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COVER
STORY: DOCTOR Vs PATIENT
Growing
Distrust
A surge
in negligence suits, lax regulatory mechanisms and rampant commercialism
seriously impair the credibility of the medical profession
by Vijay
Jung Thapa and Subhadra
Menon
He
came highly recommended. "I was told he was the best nephrologist
in the city," remembers Sadia Nazmi. That was two years ago. A harrowing
time for the 42-year-old public-sector employee from Delhi, who because
of renal failure, was constantly tired and suffered from depression. "He
was confident I could lead a normal life ... I was sure he was the one
who could turn my life around." But a year down the line, she wasn't
so sure. Life had become an endless series of expensive hospitalisation
and invasive investigation at a private clinic. Put on maintenance dialysis
because the doctor ruled out a transplant, Nazmi had lost 20 kg, looked
withered and was almost bed-ridden. Her family was running out of money,
spending as much as Rs 50,000 every month. The demi-god doctor suddenly
acquired a these-things-happen kind of attitude. It was then that her
family took her to the All India Institute of Medical Sciences where an
immediate transplant was recommended. Today, Nazmi leads a careful but
relatively healthy life and is back at work. "I thought I was destined
to die," she recalls, "but it was all greed. The greed of a
doctor who wanted to squeeze out all my money before I died."
Harsh words.
Nazmi is contemplating legal action and she is not a lone voice. A growing
number of patients who have been at the receiving end of healthcare in
India speak in the same acrimonious tone. Today, more than ever before,
there is a growing distrust between patients and doctors that threatens
to permanently impair a special relationship.
Time was
when this relationship was a sacred bond founded on trust. It was said
that when a patient seeks a doctor's help and the doctor agrees to give
that help, a special covenant is made. The patient takes the doctor into
confidence and reveals to him the most intimate information related to
his health. The doctor, in turn, agrees to honour that trust and becomes
the patient's health advocate, placing his interests, personal or financial,
above all others. Sadly, this exalted notion is increasingly being questioned.
A good indicator of this distrust is the growing number of medical malpractice
suits: last year 29,944 cases were filed in consumer courts alone as compared
to less than 10,000 in 1995. Says Dr Prem Aggarwal, honorary general secretary
of the Indian Medical Association (IMA): "This way, instead of healing
we will end up fighting."
This unhealthy
development can be linked to a raft of reasons. Not the least of which
is the fact that the Government seems to be rapidly relinquishing its
role of providing efficient healthcare. Today, government hospitals account
for barely 20 per cent of all healthcare in the country, with the major
share being looked after by the burgeoning private hospitals and clinics,
most of them unregulated.
Look at
it through the prism of an Indian patient. He is stuck in a dangerous
dilemma. The choice is between a slew of over-burdened, understaffed and
under funded government hospitals where queues stretch to the horizon
and bodies are pressed together like sheep, where infection levels are
high and diagnostic facilities crumbling. And the private sector where
the range varies from glitzy five-star hospitals charging Rs 10,000 a
night to seedy kitchen clinics that advertise in loud neon and where the
price of every service is up for bargaining. "Health services may
soon invoke a statutory warning: beware, we can be injurious to your health,"
says Abhijeet Mitra, a Delhi consumer activist.
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