From childhood we hear medicine is a noble profession. Doctors make great sacrifices to save lives. On the operating table, they play God. They dedicate their lives to serving society. A Doctor exists to serve his patients etc etc. All these beliefs gave the Doctor profession a great deal of respect in the society.
Yet, it appears this respect is eroding and eroding rather rapidly. The cancer of corruption and greed that has eroded most of the institutions in the society has touched the medical profession too. The recent arrest of Dr Ketan Desai , the President of Medical Council of India, the foremost professional body of Doctors, by CBI for accepting a bribe of Rs 2 crore, just proves this.
Informal chats with professionals in the pharmaceutical marketing throws up anecdotes galore of the greed and malpractices of highly successful doctors. In the pharmaceutical trade, an amount of 35 % of the MRP of the drug is set aside for marketing expenses. A significant portion of this expenses is spent on gifts for the doctors. These gifts are so devised , so that the Code of ethics for doctors is not violated.
MCI has amended the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002.
“The amendment prohibits the doctors from accepting gifts, travel facility, hospitality, cash or monetary grants or any other favours from any pharmaceutical and allied health sector industry for self or family members.”
Yet, the Health Minister has admitted in reply to a parliament question that nearly 2,000 doctors have violated professional ethics. This is just the tip of the iceberg, because this represent only cases where the pharma companies have complained to the MCI. In most cases, pharma companies have accepted it as an occupational hazard or a cost of doing business and therefore do not complain.
In an incident which appeared bizarre to me, one pharma marketing manager was narrating how physicians deal with senior citizens. Diabetes being a rather common disorder among Indians, most senior citizens are recommended to undergo blood and urine tests for sugar. The diagnostic centre in connivance with the doctors give wrong reports indicating diabetes. The physician then puts the patient on insulin. As the patient comes out of the chamber, he is likely to be greeted by several Medical reps (MR) asking the patient, not his well-being, but what the doctor had prescribed. Based on the brand of insulin prescribed the respective co’s MR puts a tally mark against the Dr’s name. On reaching a target of say 50 the doctor is eligible for a car. Insulin being a life-long treatment and usually patients do not change the brand, the cost of car can be recovered in the long run. In the meanwhile, the competing MRs go and complain to the Doctor about how he has been partial to one company. Then they bandy their gifts and inform the doctor where the Doctor’s score stands with respect to their company’s scheme.
One pharma company CEO made a comment that he is quite happy bidding for Government tenders than dealing with doctors. Bribes in government tenders at 20 % are lower than the expenditure on gifts to doctors. In addition, he did not have to put up with the tantrums of many specialist doctors, who often insist on calls every week only from the CEO.
Govt has through various means like Drug price control order, MCI guildelines etc have tried to keep the cost of drugs in check. Yet, in healthcare , medicines account for only 15 % of the total expenditure. Other heads like diagnostics, hospitals, Doctor’s fees etc account for the rest. These are all in unorganised sector and there are virtually no price controls and guidelines for these.
Most patients would have their own story to narrate about how many tests they or their family member had to undergo before the doctor pronounced his diagnosis. On many occasions an expensive MRI or a CAT scan was done but the doctor did not even spend a minute reading the report. Upto 50 % kickbacks to the referring doctors by the diagnostic centre is the norm in most metros. The high rates of tests are not only to recover the investment the promoter has made in the equipment but also for the expenditure to cultivate a network of doctors who refer their patients to the centre.
Private sector hospitals particularly the tertiary care centres often under a corporate structure are a law unto themselves. The malpractices in pricing and dispensation of medical devices like stents or heart valves are many. Under the veneer of computerised efficiency and courteous patient care, overbilling and cheating the unsuspecting patient is rampant. Most ambitious doctors today dream of owning and operating a nursing home atleast, if not a hospital. Multimillionaire doctors like Dr Naresh Trehan have become role models for many doctors. (No wonder the Singh brothers, Malvinder and Shivinder, after selling Ranbaxy have decided to focus on healthcare, even quitting the financial services company Religare.)
It is no surprise that increasing number of doctors are unable to resist the temptation to cheat the patients a little or be greedy with the pharma companies, so as to make a fast buck. In the bargain losing respect a little. In honest chats with doctor friends, they will confess that they also started with the idealism of doing service to the society, but they could not stand up to the pressures of consumerism. Now, their ideals and ethics is limited only to family and friends. For all others, it is just money, money, more money.