You don't need to be a statistician or an expert in matters pertaining to healthcare to know that the perception of doctors in Indian society has undergone a dramatic shift in the last few decades. Once regarded as angelic, saint-like figures in the eyes of society, doctors are now seen as mercenaries who are only interested in fleecing the ill and afflicted. And it's not just the perception that has taken a blow—the rising trend of violence and attacks on doctors has shaken the very foundation of the medical profession in India. In this scenario, innocent doctors as well as patients are suffering.
So, what's actually wrong with healthcare delivery in India? Being a doctor myself, it makes me happy to see that many of my colleagues have taken to the pen not only to air their grievances but also to establish a soulful communication with the public at large, in an attempt to address the issues that are damaging the doctor-patient relationship. The Ethical Doctor, authored by Dr Kamal Mahawar is an outstanding attempt in this direction.
Mahawar dissects the grim side of the medical profession in India, expounding on practices like kickbacks, unnecessary treatments and referrals, and the unhealthy nexus between doctors and corporates...
My first impression about the book has been that more so than doctors, it's the lay public that needs to peruse this work—and that's where I feel the title of the book somewhat downplays the seminal work it actually is.
In this work, Mahawar sets sail with a discussion of the traits of an ethical doctor as set by the Medical Council of India (MCI), and quite convincingly brings out how some of them are downright impractical and overly idealistic, while many others are gravely destitute of implementation and observance. Mahawar then dissects the grim side of the medical profession in India, expounding on practices like kickbacks, unnecessary treatments and referrals, and the unhealthy nexus between doctors and corporates that has tainted and debased the profession. From here, Mahawar has been diligent at gradually leading the reader up to the bigger picture of our problems—the blemishes in our private and public sectors, the ineptitude of our policies and regulations, and finally, the frail backbone of our healthcare constituted by subpar medical education and research. The author also needs to be congratulated on his success in providing a complete and balanced account of present day healthcare challenges while also keeping the prose light, crisp and highly readable. With his style, Mahawar brings to life subjects that are usually monotonous and flat to read through.
A standout feature of this work is that the author has struck a beautiful balance in telling both sides of the story. While the unfortunate suffering of patients at the mercy of the system is well documented, Mahawar has effectively portrayed how the well-meaning, upright doctor of today is no less of a victim and is helpless in the face of the reprehensible pressures saddled on him. Healthcare is a shared responsibility with many key players, and the doctor is just a spoke on the wheel. This is an area where I personally feel a lot needs to be done today. The book also conveys the voice of a reasonably honest doctor, one who is keen for a better tomorrow for both himself and his patients, and is not afraid to launch a witheringly critical attack on the wrongdoings of his own clan. Unlike a lot of literature on doctor-patient relationships, the book exhibits no skew towards the healthcare provider, which makes it even more promising as a tool to set things right.
Mahawar has effectively portrayed how the well-meaning, upright doctor of today is no less of a victim and is helpless in the face of the reprehensible pressures...
Mahawar has adopted a very pragmatic approach while prescribing solutions to problems—from revamping and reconstituting the Medical Council of India (MCI) to allowing some freedom (and thus some accountability) to our babus and bureaucrats. Of special interest in the context of violence against doctors is the simple and basic idea of opening up a "patient complaint cell". I myself, in some of my earlier write-ups elsewhere, have tried to highlight that patients find no one to listen to their grievances which often, out of desperation, translates into assaults on the healthcare provider.
Sadly, however, the current state of our political organization renders many such practical suggestions to be a long shot; some seem downright far-fetched. How do you cultivate ethics in a political system? One way is to bring upon a colossal philosophical and moral revolution—which is a hilarious idea considering the age we live in today. The only other way is to build a closed-loop system wherein the public is answerable to the government, and the government in turn is obligated to be answerable to the public. Since we all want others to be ethical with us, such a system with mutual co-dependence is the only way to create an ethical society. A perfect democracy is always such a closed-loop system, and it's us, the very people, who have collectively made a mockery of it. Our lack of awareness, unity, and active involvement in our democracy has turned it into a system where all power flows from the government to the public—where the regulator assumes a superior, sacrosanct status. I'm afraid that until we realize this, many honest attempts to foster change will be in vain.
I congratulate the author for coming up with this brilliant work and I fervently hope it will nudge minds in the right direction.