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Ethics in the medical profession

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Broken In
source: Businessworld.

Persistent questionable practices will eventually catch up with every industry, profession or sector. For years, fast food firms and cola companies have been in the dock for producing and selling products that are harmful to health. Only after many lawsuits and continual media coverage did the erring companies decide to stop marketing their products to children and stop selling them in schools. In the case of tobacco, widespread public opinion, followed by laws, has led to a ban on advertising of cigarettes. Interestingly, the ITC chairman’s speech at the last AGM talked of everything except tobacco, the mainstay of the company. On the other hand, the pan masala industry has escaped the net so far.

Over the years, industries that have been forced to partly mend their ways (I say partly because to do so wholly would be to impose a complete ban on the production and sale of their products) have staunchly defended their products. They have produced ‘evidence’ to prove that their products are either safe, or that the evidence against them was not conclusive, or that the companies could not be held responsible for adults choosing to consume these products.

The medical profession, which is acquiring a dubious reputation, has escaped the writing on the wall. Reports about doctors involved in criminal trade of human organs or aborting female foetuses are commonplace. Barring a couple of reputable names, there is hardly any radiology or pathology lab in Delhi that does not kick back commissions to referring doctors. Some of the biggest hospitals are accused of doing procedures on patients that are either not necessary or not advisable.

Thankfully, consumer courts are now empowered to deal with medical malpractice suits, much to the chagrin of doctors who had at one time protested against this law.

How hospitals can be culpable and resort to doubtful practices was seen recently in a high profile case of drug overdose leading to death in Delhi. Does the much-coveted accreditation from the Joint Commission International, USA, cover ethics? What is the problem? There are several. I will talk of only two.

One is about greed and crass commercialism. The biggest private sector healthcare companies are hiring ‘star’ doctors at salaries that would make film stars feel small. In order to justify the astronomical salaries, these doctors are expected to bring along a ‘patient base’ to generate sufficient revenue to pay their salaries. Hospitals themselves have to generate the necessary patient volume to pay the doctors. And there are no prizes for guessing what happens. Patients are often subjected to unnecessary procedures and tests or made to stay in hospital longer than necessary. Complaints abound about unsolicited and possibly unnecessary visits by doctors on inpatients in order to charge fees. There are hair-raising stories that would be too tedious to recount here.

In some hospitals, the cost of radiology tests are linked to the category of room occupied. In other words, a patient who occupies a suite pays more for an X-ray than a patient who stays in a single room. In some up-market hospitals, inpatients are often supplied medicines at rates higher than the MRP. It is common practice to pay commissions to doctors who refer patients for procedures at major private hospitals in the capital. In fact, this writer has a copy of a letter in which a highly respected private sector hospital, while appointing a city doctor as a franchisee, has spelt out the ‘referral fees’ payable to him for different kinds of cardiac procedures. So, commissions are now official!
A medical discipline such as radiology has become a lucrative business. According to Dr Ajay Agarwal of Dewan Chand Agarwal Imaging Centre in Delhi, there are more MRI and CT Scan laboratories in Delhi than in New York and in the whole of the UK. Not surprising that investments worth many crores in rupees on sophisticated radiology equipment are yet to be recovered. And it requires no genius to guess what follows.

Secondly, there is no enforceable code of ethics and protocols, which exist mostly in binders on shelves. While human error may be condoned, negligence cannot be condoned under any circumstances. And it is negligence coupled with unethical practices that may become the undoing of the noblest profession.

Doctors are a close-knit community. They quickly close ranks against one of their own who poses a threat to them. For example, a doctor who spoke out against unethical practices was virtually ex-communicated by her community and bad-mouthed enough to lose her patients. Unless the medical profession decides to safeguard its own reputation through an enforceable code of ethics, doctors will acquire a reputation similar to that of blood sucking lawyers in the US. It will be a sad day when you have to use the same criteria to select your surgeon as you do to select your car mechanic: Is he honest? Will he overcharge me?

The moot question is: do we need a body like the Centre for Science and Environment or a sting operation to clean up private sector healthcare? Probably yes. Unless the doctors heal themselves.
The author is a management teacher and advisor. He can be reached at nonichawla@omniconsult.biz


Yes, there are gross malpractices in medical profession. Medical councils were made to check them but unfortunately they have proved to be ineffective. Due to ignorance and callousness, only few reach consumer courts. Civil Surgeons are responsible for implementation of PNDT act but most of Civil Surgeons are corrupt and therefore hardly any conviction is there under this act. Another fact is that when there is corruption in other fields, how medical profession can remain unaffected?
Only solution is education of patients. They must ask questions from doctors.
They should take second opinion if there is any doubt.
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