*Date:25/05/2008* *URL: http://www.thehindu.com/thehindu/mag/2008/05/25/stories/2008052550140400.htm * ------------------------------ <javascript:history.go(-1)>
MEDICAL ETHICS * The moral decay * DR. UMA KRISHNASWAMY The way the medical education system is set up, it's a miracle if a graduate comes out of it with her sense of ethics intact. Is there a way out? ------------------------------ The prices are crippling to say the least. A post graduate seat in Radiology may sell at about one crore rupees in the private sector. ------------------------------ PHOTO: VIVEK BENDRE * Vicious circle: Students protesting high medical college fees in Maharashtra. * The pervasive lack of ethics within the medical profession is no longer a matter of speculation. It is a fact of life in India. One needs only to read the newspapers or watch television news channels to be assailed by sensational crimes committed by doctors singly or in collusion with other individuals or institutions: kidney thefts, cyber crimes, immoral trafficking of women, female foeticide... In the face of such appalling crimes, medical insurance frauds, the issue of false medical certificates, self-promotional advertisements etc. seem to pale into insignificance. Gross violations of the medical code of conduct or even common decency are run of the mill events in Indian medical practice. The more insensitive among us ignore them and the more corrupt among us revel in them as an opportunity to wealth and fame. Practical difficulties Professional organisations, while deploring the general deterioration in standards, can do very little. The difficulty in securing cast iron proof of wrong doings, a reluctance to ruffle political feathers, silencing disgruntled patients with out-of-court settlements, the diffidence of most doctors to speak out against erring colleagues, all lead to an impasse. Not to mention the fact that regulatory organisations are hampered by outdated and toothless rules and regulations. What is worrying is that all of us, both patients and doctors alike, accept that this level of moral decay and degradation has come to stay within the Indian medical profession, not withstanding the fact that there are many decent and competent professionals who tirelessly strive to improve the technical and ethical tone of medical practice and who have made India proud. The question that springs to mind is, "What ails our doctors?" Can we no longer expect medical professionals to have higher standards than the rest of society? Is the Hippocratic oath outdated? Has society changed so much that such ideals are no longer attainable or sustainable in India? The answers to these questions are not palatable. Can we, in all fairness, expect the medical professionals to have value systems that are eroded from the moment an individual decides to seek a career in medicine? An aspirant student is not assured a medical college seat based on his competence or aptitude. Competitive examinations may assess the individual's ability to be "book smart", but ignores personality traits and aptitude. Moreover, the availability of seats in both the government and private sector is coloured by many other issues like social class and political clout. Let us not forget money! The medical seat in private institutions involves not merely capitation and tuition fees, but also receipt-free amounts to the tune of many lakhs of rupees. Twenty, 30 or 40 lakhs are figures commonly mentioned in this context. Having entered the medical course, the next hurdle faced is the dreaded MBBS examination, where, again the payment of money to certain corrupt examiners can ensure smooth sailing for many. Having completed the undergraduate medical studies (by fair means or foul), the next step most young doctors take are to seek post graduate qualifications. This is easier said than done. The prices are crippling to say the least. A post graduate seat in Radiology may sell at about 1 crore rupees in the private sector. Imagine the agony of paying this amount in cash with no receipt. How does an average Indian family secure this amount? Dowry is an obvious answer for eligible medical bachelors! After such rites of passage, the newly qualified doctor enters the professional arena and encounters merciless competition. The young doctor now discovers that building a private medical or surgical practice based on ethics is too arduous and time consuming. Unless, of course, one has a parent or a godfather to hand over the clientele on a silver platter. In the absence of such help, what does the impatient young man or woman do? To secure instant financial success and recoup the capital invested thus far, there are many options one can resort to. Paying touts to steal patients from another established practitioner, giving "cuts" to referring doctors, taking "cuts" from laboratories, issuing false medical certificates, engaging in insurance fraud in collusion with patients, engaging in self-promotional advertisements, self-styling oneself as an authority in a given specialty with no professional accreditation, undertaking unnecessary investigations and surgery are all grist to the mill. Many a busy practice has been built on these fail-safe methods. Wrong role models And in keeping with the warped nature of our society, it is these doctors who are feted by the media, by political heavy weights, screen personalities and other individuals of enormous influence. Once their professional berths are thus secured, these men and women doctors (I do not use the word gentleman or lady advisedly) wield enormous influence, perpetuating the very value systems (or lack thereof) that have boosted them to the top. How can the public and professional conscience be stirred? How can the righteous members of the medical profession do anything to stem this rot from within? Does one simply wait for a benevolent providence to intervene? * * (c) Copyright 2000 - 2008 The Hindu
