In 1976, I passed out of MBBS. When I joined as a medical officer in a primary health centre (PHC) of a remote village called Birwardi, 20km interior of Mahad town in Raigad, I was aware of my duty towards patients. However, my seniors advised me to charge each and every patient over and above my salary. My illiterate parents, however, had counselled me that a monthly payment was the only thing I was rightfully entitled to.
My principles did not resonate well with my higher-ups. I continued my research in scorpion and snake bites. My seniors never encouraged my research. I never entertained them for a cocktail party or passed on any extra payment.
Last March, I received a cheque for Rs1,200 from an imaging and diagnostics centre based in Mumbai and Pune. On inquiry, I discovered that the cheque was a “professional fee” for referring a patient to the centre “for MRI”.
The patient had already paid my professional fee, when I had examined him at my hospital. So, I returned the cheque, which was reimbursed by the MRI centre to the patient at my request. I lodged a detailed complaint against this unethical practice with the Maharashtra Medical Council (MMC).
Patients are made to undergo unnecessary investigations, hospitalisations and even surgeries in cases where there may be no need for any of that. In a majority of small nursing homes, doctors own medical stores and laboratories. Unnecessary prescriptions of expensive drugs are asked to be procured with no explanation given whatsoever to patients and relatives. Nobody is interested in the concept of generic medicine.
Large multinational pharmaceutical companies regularly supply expensive gifts and other medical equipment to leading physicians who then only prescribe that MNC's drugs. Doctors are put up in five-star hotels along with family members, while being gifted holidays abroad by the MNCs.
Hospitals, at times, put doctors under pressure so that they reach a set target of patients. Bribes are offered so that they may refer those patients to the hospitals.
I wrote an editorial in medical journal Lancet after an incident of bribery. I wrote, “Many hospitals and clinics routinely issues cheques to doctors under sanitised names, such as professional fees, to encourage them to use their services. The medical council rules are quite robust, but enforcement is a problem. At the most, the council will suspend or cancel the licence of the doctor violating the code, but it can't do anything to stop pharmaceutical companies from offering doctors gifts because they fall outside the purview of the code.”
I also wrote, “In India, admission to medical colleges is based on entrance exam, not on vocation, aptitude or attitude of the student. Moreover, to settle in big cities, where life is expensive, doctors might unwillingly practice unethically. In government hospitals, doctors are overworked and under pressure from politicians.”
Working as a physician in remote areas of Maharashtra for the last 37 years, treating life-threatening tropical emergencies without access to modern ICU gadgets, counselling grieving families and researching on rural health problems, I have many often encountered challenging and stressful situations. But my work gives me such satisfaction which money can never buy. There is still room for honesty, dedication, sincerity and devotion in this profession.
