroenterologist and surgeon at Sir Ganga Ram Hospital, is the editor-in-chief of the journal ‘Current Medicine Research and Practice’. This article has been excerpted from the same journal ) [Source]
Read the Original article in British Medical Journal
Corruption ruins the doctor-patient relationship in India
Link : http://www.bmj.com/content/348/bmj.g3169
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