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Sunday, April 20, 2008

The circle of life and everything in-between….

Life by no means is a perfect circle. It is not even close to the circles I churned out when I got a grade “C” in geometry while in school. I am sure you would have figured out by now, but my math was as good as my knowledge of the Latin language.
In this circle of life is where “Murphy’s Law” plays its part in many ways and circumstances. It may be career, finances and loads of other problems known to mankind, which more often than not do have preventions and solutions if worked with a diligent mind. But the main obstacle which is almost impossible to overlook is the one concerning health issues. Well, this is where my audience, the part of the “Health Care Sector” shows out its ugly face behind a kind and smiling mask.
As a professional in the health care system, I always wondered the way corporate hospitals run the show and their sustainability strategies. I see my share broker friends investing heavily on the health sector as it yields high dividends and gives more value on selling them. I could never imagine the corporatisation of the health profession. Doctors I agree are not here for charity although a small section of them still do it for saving the grace of this so called “Noble” profession. Doctors also have mouths to feed and families to care and provide for. The point I want to make here is the question of ethical practice, where the intention is to benefit the needy more than making them crib and ponder over the costs incurred.
I would like to narrate an incident where a cousin of mine in India landed up at a fancy corporate hospital for a broken leg. It demanded surgical intervention and rightly so. But the bigger shock was the manner in which the bill for the expenses was generated. Although she was taken into the operation theatre only once and the surgery was performed at a single go, the different procedures of the surgical treatment were billed as three distinct surgeries. Although the anaesthesiologist, the surgeon and all the support staff played their part only once, the bill presented to her categorically stated that each of them be paid thrice! So the surgery cost went up by three times flat. This was an intriguing situation for her and she demanded an explanation for this. The reply given to her was that the insurance is paying for it, and why should she care as to what the bottom line reads? This is just one off real life example I have narrated. Other actions of prescribing an expensive drug because the company would give the doctor a fat payback when cheaper alternatives exist and unnecessary diagnostic procedures to recover the cost of expensive equipment are a few.
Now this opens up a whole new debate about these insurance companies. Since the insurance companies know that hospitals are going to manipulate the costs, they raise their premiums and add a few hundreds of clauses which have an explanation to every tricky question even Einstein could come up with. To augment the agony and to suck the policy holder silently but yet efficiently are the numerous hidden costs behind the Great Wall of China where it is virtually impossible to even imagine that a whole new equation lies behind it. I always wondered why business graduates from premier institutes were paid so high. Does it answer the same question which I am thinking about now?
Well the argument about whether the chicken came first or the egg still persists and it is hard to point a finger at one particular area. But the truth lies in the fact that the general public is getting ripped off their valuable and hard earned money due an unethical system which exists in our country presently.
Here is a situation where we see a vicious cycle of rising costs of insurance and health care expenditure. Health care to a society is one of the main issues which can make or break an economy and a nation. The human resource is one of the most important and strategic resources for a country like India where growth is driven by knowledge processes. With an unethical health care sector, the percentage of people who can afford quality health care is limited. Like medical education and most other needs which has become a luxury only for the rich, it alarms me that health care is also taking the same direction and its effects are already been felt.
Is there a way out to this? Not that I can think of at the moment. As a health professional, the only part I can play here is to endorse ethical practice and not to make my Hippocratic Oath in my graduation gown a formality for nice pictures. The vicious cycle has to be intercepted at some place and why not start from us.
Health care is a delicate and emotional area where hard core corporate rules of making more money and attracting a large number of share holders should not be the ulterior motive. Increasing volumes that have access to genuine care and making it affordable should be the goal. Churning out profits through legal and ethical means should be the path we should resolve to take.

Doctor 1- “Dr 2 bought a Mercedes Benz last week; I am still driving my 1 year OLD Skoda. NURSE! [He shouts], is that medical representative from the MNC drug company representative outside? Send him in and tell the patients to wait……..

4 comments:

ckbelludi said...

Hey Doc,
Good that you opened up this topic. After having stayed in a medical college and its attached hospitals for around 6 yrs, I too have had enough confrontations with the other side of this so-called 'Noble' profession. The profession has gone to dogs and it's unfair to think of an overnight change for good. That's not just improbable but impossible too. Here's how it is.

Let us say we come up with a strict Law enforced in India that bans all the unethical practitioners from practising medicine; I know, this is even more impossible in a country like ours that is run by "Professional Politicians" but for theoretical discussions, let us assume it to be so. 95% of the present day doctors will be banned from practice, if such a thing happens. In India, where the doctor-patient ratio or the doctor-population ratio is sky-high, banning the 95% of the doctors would immediately manifest with appalling no. of deaths! That way, the doctor-population ratio will be brought back to normal (not by increasing the no. of doctors, but by decreasing the no. of patients!).

As far as your cousin is concerned, ask her to be happy that at least she got her leg repaired, let alone what it costed her! You can't expect anything more from the existing health care system. Sorry to say so, but that's a fact and has to accepted.

Teju said...

Hey chinnu..

Hate to admit, but this is really true..unfortunately every word is true.

Unknown said...

hey chinnu.. very well written..its soo true..

Amogh Masur said...

Ever heard the line 'And thats the way it goes'? It refers to a chain of events that causes a particular result. In this context I mean the politburo, Insurance Agents and Companies and last but not the least the HealthCare Provider. these are all actors performing on a very big scale. Why? Because all stand to make money. How? As you rightly said, overbilling and expensive premiums. The politburo makes apalling laws, the insurance agents milk the Insured through premiums and the HealtCare provider by over-billing the Insurance Company. The Insurance Company by adding additional amounts to existing premiums because the Insured 'cannot take proper care' and is careless which is reflected in the bills being charged.
Let me give you an example of the medical law of our country. They come under a division called Law of Tort, which governs all Civil Wrong Doings. Medical mishaps are a civil wrong doing. Being a Law student I have read many case laws regarding Medical Jurisprudence and in so many cases the Doctor would have clearly screwed up the patient but is saved by a very important line which allows for such mishaps, which roughly goes like this - If the act done is that which would be done by a prudent man under the said cirumstances than such Act ahall be pardoned. This is the Law of our country and would have been perfect for say 20 years back. Not now in this age of super speciality and super perfect instruments.
And that is the problem in my country. The laws have not changed to suit a Newer, Younger, more Aware, Space Age generation. Nor have the politicians. The only way forward is to commit to YOURSELF that
i) You will abide by the rules.
ii) You will be the change that you want to see.
iii) You will make an effort as far as possible to educate the unlearned about their rights and share.
iv) Do it with Care.
This, I think, is the way forward.

and Chinnu thaks for putting my mind to work again. :-)
(Do it more often please.)