Of late we have been having an interesting and involved discussion on the subject of medical ethics in India, especially in so-called corporate hospitals involving also doctors in both private practice and government service. Interesting and involved because everyone is an interested party; at some time having been the recipients of the tender mercies of doctors and our hospital system. What I have been left with at the end of it all is the distinctly alarming feeling that the entire concept of medical ethics seems to be Greek and Latin to most doctors – or at least that is how they seem to act. So I thought it would be a useful exercise to put this down on paper, the way I see it so that we can take it on from there.
There are five players in this game – the game of medical care in India. They are:
1. Corporate Hospital
2. Diagnostic Center
3. Pharmaceutical company – represented by its salesmen
4. Individual doctors – independent & employees of corporate hospitals
5. Patients
It is symbolic that the name given to the sufferer of a disease is ‘patient’. Perhaps it is a reminder to him of what he needs to be above all else – patient in the face of not only suffering which would be a trial enough, but even more patient in the face of open exploitation by those who he trusts, needs desperately and looks up to as his saviors. The problem is that of a lack of sync in perception. Those who he looks to as his saviors see him as their victim or prey to be used and abused until he can give no more. Exploitation by anyone is bad. But exploitation by those who are trusted is blasphemous and evil. Exploitation by doctors, hospitals and medical service providers falls squarely in that category. Let those who indulge in it fear the Day when they will meet their Creator and have to answer Him for what they did. It doesn’t matter whether you believe this or not. It will happen just the same. Just as not believing in cholesterol will not save you from a heart attack; not believing in AllahY and the Day of Judgment will not save you from it. If you don’t believe me, just wait a bit.
So what is evil about the system as it exists?
What is evil is simply the issue of breach of trust. The trust between the doctor and his patient. There are many relationships in our lives which are based on trust. Parent/child, teacher/student, husband/wife, employer/employee, lawyer/client and others. However it can perhaps be argued that the most intimate of these is that of doctor/patient, where the doctor has access to such intimate personal details of the patient that almost none of the above relations have.
A relationship that is based on trust is unique in that between the two parties there are no barriers, defenses or filters. So any hostile act goes straight to the heart without any hope of being either diverted or combatted. Add to this the complexity that in the doctor/patient relationship the trust is completely one-sided. The doctor knows everything about the patient and can learn whatever he wants simply by asking while the patient may not even know the doctor’s full name, let alone anything more about him. After all in which of these relationships can one simply order the other to drop his pants with the full assurance that his order will be obeyed without question?
Therefore when that relationship is abused the crime is compounded in it heinousness because it amounts to predatory behavior. Given that the medical profession is perhaps the only one where those who graduate as doctors actually take an oath to keep the patient as their first and only concern and to practice their profession with honor and with the sole aim of helping the patient in his hour of need; when those doctors instead start to treat the patient as prey and instead of helping him, proceed to abuse the trust to loot him; the crime becomes worse than that of highway robbery.
The situation as it exists today is as follows:
1. Most Corporate hospitals give doctors commercial targets that they are supposed to achieve every month. If they don’t do it, whatever be the reason, they are penalized directly or indirectly.
2. In order to achieve these targets doctors have only one way; prescribe unnecessary investigations, treatments, hospitalization, surgical procedures, ICU care and expensive medication when cheaper alternatives may be available.
3. Diagnostic centers give doctors commissions which are a percentage of the billing they do for patients that those doctors send to them. This has been made such a fine art that even if a doctor doesn’t send patients to a particular diagnostic center, once a few patients come to them from that doctor, they automatically send a payment to that doctor.
4. And pharmaceutical companies give doctors bribes (they call them incentives or commissions) in the form of cash and kind – holidays, eating out, gifts etc.
The person who eventually pays for all these is of course the patient as he is the only one in this racket who pays. All others collect at his expense. The patient pays directly in terms of needlessly high cost of treatment because all the incentives to doctors are passed on to him. Or indirectly through cost of medical insurance for the same reason.
The questions I want to ask the readers who are doctors are:
1. Did you take all the pains to study medicine, qualify in tough exams and work all hours and take an oath at the end of it; to alleviate suffering or to inflict it?
2. How is it that you don’t feel insulted when you are given commercial targets and when you are offered incentives and commissions?
3. Are you a doctor or are you a you-know-what (let me know if you need me to explain what that is)?
1. Abdullah bin `Amrynarrated that Rasoolullahr said: “The curse of AllahY is upon the one who offers a bribe and the one who takes it.”
(Ahmad, Ibn Majah and authenticated by Al-Albani)
2. Abu Sa`id Al-Khudriynarrated that Rasoolullahr said: “Whosoever amongst you sees an evil, let him change it with his hands; and if he is not able, then with his tongue; and if he is not able, then let him hate it in his heart, and that is the weakest of faith.” (Authenticated by Al-Albani)
3. Abu Humaid As-sa’idiyreported that Rasoolullahrsaid: “Gifts offered to public servants are ill-gotten gains (ghulul).” (Authenticated by Al-Albani)
4. Buraidah ibn Al-Husaibynarrated that Rasoolullahrsaid: “When we appoint someone to a (public) post and provide him with an allowance, anything he takes beyond that is an ill-gotten gain.” (Abu Dawud and authenticated by Al-Albani)
5. Khaulah bint `Amir (RA) reported that Rasoolulahr said: “Some men abuse AllahY‘s Property (that is, public money and funds). They will go to Hell on the Day of Resurrection.” (Bukhari)
It is clear from all of the above – if you need proof for what your heart should have told you without any of this – that having anyone other than the patient as your primary client whose welfare must supercede every other consideration amounts to breach of trust of the worst kind. Taking all commissions, prescribing unnecessary treatments, making money from the patient beyond a reasonable fee, amounts to ill-gotten gains which attracts the punishment of AllahY.
I didn’t want to make this too long and so I recorded a video about this in which I have told my own story of how I was exploited and how my father was exploited by big name corporate hospitals. Sadly my story is not unique. Stories like mine and far worse abound and every day we hear a new story of gross medical malpractice which is aided and abetted by destroying all evidence of it, doctors lying about it and ensuring that no legal action can be taken against the perpetrators – hospitals and doctors. It is a racket of organized crime – to put it simply and directly.
But in all this such doctors and their colluders forget that what they try to hide is very visible from One who watches and to Whom they are all answerable.
So ask yourself these questions:
1. How would you like to be in the care of a doctor exactly like yourself?
2. How would you like to be the victim of a doctor working to meet a commercial target who exploits you by prescribing treatment you don’t need and inflicting suffering on you so that he can generate bills for surgical procedures, investigations and treatments which are useless or may even be harmful?
3. How would you like to be in the care of a doctor for whom you were the first and most important priority?
4. How would you like to be in the care of a doctor who was interested only in your welfare, ensuring that you received the best care, in the most compassionate way at the lowest possible cost?
5. How you would like to be in the dua of all those you help through their pain and sickness?
6. How would you like to cursed by all those you victimized, deceived, exploited and abused?
Finally I say to those of you who still want to take commissions and work to meet commercial targets, ‘See you on the Day of Judgment before the Throne of my Rabb.’
Remember my dear friends what your Creator, AllahY said:
أَلَمْ يَعْلَمْ بِأَنَّ اللَّهَ يَرَى
Alaq 96: 14 Doesn’t he know that Allah is watching?
One of my friends who owns a restaurant and also happens to be a volunteer told me this: A team of Pediatric doctors who were treating one of the NGO sponsored patients requested him to host a dinner at his restaurant which was sponsored by a pharmasutical company. The doctors not only had their fill but also ordered for take away for their families. The pharmaceutical sales guy who sponsored the dinner was also there. He pleaded the my friend to be considerate in his supplies and not give them whatever they ask because he has a budget that couldn't… Read more »
Does give one a sinking feeling! In times of trouble, one is wholly dependent on the doctor and his judgement and trusts him only next to God. To think that he saw you only as a means to earn money or experiment on without the slightest semblance of accountability is frightening, to say the least. Just as a patient is expected to be so, when they say a statement is doctored, we know it isn't reliable and that cannot be good. The punishment for unethical behavior must be prompt and exemplary. One can only hope and be, yes, patient.