Dissenting doctors seek cleansing of greedy medical practice  Dr Gopal Dabade, March 23, 2015, Deccan Herald

Dissenting Diagnosis

A patient sought a second opinion for an existing heart problem and was again unnecessarily subjected to all the investigations that had been earlier done during the first consultation. On enquiry, the patient was consoled that this is all just a ‘routine matter’ in every hospital and that is how it works. This has been the experience of most patients that have utilised the dominant private health provider in India.

In fact, there are several other facets which include excessive and irrational medications, procedures, surgeries and investigations. In addition, kickbacks for referring substandard care with unethical practices leading to gross violation of patient's human rights have become part of the well-established private health sector. During several informal discussions, many people recount a variety of negative experiences with great disappoint while being treated in private hospitals.

The patient is often in a helpless situation and during these critical hours of ‘life and death’, he is more often unable to take any logical decisions. All these create a feeling of being totally helpless.

This is one side of the picture. Has anyone at any given time wondered as to what is the state of mind of doctors who want to be ethical, rational and want justice to be delivered to their patients? How they wished that there was some platform where the doctors could pour their hearts over the existing ruthless system and perhaps even build on it a system that works and brings in useful changes.

Until now, this was just a wish and a distant dream but the winds of change seem to be blowing. A group of doctors have courageously come forward to document by holding up a mirror to their own profession. There is rage in their statements. Yet, at times, they seem helpless at the state of affairs of their own once ‘noble profession’.

The lead for this so called beginning of the cleansing has been conceived and initiated by Dr Arun Gadre with a team of his friends in and around Pune. Initially, he went around and contacted his friends’ circle and slowly expanded to several metropolitan cities as well, who shared a similar vision. Dr Gadre, himself a practicing gynaecologist in rural areas, was well aware of the exploitative system and decided to interview other doctors after preparing a simple questionnaire. Over a period of a decade, with continued persistence and perseverance, he compiled the confessions of 78 doctors from all over India.

The interviews by these practicing doctors and some leading consultants in the private sector shatter the myth that is created by members of the medical bodies that there may be few ‘black-sheep’ and that everything else is fine. On the contrary, the interviews bring out ugly facets of the deplorable decline in ethical standards due to a high degree of commercialisation. They point to a serious and ugly reality.

There is anger and frustration expressed by these doctors on many of the irrational and unethical practices that are rampant and abundant. A vast majority of these doctors often have a tough time as they continue to struggle every day to maintain a good distance from the jaws of unethical and commercial practices.

Testimonies of doctors

Most testimonies bring out the various facets of the unprincipled practices. But the one by Dr Vijay Ajgaonkar, a senior practicing diabetologist from Mumbai who has given extensive evidences says, “Huge corporate hospitals put pressure on all doctors linked to the hospital, and on their full-time employees. They demand that they must send a certain quantum of business to the labs and the radiologists. There is no doubt that this practice has become commonplace. Unnecessary investigations are then forced upon the patients. The unfortunate patients are often trapped. They keep running from one big hospital to another”.

Dr Shyam Kagal, a physician in Pune says, “I know a gastroenterologist who performs numerous endoscopies on the same patient, when one is sufficient”. Dr Sanjay Nagral, a surgeon from Mumbai recounts painfully that “the criteria of doctors’ success have changed. Now, the successful doctor is one who has a big car and earns a lot of money! Due to this, everything is now dictated by the logic of money. The very structure of private medical practice has become such that there is no place left for ethics”.

Evidences one after the other by these various doctors from divergent specialities bring forth the anguish and pain as they keep the struggle on. The news of these statements seem to be spreading slowly as evidenced by the coverage this issue got in the prestigious British Medical Journal of March 2, 2015. Reacting to these testimonies Dr Samiran Nundy, a gastrointestinal surgeon at Sir Ganga Ram Hospital, New Delhi, mentioned to the BMJ that “I’m optimistic that this campaign will expand – such a movement gains credibility when it is driven by doctors”. He further added that “the silent minority must try and do something about it.”

But the picture is definitely not rosy as the forces acting against these doctors are much stronger and have powerful lobbies including the huge corporate hospitals. There is an intense and genuine fear that such ethical doctors may soon become endangered species. If such a situation has to be avoided, then the government through the Medical Council of India (MCI) must proactively create structures and mechanisms that would ensure protection of rational and ethical medical practice.

(References: http://privatehospitalswatch.org)

Indian Doctors for Ethical Practice (IDEP) We are a network of --- ‘Doctors for De-commercialized, Ethical & Rational Health Care’

We are speaking on behalf of the large number of conscientious, rational doctors in India with a sense of anguish and distress regarding the state of medical practice in India today.

We are worried about
Deteriorating ethical standards in private medical practice, and stark commercialization of this once a noble profession(Rising incidences of malpractices, irrational investigations, unnecessary procedures and surgeries, kickbacks).Adversarial relationship between patients and doctors leading to insecurity among doctors.

We want to bring back
the healthy and harmonious relationship between doctors and patients.

  • Checking corporatization of Health care.
  • Regulation and rationalization of fee structure in private medical colleges.
  • Regulation of pharma industry, equipment industry and consumables (Stents etc).
  • Solving the practical problems of rational doctors – like high handed implementation of PCPNDT in which many honest doctors have suffered.
  • Capping the amount of compensation in medico legal cases.
  • Honouring patients’ rights, transparency regarding charges and for readiness to give enough time to patients and answer their queries.
  • Following standard treatment guidelines prepared by organizations in India with due consideration for local constraints.
  • Bringing in Clinical establishment act that would protect honest and ethical doctors and would not bring in corrupt Baburaj.
  • Reconstitution of Medical Council of India on democratic lines, and bringing Corporate Hospitals under the control of MCI.

We have a dream
To bring Universal Health Care in India like that in UK/ Canada/ Thailand a system wherein private-practitioners would be paid from public fund on the principle of ‘standard payment for standard care’ and hence doctor-patient relations would not be based on the market-logic.
From – Dr Arun Gadre MD (OBGY) Pune, Maharashtra, 09822246327,
Dr Sanjay Nagral, Dept of Surgical Gastroenterology, Jaslok Hospital, Mumbai, 09820285458

Networks of ethical doctors and health activists resolve to form National coalition for restructuring of medical regulation in India

Several networks of rational, ethical doctors and civil society groups working in the field of health including Indian Doctors for Ethical Practice (IDEP), Jan Swasthya Abhiyan (JSA), Indian Doctors for Peace and Development (IDPD), Medico Friend Circle (MFC), Forum for Medical Ethics Society (FMES) and SATHI, Pune collaboratively organised a National Consultation on ‘Reform and Restructure of Medical Council of India’ on 4th May 2016 at YMCA, New Delhi. Over 75 rational, ethical doctors, health activists, academicians and senior retired officials from different parts of the country along with three Members of Parliament participated in this consultation, which was held given the following background:

  • The recent report of the Parliamentary Standing Committee (PSC) on the Functioning of Medical Council of India (MCI) released in March 2016 has scathingly criticised MCI for it’s widespread failures, opaqueness, corruption and non-responsiveness. This is accompanied by a comprehensive range of recommendations by the PSC for thorough overhaul and basic restructuring of MCI, to transform the scenario regarding regulation of medical education and protection of medical ethics in India.

  • The recent Supreme Court order (2nd May 2016) dealing with medical admissions has also clearly indicted the MCI for its complete inability to regulate admission processes and fee structure in medical colleges, and has appointed a three-member oversight committee.

  • The High level Committee led by Dr. Ranjit Roy Chaudhury (Sep. 2014) has also emphasised the need for major changes in the ethos of MCI as a regulatory body, requiring major structural reconfiguration of its functions. This expert committee has suggested the formation of a National Medical Commission (NMC) through a new Act.

The consultation was preceded by the press conference and book release ceremony of the book ‘Dissenting Diagnosis’. Reporters from major newspapers, magazines covered this press conference. Dr K. V. Babu from Kerala who is known for courageously taking on mighty Indian Medical Association for its unethical endorsements of commercial products and who himself is a victim of vested interest in MCI made opening remarks in the press conference. Dr G. S. Grewal (President- Punjab Medical Council) exposed corruption and ghost faculties in medical colleges. He took on both MCI and Health Minster of Punjab State for providing protection to these kind of blatantly unethical practices. He described how gold is preferred instead of cash by the medical college inspectors! He welcomed the Parliamentary Standing Committee Report. Dr Samiran Nundy(Senior Surgeon) demanded adoption of General Medical Council model of UK in place of existing MCI and open up membership of medical council to non-medico persons of repute like public health experts, health activists, representatives of patient advocacy groups, legal experts etc. Jashodhara Dasgupta talked about unethical conduct of medical practitioners and failure of MCI in redressing patient’s complaints.

She emphasised that restructuring of MCI must be done. Dr Abhay Shukla demanded that the entire current MCI leadership should resign on moral grounds in the backdrop of two strongly critical reports from nation’s topmost institutions of governance i.e. the Parliament and the Supreme Court. He demanded scrapping of the current Indian Medical Council Act and bringing a new law in its place to curb corruption in medical education and to promote ethics in the medical profession. A broad based, participatory process should be adopted to draft such a new statute. Dr Arun Gadre declared that new coalition of ethical doctors and health activists will undertake nationwide campaign for restructuring of MCI. Speakers in press conference expressed their worry about the silence of the Health Ministry on the Parliamentary committee report and Supreme Court judgement. Dr Grewal while answering questions from journalists said that this new coalition of doctors and health activists will meet PMO, NITI AYOG, Health Minister, leaders of all political parties and urge them to take appropriate actions and stands on the demands raised in this press conference. Dr Abhay Shukla told that if government does not make efforts to bring in new law then this coalition will take draft a model bill and will do advocacy for adoption of that bill.

During the press conference, the book 'Dissenting Diagnosis: Voices of conscience from the medical profession' (Authors- Dr Arun Gadre and Dr Abhay Shukla; Published by Penguin Random House) was released, which is a hard-hitting expose of the sickness in India's healthcare and a call to arms to re-establish ethical medical practices. This book was released at the hands of Dr Samiran Nundy (Senior Surgeon, Gangaram Hospital), with Dr G. S. Grewal (President- Punjab Medical Council) as the Chief Guest. Ms Dipti from Penguin Random House gave brief introduction about this book, followed by thought sharing by one of the author Dr Arun Gadre.

In the first session, senior medical professionals and health activists from across the country, who have been demanding reform of medical education and protection of medical ethics spoke in the consultation. These include Dr K.V. Babu (Kerala, Health Activist), Dr Sanjib Mukhopadhyay (Kolkata, Indian Doctors for Ethical Practice), Dr Sanjay Nagral (Mumbai, Forum for Medical Ethics Society), Dr Amit Sengupta from Delhi (Jan Swasthya Abhiyan), Dr Shakeel Ur Rahman from Bihar (Indian Doctors for Peace and Development). Dr Arun Mitra from Punjab Medical Council moderated this session.

Participating doctors and activists strongly expressed the need to substantially restructure, reorient, make transparent and democratize the Medical Council of India and State medical councils, in view of the recommendations of the recent report of the Parliamentary Committee related to MCI and the recent Supreme Court judgement related to MCI. This includes mechanisms for Medical councils to deal with patient's complaints regarding unethical conduct and malpractices by a section of doctors and hospitals.

Participant in this session welcomed the Parliamentary Standing Committee Report but expressed caution about what kind of structure will take place of the MCI. It was emerged through the panel discussion that we need to be more alert and keep watch on moves happening in PMO and NITI AYOG. Some of them expressed their disapproval about recommendation by PSC about scrapping election process in MCI and appointing new members by selection considering bad record of political nominations over many such bodies. Some panellist stressed that reforms in MCI should be looked in larger public health system perspective. Conversion of district hospitals into medical colleges managed by private institutions was heatedly discussed. Participants discussed recent experience of Andhra Pradesh where 13 district hospitals are proposed to be taken over by private corporate medical colleges. Some participants raised fear that dissolution of MCI may accelerate this process by removing last barrier.

In second session, Dr Amar Jesani emphasised the need to make medical education affordable while minimising the costs to students, and to definitively eliminate gross commercialisation of medical education. It is also being expressed that the system of regulation of medical education and ethics must help to bring down costs of health care for ordinary people. Further, there needs to be effective regulation of corporate hospitals to prevent growing commercialisation of health care.

Shri K.C. Tyagi (MP- Janata Dal United) criticised privatisation of education in general and privatisation of medical education in specific. He supported the demand to restructure MCI and assured his help in raising this issue in Parliament. Shri Husain Dalwai (MP, INC) also expressed his support to the new coalition of doctors and activists in raising this issue in much bigger way in Monsoon Session. Shri A V Swamy (MP from Orissa) shared memories about Medico Friend Circle in 1980s. He promised all support for this advocacy. Shri Keshav Desiraju (Former Secretary, MoHFW) welcomed this courageous step by networks of doctors and health activists.

He stated that reforms in mere MCI is not sufficient and doctors, health activists should also demand reforms in state medical councils. He informed that about 88 Members of parliament have direct interest in medical colleges. Thus reforming MCI is very tough task considering entrenched vested interests but recent PSC report and Supreme Court judgement definitely provided an opportunity which must be used. Dr Samiran Nundy and Dr G S Grewal gave some concrete practical suggestions to carry forward the functioning of this new coalition for restructuring the MCI. Dr Abhay Shukla and Jashodhara Dasgupta facilitated this session.

Overall, it was fairly successful programme