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‘A plus’ persons but ‘D minus’ citizens

Doctors are now routinely beaten up for death of patients ranging from swine flu to amniotic fluid embolism. A public sentiment against MBBS doctors has been created by sustained propaganda regarding:

Dr Neeraj Nagpal

1) Their not attending patient in time; (It took all of 11 minutes for patient to be attended in a recent case)
2) Their preference of favourite companies when writing drug prescriptions
3) Their role in sex determination
4) Their incompetence to save accident victim with major blood loss
5) Their kickbacks when using implants and stents

What is, however, hidden in the cacophony is the fact that if Government provides reasonable healthcare to its citizens free of cost or at nominal cost the need for expensive private healthcare would cease to exist. This, however, cannot be achieved in the miniscule amount of funds Government allocates to Health. Even this ridiculously low figure was further slashed 20% in 2014. These same doctors are not provided staff, protection gear like masks or vaccinations and drugs even when dealing with epidemics but these are issues, which are never heard.

The 11 minutes it took the Gynaecologist to attend to patient because she had to come to hospital from her residence would not have been needed if there were sufficient gynaecologists hired to provide emergency services by rotation. One gynaecologist cannot stay in hospital and provide services 24 hours a day 365 days a year. This, however, is not feasible within the budget allocated. It is so much easier to blame the walking speed of the doctor for the loss of life.

The drug company – doctor nexus and kickbacks in implants are made out to be the culprit for high cost of medicare. This assumes importance because medical care is availed by most people as out of pocket expenditure. Question which needs to be asked is why is MDR TB rising now that all anti-tubercular drugs are procured centrally by the Govt. Why many specialists and superspecialists even in premier Government institutions still prefer to use anti-tubercular drugs of various companies rather than place their patients on the Government provided free ATT. A recent report from J&K showed the Government procured amoxycillin as having 5% drug of the amount claimed in it. Since the doctors are the frontline troops when dealing with the public they give treatment which they have themselves faith in. Government policies do not promote indigenous production of implants and stents. Market forces will force all companies to slash their rates and commissions once even one company provides standard products at nominal cost. Basic issue still remains if the Government’s focus is brought back to health by allocating 4-5 times the current budgetary allocation to it, government hospitals will be in a position to provide superspeciality services at a fraction of market cost and this will slash costs of medicare across the board even in private sector.

The PCPNDT (Pre-Conception and Pre-Natal Diagnostic Techniques) Act is used as a tool to keep the medical professionals in check. Ultrasound is an important medical tool without which no hospital can function. Having power to seal the U/s machine the authorities at the behest of their political masters use this power liberally to browbeat already compliant doctors into further submission. It is again conveniently forgotten that this Act and harassment under it have not achieved any decline in sex ratios in the past two decades. What is needed is Government’s will to Act. If the Government for two decades would ban transfer of ancestral property to males the male/female ratio would reverse instantly and forever, because a social ill cannot be remedied by a bureaucratic pill of banning sex determination. The reason for adverse sex ratio is not sex determination on ultrasound but the pitiable status of women in our society. Without correcting the status we give to our women no method will succeed in reversing the sex ratio.

Government has abdicated its role in medical education and has passed on the responsibility to private medical colleges most of which are owned by senior politicians or their minions. Government has also officially equated competence of an AIIMS MBBS graduate with any AYUSH graduate from any institution in the country. It has therefore no business to talk about quality or competence of its MBBS doctors.

Hope someday we have a Government which allocates 7% or more of its budget to health, which has the political will to ban inheritance of property by males, and which brings back Indian Medical Service to free MBBS doctors from the bureaucracy they currently suffer.

Dr Neeraj Nagpal
Convenor, Medicos Legal Action Group
Ex-President, IMA Chandigarh

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