Indian health care needs strong prescription to cure its ills

Last week, I met the best and worst of Indian doctors. I had to rush to the Punjab because my 92-year-old father was in intensive care. A cocktail of ailments forced doctors to put him on a ventilator. The neurosurgeon told me an MRI would be necessary to see if the brain had been damaged because he was neither speaking nor moving. However, as my father came off the ventilator, he began to regain his senses and the neurosurgeon cancelled the scan.

At the other end of the spectrum, a spinal surgeon had earlier diagnosed him as suffering from lumbar spinal stenosis and urged surgery. Spinal surgery on a frail old man?

In India, as the controversy over corruption in the medical profession snowballs following a scathing article in the British Medical Journal, it is the latter kind of doctor who predominates, the kind who puts patients through unnecessary diagnostic tests and procedures.

The article, by Dr David Berger, an Australian doctor who worked for six months as a volunteer in India, described how kickbacks are routine. He spoke of “needless” deaths. Dr Berger’s experience merely confirms what many Indians have long suspected: that X-rays, MRIs, CT scans, ultra-sonographies, and ECGs are routinely prescribed for patients who did not need them.

For years, they have read horror stories about unwarranted hysterectomies, stent procedures and appendectomies being carried out. Darker still, they have heard of doctors in private hospitals being given “quotas” – the amount of revenue they need to generate every month.

For every patient, this unethical behaviour is unacceptable. For poor Indians, it is a calamity. Fear of a serious illness in the family keeps them awake because they know it will ruin them financially.

The suicide statistics for 2013 show that 72 Indians kill themselves every day due to illness, the second largest number after the 89 who kill themselves over family problems. My hunch is that many of them committed suicide because of concerns over debt caused by their illness.

To inflict unnecessary medical expenses on the poor is a huge betrayal of trust. The poor are not even familiar with the concept of getting a second opinion; they revere and trust their doctor.

Corruption in the medical profession is a global challenge but given that corruption generally can be found in the tiniest spaces in India, it can safely be presumed it must be a whole lot worse here. Transparency International has found that the health care sector in India is the country’s second most corrupt institution, after the police.

Fortunately, the British Medical Journal has launched a campaign against corruption in medicine which will begin with a focus on India in the belief that if it can be reduced there it can be reduced anywhere. This is a reasonable assumption given that corruption in India extends to the stage where some medical students give bribes to get into medical school and later to pass their exams.

Dr Berger’s article has struck a chord, even though it’s a shame that it took an Australian doctor to wake people up. It’s a good time to tackle this corruption. India has a new government, swept into power on an anti-corruption wave. It seems inclined to act rather than merely talk.

For a start, it needs to provide regulatory oversight of both the private and public sectors. It’s shocking that there has only been self-regulation for so long. Without specified standards and codified guidelines on professional behaviour, no accountability is possible and no punishment for those who break the rules.

A national watchdog would be useful, a place where patients and relatives can go for an expert decision on their question, or where people can report bribe-taking and unethical behaviour by a doctor.

The Medical Council of India must strike off any doctor who is found guilty of this sort of misconduct. Its existing Ethics Committee has been lax and its current director cannot even say how many doctors have been struck off in the past, if any.

And of course a campaign to make the public aware of this danger would be hugely helpful. At the moment consumers do a doctor’s bidding blindly; replacing blind trust with reasonable doubt would be a small but important start in changing the doctor-patient relationship.

Thanks to his good doctors, my father is out of intensive care and even moving around. Had he gone along with the doctor who wanted to poke around in his spine, he would have been bedridden, at best. What’s worrying is that the happy outcome was purely down to chance. That needs to change.

Amrit Dhillon is a freelance journalist in New Delhi