By Jhilmil Breckenridge:
Big Pharma rules everywhere. We are all pawns in this nexus of money, kickbacks, referrals and sleaze. Healthcare? You’ve got to be kidding! In this scenario, is it even possible to be an ethical doctor, Dr Maharwar asks.
“The Ethical Doctor”, released recently by Harper Collins, asks tough questions, presents heart breaking case studies, offers options and alternatives and suggests reforms in the healthcare sector as a possible way forward. Written by Indian doctor, Dr Maharwar, who studied in India, used the low cost colleges to get certified in Chandigarh, and then proceeded to a better life in England, where he now works as Consultant General and Bariatric Surgeon with the NHS, this book is an attempt to give back a little to his homeland.
Dr Maharwar is clearly bothered enough to write a very clear and compelling read opening our eyes, as consumers, to the realities of hospitals, state medical boards, so-called professional alliances and boards, chemists, ultrasound clinics and pathological sample collecting centres, and of course, doctors. Those people in white coats who have all the authority, those people in white coats who demand our trust, those people in white coats who are supposed to care.
The reality is far from this.
And while you begin the book, with a deep hatred for these doctors, thinking they are the villains of the piece, as the book progresses, you begin to see their helplessness. A doctor who begins his profession, idealistic and well meaning, will soon succumb to the pressures of healthcare representatives, tie-ups for kickbacks with other clinics and healthcare providers, and will allow himself to be lured by luxurious conferences and more because he will soon realise, if he wants to make a living and provide for his family, he will have to join the system.
A system that is highly patriarchal, highly exploitative, where the only thing that matters is the ‘cha-ching’ sound that coins make, is beautifully portrayed in the cover image with a stethoscope hovering over a stack of coins.
And ethics? Well, those are shed as you step out of medical school and put up your name on a board announcing your practice.
The author rewrites news into compelling case studies which read like well written fiction. If only that were true. He writes about Samastipur in Bihar, where the sex ratio is an alarming 909, as compared to 940 per 1000 women which is India’s, far lower than most of the developed world. In 1992, Nobel Laureate Amartya Sen refers to this shortfall in the number of women as “missing women” in excess of 25 million. Surely this number should haunt generations of Indian doctors, or should we call them murderers, abetting murderers in the wombs of hapless women?
Dr Maharwar describes a uterus scandal at Samastipur through the story of Sunita, a poor woman eking out a meagre existence with her husband and three children on a tiny piece of land and a small 10 feet by 12 feet hut. Sunita goes to see Dr Goyal for heavy periods and abdominal pain, naively trusting that the tests and ultrasounds he would prescribe would actually help her. With absolute authority, Dr Goyal announces she has cancer of the womb and needs an operation that very day! Grateful Sunita goes under the knife in a few hours, after all, she has a government scheme smart card, and who would look after her three children if something were to happen to her?
Samastipur was just one of the districts where large payments were being made for this sort of operation called a hysterectomy, a total removal of the womb, to an ambitious health insurance scheme. Gullible women were conned into thinking they had cancer or some other life threatening illness and that they needed immediate surgery. Sadly, an insurance scheme that was meant to protect consumers became the very instrument of their exploitation.
The book continues to shine light on other scams: organ donation, surrogacy, guinea pigs for medical trials and more. As you read, you feel you are living in a sort of draconian, science fiction, alternative reality world, and anything could indeed happen. The book is a roller coaster of facts, intelligently argued theories and the author’s views as he exposes one myth after another — cuts and commissions, completely unnecessary treatment and tests, Big Pharma and medical representatives, touts, professional bodies, private hospitals, the public sector and more.
In his author’s note as a preface, Dr Maharwar rues the fact that life deals us a set of cards, that we live in a society and systems that make the rules, and we have no option but to play. Of course, declining values and corruption is at the heart of most that he describes, but he suggests a time has come to take stock, introspect, evaluate and think of possible ways ahead. The last few chapters of the books do offer some reforms and an overhauling of the Medical Council of India and various other regulatory bodies. Dr Harsh Vardhan, Union Health Minister, in June 2014 said, “For a long time, the Medical Council of India has been a big source of corruption… instead of strengthening the components of medical eduction, it has weakened it.”
Although population is always quoted as the reason India’s systems, not just healthcare, are such a mess, this is far from true. Policy reform is needed everywhere and population is not the culprit. “The healthcare mess in India is a failure of policy,” says Dr Gita Sen of IIM Bangalore. From the role of the media, consumers, advocacy, patient complaint cells to many other small and big changes, Dr Maharwar offers several ways we can start. Let’s start anywhere, but yes, let’s start. It is time to start following the amended Hippocratic Oath, adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland: “I solemnly pledge to consecrate my life to the service of humanity. The health of my patient will be my first consideration.”
Let’s just start. Patients are losing their patience. And this is not a humane world for them.
Overall, the book is easy to read, well argued and is a must read for the layperson but it is not targeted at doctors or the medical fraternity.