HOW NOT TO CARE

The Telegraph, 15th June 2017, By Arunabha Sengupta

The Chinese word, Yi Nao, which means disturbance in hospitals, is a bizarre one to be included in medical parlance. Violence against medical establishments for 'faults' has become so rampant in some Chinese provinces that armed 'Yi Nao' gangs now take contracts from families to beat up doctors. On the flip side is the obdurate practice by the doctors there to collect 'respects' from patients in the form of red envelopes traditionally used by the Chinese to gift money to friends and relatives.

Such is not the case in India, or is it? Allegations of mishandling by hospitals and violent public retributions are now perceived to have reached a level so as to disrupt medical services as a whole. The president and the chief minister expressed their concern about this at a function in Calcutta, criticizing private hospitals for their misconduct on one hand and irresponsible public behaviour on the other. However, they have not elaborated on what is central to the malaise: political will. A Planning Commission report, India Vision 2020, had identified four criteria for a just healthcare system: universal access; fair distribution of financial costs; trained providers with competence, empathy, and accountability; special provision for children, women, disabled and the aged. We are far from approaching any of these goals.

In the absence of universal access to adequate healthcare, the private sector rules the roost. Most patients are forced to submit to unregulated private hospitals and expose themselves to varying degrees of exploitation and unexpected expenses. In the absence of a fair distribution of financial costs and social insurance for long-term care, punitive out-of-pocket expenses force families to become assertive while judging the end result, demanding value for their money. Instances and allegations of malpractice and overbilling by hospitals have led to a growing negative perception about men of medicine. This riotous situation in India has attracted international criticism in the form of worried editorials in the Lancet and BMJ. The Medical Council of India, the apex body authorized to grant licences and monitor medical practice, itself got so embroiled in corruption that its governing body had to be sacked and booked by law. There is no law here that mandates large hospitals to report their adverse events and medical errors like in the United States of America, the preferred model for our private providers.

Nothing, though, justifies or fully explains the present spate of violence in our hospitals. Often even the motivation is not clear. Doctors in two different states in India have been beaten up for wanting to refer a patient to a higher centre in one case and for not referring in the other. In spite of several court rulings to not equate every death with medical error and every medical error with gross negligence, often just the news causes an impromptu gathering of a frenzied mob, which does not wait to ascertain if the doctor did all there was to do and did it right. The government has failed to protect doctors and has allowed their tormentors to go unpunished, encouraging others to repeat the act with impunity. The good intention of the state government to impose regulations on the private sector is already lost to a great extent because of the public behaviour stemming from a misunderstood message delivered by the sweeping nature of the act and the way it tarred all and sundry with the same brush.

The extent of public wrath and distrust has made the medical community uneasy. The authority of the medical profession grew towards the last quarter of the 19th century when new-found treatment methods enhanced cure rates and training and licensing of doctors became organized. It had taken a few thousand years for the medical community to earn the trust it enjoyed in the last century; losing or withdrawing that trust again will be regressive.