Epilogue: Satyamev Jayate Healing the Healthcare Biting the bullet; the a.

. way The latest episode of Satyamev Jayate has stirred the hornet`s nest! Many reactions and heated debates! I wanted to jump in, but had missed the episode, so had to wait thus far. Finally I saw it! What was overtly palpable was the discontent my doctor colleagues exhibited towards the show. Seems we have come to think of ourselves as saints and demi-Gods! Our knowledge unquestionable; our skills unparalled. While we have many a diseases which plague our fields I though the episode was massively thought provoking, to say the least. That, given we agree we need to have some changes. For those who subscribe to the demi-God school to thought for the doctors may stop reading further. In this day and age where electronic media is available to most of the literate people, few things are a secret, many are open secrets and innumerable skeletons have tumbled out of everybody`s closet. This reminds me of the Hindi saying Hamam me kya sharmana, tum bhi nange, hum bhi nange. I still remember when I was a kid, doctors were revered. To be a doctor was akin to entering the only so called Nobel profession. For a patient, the doctor was nothing short of a GOD and his words were patthar ki lakir. Ah those days, those were the days! What do we find today?

Each time the patient comes out of the clinic or a hospital, the first thing the patient thinks of is visiting another doctor! You may frequently come across people saying that the medical profession is now a business and a ruthless one at that. Some of the frequent doubt the patient has today after a doctor`s visit are a. b. c. d. Are the tests which are ordered really needed? Do I need to buy all the medicines on the prescription? Do I need to buy the exact number of pills per medicine prescribed? If a surgery is asked, is it really needed?

Of course as doctors we may disregard these doubts as unnecessary, but if we need to fulfill our role completely we are not offered the luxury of dismissing them. The noise has grown many a times and many folds to be silenced or ignored, lest we do it at our peril. Medical seats are sold for a donation; this is a fact that is now in the open. Alost everybody directly or indirectly knows one or more of such touts who arrange for admissions in medical colleges. The MCI chief on Satyamev Jayate was seen in a very uncomfortable situation when all the students said that they need to pay 60 lakh per seat as donation to the medical colleges. The donation of the medical colleges for post graduate seats is seriously obscene. Upwards of 1 crore. And we are still talking about India! It does not need to occur to a genius that money in a dad`s deep pocket does not automatically translate into brains in a child`s skull. Very soon we will have majority of the doctors who have a qualification because their dad had the booty and not because of their talent. Obviously then, the health of the patient is not entrusted to the best man possible. The donations are not for altruistic purposes. If one gives such an absurd amount of money, he ought to earn it. I do not see a legitimate way of making such moolah at least in one lifetime unless you are a cardiovascular surgeon or an interventional radiologist or some other fancy domain. The CUT practice Acceptance of kickbacks from other doctors and pharma companies was perhaps the earliest of the dirty truth that was known widely to the public. The visit of the medical representative (MR) is the highlight of the day for many junior residents! I still remember my H.O openly asking the MR to hand over the entire month`s supply of anti-hypertensives and other drugs for his father or else. We all understood what it meant! The deal was as bare and as shameful as it could be. It was like sex, but without foreplay. This guy meant business. No small talk. Another friend was approached by an MR on the first day of the PHC posting and offered a straight 20% cut on whatever medication he prescribed. Why do you think some medicals have only a specific brand of the drug and not anything else? In case one forgets to buy the medicines from a pharmacy near the clinic, chances are, more often than not the poor fellow has to travel back again near the same clinic to get the particular brand. The medical shop owners are also champions of their trade. Multiple cases of a same person operating multiple shops under the same certificate with no qualified pharmacist at any of the locations is so acceptable, that I think it won`t raise a brow today. You still get a below 50 micron

plastic bag at all the medicals even if you dint ask for one. You get hypnotics on prescription but if u are a buddy, that is completely optional. The whole issue boils down to the over tight regulatory rule book and equally lax application. Rule book enforcement comes as clonic jerks in most of the systems in my motherland and this is no different. One fine day suddenly the plastic bag stops and without prescription medication stops: Yar bohot surprise inspection ho rahe hai! Slowly it cools down and we are back in business. The price of the medication / device is directly proportional to the cut the doctor takes. More expensive prescriptions like intraocular lenses, prosthesis, implants, valves, and stents are some of the devices on which the margin of the product is profuse and so is the kickback to the doctor. Very recently there had been a lot of reports in the media about a study of drug safety conducted in India where the drug controller authority of India concluded that many medicines are pushed into the market even without proper completion of clinical trials. The recommendation letters for the medicines in trials send by various so called authorities in medicine were exact photocopies with just the name changed at the bottom! (And thank heavens for the arduous task that the giants of our profession did) Why were we then calm, why dint we raise such a cry to bring these rubber stamps to justice? Fake Meds A very good friend not long ago told me that when he was working in a hospital at Noida, they knew that majority of the medicines the patients purchased were fake and had little or no active content in them. We might jump the gun here and say now now; doctors dont make medicines! No they dont, but these doctors sure were routinely prescribing these medicines in spite of knowing that the medicine is a fake! He went to add further that they asked the sister to ask for the ORIGINAL when the patient got really critical and nearing his death! Would we be so amused if it was one of our relative who was admitted in the hospital where doctors knowingly tolerate this fake medicine racket? Do we allow our near and dear ones to slip into death`s clutches and then perhaps have the audacity to ask for the real meds. I think not. Shooting the messenger Many in my fraternity have had a deep impact from the ruling government it seems. The top weapon in the arsenal is Shoot the messenger. Messenger: Zille-illahi aapka beta jung me shahid ho gaya. Zille-illahi: Tumhe jine ka koi hak nahi, kuchalwa do is namakul to haathi ke pairo tale! Though I am in no capacity defending the show Satyamev Jayate, nor am I Aamir`s spokesperson, but I think what the show did was create awareness of the rot that has threatened to engulf the whole medical brotherhood and given us a talking point to do whatever we can to cleans it. If there is nothing that can be done individually, at least today people are aware, which is always the first step in reforms.

The MCI has been the top watchdog in all these affairs. The recent turn of events in the MCI had shamed the medical people already. The fume that we vent now, in my opinion, should have been vented then, when Dr. Ketan Desai was arrested for rampant corruption and the courts described the MCI as a den of corruption. My friends who have studied in private medical colleges or are working in one would very well know what MCI inspection means. Its like a big mating dance between the management and the MCI inspectors. They know by the evening they have to bed, they just play hard-to-get! The MCI has been slowly but surely diluting guidelines to suite the private medical colleges. They reduced the land needed for establishment of medical colleges, they reduced the number of faculties needed, especially in non-clinical subjects for the courses and the list goes on. If one remembers there was even a media blitz months ago which emphasized how Indian healthcare is lacking teaching hospitals and how the private colleges are the only viable solution to the existing problem. This show had a few top government actors also! The kidney racket This was one scandal we would have surely done without. All over the news were rich Indian families and foreigners shelling out cash to buy poor Indian`s kidneys! Episodes like these have severely dented the repute of doctors in India. People at that time were running scared at the prospect of a surgery. Everyone was pretty sure that the kidney would be stolen if they had an operation for an appendix of fracture for that matter. So my friends, the fight we need to have is not about who shoots the messenger first but about saving the innocent lives, who have literally everything to lose, and then may be our pride. More often than not our personal projection of the problem clouds the real picture and a cascade effects starts. The respect and the reverence that we expect as rightfully ours will be reinstated if we curb the evil that plagues us and will be only fanned by throwing mud at each other or the messenger. So shall we doctors go in and wash our dirty linen in private, trying that our kids would have a future without these blotches. Cheers Doctors!