In the past, when we fell ill, we relied mostly on government hospitals and doctors, trusting that we would be cured and treated with humility and humanity. Although government hospitals had fewer doctors and limited resources, the faith and trust in the healthcare system was very high. Doctors were seen as saviors and gods.
After liberalization and the explosion of private hospitals and healthcare, people are afraid of doctors, hospitals, health insurance industry and their nexus which is designed to exploit and impoverish people. They lure us through medical advertisements, which emphasize the packages, facilities and qualifications of doctors. However, common people, especially those belonging to the underprivileged and lower middle class, do not have health insurance and are afraid to go to them. It is not only the high cost and affordability but also the loss of trust in the system. The increasing commercialization of healthcare has led to practices that put financial gains before patient care. Private healthcare providers often use aggressive marketing tactics, promoting expensive treatments and procedures that may not be medically necessary. Doctors in private hospitals are given targets, forced to conduct unnecessary tests, hospitalize patients unnecessarily, prescribe expensive drugs and perform surgeries to make more money. They have become part of this dirty business and forgotten their Hippocratic oath. They do not understand the damage they are doing to their brotherhood and this noble profession.
The shift from a patient-centric approach to a profit-driven model has significantly eroded trust in doctors. In this profit and market-driven medicine, which forces excessive medical utilization, doctors in India have become day laborers, paid based on the ‘business’ they bring to a hospital. They are forced to be part of this evil, not following standard protocols for surgical compliance and performing surgeries even when they are not required. Differences in opinions (between the patient’s doctor and the second opinion giver) and poor adherence to surgical guidelines across specialties are serious concerns. Such malpractice and monetization of medical services have led to second opinion services in many cities.
People have lost trust in doctors and are looking for ‘good doctors’ who are still human, knowledgeable and trustworthy. This loss of trust has led to people seeking multiple consultations, forcing them to spend more. The definition of a ‘good doctor’ has changed. In the past, a doctor with good training and diagnostic skills was considered a good doctor in his field and among the people. The criteria has shifted to owning a hospital, nursing home, clinic and diagnostic centre. The parameters are wealth, business and revenue. In this race, doctors have forgotten who they are. This greed has taken over the profession and forced them to become salesmen for the medical industry by partnering with pharmaceutical companies and diagnostic centres.
In 1938, Bertolt Brecht (1898–1956), a German playwright, poet, theatre director and physician, beautifully reminded us in his poem “A Worker’s Speech to a Doctor” that every doctor should read the following:
“We know what makes us sick.
When we are sick we are told
That it is You who will heal us.
When we visit you
Our rags are being torn from us.
And you listen over our entire naked body.
As for the cause of our illness
One look at our rags would
I’ll tell you more.
It is the same cause that wears out
Our bodies and our clothes.”
The silence on such malpractices by the Medical Council of India and professional bodies like the Indian Medical Association is a matter of grave concern. They need to come forward to tackle such malpractice. The unregulated loot and greed of the private healthcare sector is impoverishing people. Governments and regulators need to enforce stricter regulations to ensure transparency, accountability and ethical practices in private healthcare. This includes clear pricing policies, monitoring of medical recommendations and penalties for fraudulent practices. Only through these efforts can private healthcare regain its reputation as a trusted and essential part of the healthcare ecosystem.
The state should address the above and regulate the private healthcare sector. Strengthening and creating state-of-the-art government hospitals that can compete with private healthcare is another solution to address this problem in the long run. Bridging the gap between private and public healthcare systems through collaboration and integration can help address inequalities. Many government hospitals face issues of adequate funding, healthcare personnel and supplies that need to be addressed. Ayushman Bharat is a good initiative to provide medical coverage to the poor and the marginalized. However, the state should rethink Ayushman Bharat and reinvest its money to strengthen the government healthcare system and infrastructure to provide quality healthcare to all.
The author is a professor at Xavier Institute of Social Service, Ranchi. The views expressed are personal. Views are personal Email: [email protected]
