B L Razdan
The recent incident in a Kolkata hospital involving two interns who were beaten up by a mob following the death of a patient has led to doctors in several hospitals across India agitating for security. While the violence on doctors must be condemned in unequivocal terms, there is a growing lurking feeling among the public at large that doctors are no longer what they used to be and that greed for money has led to general apathy among the medical practitioners. Even in this case, the patient’s relatives were of the opinion that the death was because of doctors’ negligence. “India is said to have one of the most corrupt medical systems in the whole world. The situation has become so bad that patients today approach doctors with mixed feelings-of faith and fear, of hope and hostility”; writes Vijay Mahajan in an article titled ‘White Coated Corruption published in the Indian Journal Of Medical Ethics’. He offers details showing how greed for money and utter callousness afflict a large section of the medical profession. While there are many upright doctors, no doubt, others have no ethics, some heartlessly fleecing patients, prescribing unnecessary drugs hand in glove with the pharmaceutical companies, performing unnecessary operations, and even indulging in the illegal organ trade. No wonder that a large section of Indians are fast losing respect for doctors and a few even resorting to violence against them as has been the case recently.
The Pharmaceutical Lobby is very powerful across the globe, as we all know. It is not happy even with 100% profit. It wants Rs. 100 or even more for every Rs. 10 worth investment. No wonder, they have adopted ways and means not only to scare potential patients but have also successfully punctured the conscience of many a health practitioner, who, ironically are bound by Hippocrates Oath but have jettisoned it for economic gain since long. No wonder, the Government had to step in and reduce the prices involved in stents and knee replacement. Some 26 years back my own mother developed increased heart rate and I took her to AIIMS where a specialist examined her and recommended angioplasty. A friend of mine recommended a private doctor, who was rather doing fabulously well in an up market locality. When I took my mother to him, he recommended a pace maker. I was rather baffled and when he asked me the reason, without any hesitation I told him about the earlier recommendation. I could sense his discomfiture; but then he told me to consult one Dr Mehta who practiced in USA after having served in London for 10 long years. Dr Mehta was in India to attend an International Cardiology Conference being held at the Taj Mansingh Hotel in New Delhi. When I asked him how I could fix an appointment, he offered to do that but told me that I shall have to wait upon him on the day when he would be visiting his mother in Noida and that he would let me know the date also. On the date communicated by him I took my mother to Noida and went to Dr Mehta’s mother’s residence at 6.00 p.m. sharp along with all the test reports including the Holter record. Dr Mehta turned up at 10 p.m. and was a bit taken aback that I had waited so long. Spending just 5 minutes in wishing his mother, he saw the reports and simply trashed them both. He wrote a prescription and asked me to tell the private practitioner to give an Indian version of the medicine if it was not available here. The next day I went to thank the private doctor and he gave a medicine and told me to adjust the dose corresponding to the palpitation and bring the mother for checkup every ix months. My mother lived 20 long years thereafter and expired at the age of 92 very peacefully in early morning apparently not because of any heart problem. Of course, we were lucky to have Dr Mehta by chance. If we were to follow either of the two earlier doctors, one Government and one private, I am sure she would not have survived. Misdiagnosis would have led to complications, which would not have been addressed properly, as happens often. I discussed the story among my friend circle and they told me there was a huge cut the doctors used to get on pace makers and hence the earlier recommendation of the private practitioner. Obviously we are easy targets of greedy doctors.
Some years back I had the occasion to read New York Times which had reported that the Government of USA had saved billions of dollars by constituting a committee of experts to recommend how the huge piles of pharmaceutical inventories of US defence forces should be dealt with. The expert committee recommended that most of the medicines had not expired by the date mentioned on the foil, etc. and that barring a few medicines, most of these were equally potent and effective beyond that date also and that the US defense forces could use them without any risk. The expiry date has been invented by the pharma lobby who want to profit even as the defence budget would incur loss. The malpractice has spread the world over.
Over 10 years ago I had myself developed a slight occasional pain in one of my knees. One day my wife had a small fracture in her foot and we went to the orthopedic. After getting her x-rayed and prescribing her medicine we were about to leave when my wife recalled my knee problem. The doctor quickly suggested an X-ray and also had it done in no time and told me that my knee bone had become very week and gave a huge prescription with advice that I should visit his physiotherapist every alternate day and that he would watch the progress every week. It was a worrying night I would rarely spend. In the morning, I went to the Park for my morning walk and shared my problem with some elders of the bureaucratic fraternity, when one of them almost chided me to have gone to the doctor with the petty complaint. He had noticed that instead of the usual 5 rounds, I was taking only two rounds of the park and according to him that was the cause of my occasional pain. His prescription, “Restore the original walk – length and time – both. And here I am doing fine after having trashed the orthopedics’ prescription 10 years ago.
Frankly, I avoid going to doctors lest they invent an ailment where there is none. At 70 I am without blood pressure, blood sugar and blood cholesterol. God’s grace of course, but distance from doctors also seems to have helped.
My revered friend Gautam Kaul narrates, “Two years ago when I fell ill in Singapore and was admitted for 5 days in the city’s general hospital, The MS on her round told me ‘you are a victim of your doctors’. You have lacto acidiosis. This is due to over drugging and doctors have not corelated their prescriptions. We will put you on saline drip and no drugs for you. At that time I was taking 8 tablets plus Insulin per day. For the first three days I remained on saline then on 3rd day evening I was given one third of the Insulin doze and the next day it was made half of the original doze. My metformin was reduced to half and then I was discharged on the fifth day.. Parting instructions were, if you live in India, take half of the prescribed dosage, you will survive.”
To regain social respect, doctors must remind themselves of their Hippocratic Oath and develop a spirit of service, empathy, and a bit of sacrifice, as exemplified by the life of Dr. Dwarkanath Kotnis. The uncle of Gautam Kaul, Dr Madan Lal Atal, also a nephew of Pt. J. L. Nehru, was with Dr. Kotnis till his death. I reproduce below excerpts from an account of his death written by his Chinese wife Guo Qinglan:
“On 27th November 1937, at the suggestion of an eminent American correspondent Agnes Smedley, Zhu De, Commander-in-Chief of the Chinese Eighth Route Army, wrote a letter to the Indian National Congress leader Pt. Jawaharlal Nehru expressing gratitude for supporting the anti-Japanese struggle of the Chinese people and requesting… a medical team from India. Consequently Pt. Nehru proposed that a Medical Mission be sent to China…Dr. Kotnis, who had qualified as a doctor from Bombay Medical College, joined this Medical Mission. He went to Sholapur, his home town, and told his family about it. At this, his brother Mangesh said, ‘For the sake of our education father had to borrow a lot of money. Now our parents are old and need a helping hand.’ However, when his father saw that he was adamant, he said, ‘So, Dwarka, you have decided to go. I would like to remind you not to let the Indian people down. Since you have decided to go, you must do a good job and good things to the Chinese people, and win laurels for your family and country.’
“In September the team of five Indian doctors went by ship to Hong Kong. They travelled then to Chongqing. There Dr. Kotnis received a letter from his brother in India, which said, ‘Father has passed away suddenly.’ This was a bolt from the blue and he could not stop crying. His colleagues tried to persuade him to go back to India, but he said he will never let his father down and the best way to commemorate him was to help the Chinese people eject the Japanese invaders. So he continued with the Mission to Yenan, where they lived in caves. They spent the next four years treating the wounded and the sick Chinese.
“During these four years Dr. Kotnis had overloaded himself with work for a long period until his health completely broke down…He went without food and sleep for long periods and endured extreme pain during this period and sacrificed all he had till his last breath…
“On 8th December [he] suffered an attack of epilepsy… At 8pm he went to his room to be with me and our 108 days old child. As he was talking he remembered that the younger brother of his landlady was seriously ill. He went there to treat the patient and returned after two hours totally exhausted…At midnight he asked me for some boiled water as he was thirsty. An hour thereafter I was suddenly awakened by the groans of his pain, only to discover that all his four limbs were severely twitching. His complexion had turned pale. He had suffered another attack and it was serious. A senior doctor was called and he gave him morphine and camphor liquid, but to no avail. The doctor then tried spine puncturing, but it was of no use. Dr. Kotnis breathed his last at 6.15 a.m. on 9th December 1942…He was just 32 years old. He had spent over four years in China during the War of Resistance against the Japanese, treating the wounded and sick Chinese.
“The sudden demise of Dr. Kotnis left everyone in Tang County in grief and even the Tang River wept. The people in the county felt they were rendered orphans. An atmosphere of grief shrouded the entire valley. The villagers of the Ge Gong valley came to our place from all directions. Everyone who came was crying in the streets and in the courtyard, where his body lay.
While I understand that it will be expecting too much that our doctors follow the example of Dr. Kotnis, they can at least be like the doctors I chanced to befriend on my first posting in Mumbai way back in 1978, as I T O incharge doctors; Dr Shashikant Naik, who had always a long queue before his clinic as he charged only Rs.5 as fee and would waive even that if the patient could not afford and his pathologist wife, who similarly do her job. Others that come readily flash my mind’s eye are Dr S N Bhagwati, the renowned neuro-surgeon, who, though a private practitioner, would visit the Government J J Hospital to take care of the poor patients; Dr Faroq Udwadia, the famous cardiologist who believed in a lot of charity, Dr Shankari, the famous Gynecologist with nimble hands at Nanavati Hospital, Dr P B Pai Dhungat, who told me that he could not sleep unless he would take night round of all his patients before hitting the bed; and many others who respected both the patient and the profession. And here too we had one doctor (name withheld) who used the occasion of the 100th birthday of his mother to launch preventive health scheme, when I had remarked, “You don’t seem to be satisfied from the earnings from the sick, you want the healthy ones also to add to your kitty.”
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