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Follow professional ethics, doctors urged #SJ #Aamir Khan

Aarti Dhar, The Hindu, June 13

Aamir Khan’s “Satyamev Jayate” has drawn sharp criticism from Indian Medical Association

Taking forward the debate on commercialisation of , initiated by actor Aamir Khan in his television show “Satyamev Jayate” that drew sharp criticism from the Indian Medical Association (IMA), activists have said distortions in medical practices, induced by unregulated commercialisation, have become systemic problems.

In an open letter to the IMA, which has sought an apology from Mr. Khan for “maligning” the entire profession because of a few errant doctors, the Medico Friend Circle (MFC) and the Forum for Society (FMES) have sought self-regulation by medical professionals and active involvement of citizens in the process, than bureaucratic regulation, to ensure rational care and patients’ rights.

‘Uphold dignity of medical profession’

They said: “We very much appreciate that you want to uphold the dignity of the medical profession. However, we feel that denying or minimising the importance of the issues raised by the show and demanding an apology fromAamir Khan is definitely not the most appropriate way of upholding the dignity of doctors. Instead, the IMA should seriously try to reverse the process of health system reforms for eliminating the distortions in medical practice. This would be immensely beneficial to patients and would also raise the dignity of the medical profession manifold. Instead of ‘silencing the messenger,’ we need to listen to the main message of the show and take steps to address problems which are very real.”

The letter raised questions on cut practice and commissions, irrationality in investigations and surgical practices, influence of the pharmaceutical industry on doctors, and inflation of patient bills as a consequence to all these practices.

“This has resulted in massive problems related to both cost and quality of medicare for people. Besides the evidence from various studies on Caesarean section rates, injection practices, prevalence of hysterectomies and sex selective abortions are admitted to by most practicing doctors, and are not limited to a few isolated individuals,” the letter said.

“As good physicians, if we go beyond addressing the ‘symptoms’ and make a ‘comprehensive diagnosis,’ it will be obvious that all these disturbing features are due to a system of unregulated commercialisation of medical care, which has emerged over the last few decades.

Large number of discontented individuals, doctors as well as ordinary citizens, need to come together and start changing this system through a large scale social process,” the MFC and FMES said.

*An open letter to office bearers of IMA*

To,

The National office bearers,

Indian Medical Association

Dear IMA office bearers,

We are writing this letter in context of the apology recently demanded by
IMA from Aamir Khan, regarding the episode on 27 May 2012 of his show
‘Satyamev Jayate’ (SJ) dealing with certain practices of the medical
profession. We write to you as members of Medico Friend Circle (MFC,
www.mfcindia.org) and Forum for Medical Ethics Society (FMES). MFC is a
nation-wide 39 year old platform of pro–people doctors and health
professionals, scientists and social activists, involved in improving
health care, especially for the deprived sections of people. FMES is an
association of doctors and health professionals which has been actively
campaigning for reform in the healthcare system and medical education, and
has been publishing the Indian Journal of Medical Ethics since 1995.

We very much appreciate that you want to uphold the dignity of the medical
profession. However we feel that denying or minimising the importance of
the issues raised by this show and demanding an apology from Aamir Khan is
definitely not the most appropriate way of upholding the dignity of
doctors. Instead, IMA should seriously try to reverse the current
widespread unregulated commercialisation of health care in , and
should contribute to the process of health system reforms for eliminating
the distortions in medical practice. This would be immensely beneficial to
patients and would also raise the dignity of the medical profession
manifold. Instead of ‘silencing the messenger’, we need to listen to the
main message of this show and take steps to address problems which are very
real.

We would not go into the details of the content and form of this show. We
would rather point out that the critical issues raised regarding cut
practice and commissions, irrationality in investigations and surgical
practices, distorting influence of pharma industry on prescribing by
doctors, and inflation of patient bills consequent to all of these, are
extremely widespread. This has resulted in massive problems related to both
cost and quality of medical care for the people. There is no point in
dismissing these issues as just being related to a few ‘black sheep’ in the
profession. Besides the evidence from various studies on cesarean section
rates, injection practices, prevalence of hysterectomies and sex selective
abortions etc., most practicing doctors admit in private that malpractices
are a pervasive trend, not limited to a few isolated individuals. In
fact *distortions
in medical practice induced by unregulated commercialisation have become
systemic problems*.

Given this reality, let us move beyond the ‘few rotten eggs’ type of
defensive arguments focussed on individuals, and look at the systemic
problems which include-

· Astronomically high ‘donations’ charged by mushrooming capitation fee
medical colleges are a major influence which is pushing crass
commercialisation of medical practice, besides placing medical education
beyond the reach of many deserving poor and middle class students.

· Widespread cut practice, intense competition and defensive medicine
are causing dissatisfaction among many doctors, not only their patients.

· Pressures are imposed on doctors by hospitals, inducing them to advise
more than necessary investigations, procedures, intensive care admissions,
hospital stays.

· There are continuous tensions between doctors and patients over
payment issues, and even occasional outbreaks of violence against
hospitals.

These are serious problems going beyond just a few individuals, which are a
product of the increasingly commercialised, market oriented nature of
medical care in India today.

As good physicians, if we go beyond just addressing the ‘symptoms’ and make
a ‘comprehensive diagnosis’, it will be obvious that *all these disturbing
features are due to a system of unregulated commercialisation of medical
care*, which has emerged over the last few decades. Instead of being
foremost healers and protectors of their patient’s health, doctors are
increasingly forced to become hard-nosed businessmen, often in order to
repay large scale loans, to ensure their practice, and to remain ‘in the
system’ despite the fact that many would not have liked to depart from
their principles. In this situation, the increasing numbers of ‘black
sheep’ (and much larger numbers of ‘grey sheep’) are the inevitable
products of this system. Of course there is a role for individual
responsibility, but such an entrenched system cannot be changed just by
giving moral science lectures to individual doctors, by asking them to
follow rational principles in isolation. Instead of this, large numbers of
discontented individuals, *doctors as well as ordinary citizens, need to
come together and start changing this system through a large scale social
process.*

Of course, commercialisation and linked distortions are seen in all
professions. But doctors’ organizations are best placed to reform the
medical profession and health care sector, thereby contributing to wider
social reform. In fact IMA’s stated objectives include “improvement of
Public Health and Medical Education in India”. Hence we would suggest that
instead of rubbishing the SJ episode and ignoring its main message, IMA
should treat this as a ‘wake-up call’ for the medical profession as well as
for wider society, and we should all start a process at two levels. We need
to initiate *social regulation of medical practice* (which would include
elements of self-regulation by the profession and active involvement of
citizens, not just bureaucratic regulation) to ensure rational care and
patients rights. Further linked to this, we need to move from a
market-centred model of health care, towards a *socialised system of
universal health care*.

This letter will not go into details of how such social regulation of
medical practice and further, a system for universal health care (UHC)
might be developed in India, which could ensure decent and secure
livelihood for all doctors (though not super-profits for any!) and access
to good quality, free health care for all residents of the country. IMA
office bearers would be aware of UHC systems which are successfully working
in a wide diversity of contexts: developed countries like Canada, Australia
and Scandinavian countries, as well as developing countries like Brazil and
Thailand. Of course we will need to evolve a UHC model that is appropriate
to Indian conditions which will require broad based debate and inputs from
all stakeholders, especially from the medical profession. This process
has already been initiated by the High Level Expert Group on Universal
Health Coverage (HLEG-UHC) appointed by the Planning Commission, which has
published a detailed report which would be taken into account while
developing the upcoming 12th Five year plan. We may differ of the details
and specifics of the model, but we need to accept that Universal Health
Care is now emerging on the national agenda, and we should all start
engaging with this process.

Such a UHC system would eliminate widespread commercialisation, cut-throat
competition and insecurity among the majority of doctors, while ensuring
them a decent income and basic security. The price of not moving towards
such a system is colossal, not only for patients from all classes of
society, but also for the vast majority of doctors who would like to
practice their profession nobly and rationally, but are being sucked into a
money-centred system which trumps humane principles and rational practices.
The potential rewards of such an alternative health care system would be
similarly enormous for our entire country of 1.2 billion people, including
our doctors who could once again become respected and honored
professionals, instead of presently being often viewed by people with
suspicion and even resentment.

In short, the time has come to do some genuine introspection and
alternative thinking, and to address the widespread problems instead of
denying them. On the lines of the call for ‘Physician, heal thyself!’, the
time has come to say – ‘Physicians, heal thy system!’

Yours Sincerely,

Executive committee, Medico Friend Circle

Managing committee, Forum for Medical Ethics Society

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