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Is he Doctor or a Greedy Demon? (December, 2006)

In a popular Tamil TV serial a lady with labor pains goes to a Hospital as an emergency. She is shown in agony lying precariously on a labor cot, writhing with pain and some tricky visuals possibly indicating that she is semiconscious or hallucinating! No one by her side! Outside the labor room, the husband and another relative pleading, begging the doctor to start treatment and the doctor refusing unless Rs. 25,000/- is paid. The relatives tell the doctor that they have the money and will pay shortly but plead and even threaten the doctor to start treatment. But the Demon of a Doctor refuses; the patient inside sinking without even some supportive treatment! The husband threatens and attacks the doctor; even then the doctor refuses to budge. The situation is finally defused when another relative rushes in with the dough needed, chastises the husband and apologises to the doctor and pleads with him to act. Then only the doctor moves.

The story becomes more spicy
The drama does not end there; suddenly the nurse comes out and asks relatives to pay another Rs 20,000/. The lady delivers a live male baby, but she is in a critical condition. Her uterus had to be removed and after blood transfusion she recovers making everyone overjoyed. Again the nurse comes with a slip of paper asking for some more payment! The facial expression of complete disbelief and annoyance on the part of the lady relative who made all the payments is the last straw which puts the whole medical profession to shame!

When finally the justifiably provoked husband meets the same doctor, thanks him profusely and apologizes for his rude behavior, the callous doctor just brushes him aside and walks away!

Are all Doctors greedy?
This depiction of the medical profession makes a layman believe that most doctors are greedy, almost cruel and like him devoid of any common decency and empathy towards the suffering patients.

As a surgeon practicing in the city of Chennai for 40 years and even now our Hospital running in Chennai, I cannot imagine that such an unsympathetic and rude doctor could be practicing anywhere!

No doctor is expected to give free treatment, though many give voluntarily; it is highly unthinkable that a doctor is unwilling even to start life saving emergency measures without getting fees, as depicted. Though in cinemas and TV serials there would be some exaggeration of people belonging to several professions like police, lawyers, money lenders and doctors too, the present depiction seems to have crossed the limit and deliberately targeted the medical profession due to some personal vendetta! Possibly the producer/director of this serial had an unhappy experience with some doctor and therefore she is hitting at the whole medical profession with vengeance!

I can site any number of personal experience where fairly well off people have taken treatment in Hospital and even undergone surgery and gone away without paying the bill. In one instance a patient, a journalist in well known English daily, staying in an A/C deluxe room for several days, underwent some surgery and wanted to go home for a day or so and come for readmission on an auspicious day. He kept a bill of over Rs Fifteen thousands pending and never came back. All attempts to collect the dues failed. Finally we filed a legal case against him; but when finally court directed him to pay, he had vanished! There are many more such instances; but in our Hospital we have never refused admission or treatment particularly an emergency, because patient in not in a position to pay an advance. Time and again we have given first aid even for those for whom our Hospital may not be equipped to take care and not collected and refused to collect any professional fees from them.

Medical Care is expensive!
Medical treatment and surgeries have become quite expensive nowadays, not because of increased cost of living or increased professional fees of doctors, but because of the mistrust of the whole profession by people. And doctors are forced to practice defensive medicine; doing all possible tests like expensive scans for minor problems (and not essential tests alone), taking opinions from specialists even when not needed (to safeguard oneself) and giving un necessary and excessive medications like antibiotics, by way of abundant extra precaution for fear of unhappy repercussions in the event of any unfavorable result. Even when the precise and best possible treatment has been given, the final outcome may not always be successful. When patient is suffering from a serious illness and vital organ functioning has deteriorated, unfavorable result and even fatality is a possible outcome. When this happens the relatives physically assault the doctors, sometimes vandalize the Hospital and file a complaint against the doctor in a consumer protection forum. And the media looking for such news sensationalize them and give wide and prominent publicity. A lifetime of good medical practice can thus be ruined because one patient did not respond well to the correct treatment given by a doctor. In fact medical profession has become highly stressful and good and ethical practice is difficult for a doctor to follow.

Are there any good Doctors?
In spite of the present complex scenario in the field of medical profession, it is still possible to follow a straight forward and ethical path without compromising on standards of medical care. The Doctor has to devote sufficient time to talk to the patient, examine him/her systematically and thoroughly and come to a conclusion (diagnosis and differential diagnosis) about what the patient could be suffering from. The laboratory and other special tests are for confirming or ruling out the various possibilities. Only tests needed and justifiable have to be done and not all possible tests in a situation. Once the diagnosis is made the treatment- medical or maybe surgical – can be precisely targeted. The correct diagnosis is the basic foundation of proper treatment.

The use of various high-tech medical gadgets while treating the patients in a Hospital or during a surgical procedure is another area where there is lot of scope for overuse. This also makes medical care more expensive. Even in such a situation judicious use of these equipments only when needed would reduce unnecessary expenditure. To buy and keep these costly gadgets in a Hospital is essential; often a well informed patient demands to know if the Hospital has this equipment or not. In this situation there is always a temptation use them and naturally patient will be billed for its use.

What is the recommendation for medical profession & Hospitals?
There is need to standardize infrastructure, facilities and staffing and their qualifications in any Hospital or even a clinic and also to some extent professional fees of doctors for various services.

Medical teaching should emphasize detailed examination and evaluation and depend less on modern gadgets for purposes of diagnosis. Ethical medical practice and need to regularly updating one’s knowledge and skill must be part of medical teaching.

System of renewal of medical license every 5 or 10 years on the basis of attending minimum CME (Continuing Medical Education) or workshops should be introduced by the Medical Council of India.

The Medical Council of India must have the will and power to take away license of Doctors who have committed certain instances of malpractice or gross deficiency in the care of patients.

Expecting a better Modern Medicare for one and all!

Dr. M.Mohan Rao, MBBS,MS,FICS,MCH,

Director & Senior Surgeon (Retired but not tired),
Dr. U Mohan Rau Memorial Hospital.



Updated on 01.12.2006.

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