'Do as much as possible for the patient and as little as possible to the patient'
Dr. Ashaq Hussain
Healthcare costs are increasing at an alarming rate and are expected to keep increasing. Fortunately, a doctor can change this state of affairs and the remedy does not require medical science breakthroughs or top-down governmental regulation but simply requires a new approach which is to do as much as possible for patients and as little as possible to the patient and compare them with outcomes. Everyone wants to be healthy, for which a significant portion of their income is being spent. The contribution of doctors or physicians in increasing this cost is not small. Health awareness and the thought of spending for it have given physicians the opportunity to fill their pockets, rightly or wrongly. Since vedic era, human beings suffer from various ailments and diseases. To treat the patients, ayurvedic Vaidyas were there. With passage of time, this pious, holy alliance of doctor and patient got expanded and entered the third party of retail chemist. Slowly, the fourth and fifth party of Manufacturer and Distributor entered to this triangle. India has a vast population of more than 1.26 billion people. The number of doctors to cater their healthcare needs; are very few. As such there is lots of pressure of vast number of patients per doctor. No doubt there are many divisions of medicine practice, like allopathic, ayurvedic, homeopathic, unani, siddha, acupuncture, acupressure, naturopathy etc. However, the allopathic medical health professionals are well recognized today and are considered as the main and leading line of medical health professionals.
Gone are the days when we used to hear that a good physician treats the disease and the great physician treats the patient who has the disease as these lines now seems to be the fictions of past. Once there was a time when true professionals used to provide considerable advice and sometimes doing nothing on the prescription in the name of medicine was exactly considered as the right thing to do and such doctor was recognized as best doctor who really cares for you. The physician used to treats with words; within the physician patient social system, the patient used to move by the physician's words and phrases. The words from a doctor had a great influence over medicines that affect the patient more than the medicine. But now with the expansion of pharmaceutical companies and offcourse the business medical institutes offering expensive medical degrees, the healthcare professionals too have changed their profession with business prospective.
Earlier the pharmaceutical company’s representatives used to meet medical health professionals (Doctors) with an aim to impart knowledge about new drugs/ medicines, launched by their pharmaceutical companies. With passage of time, this practice of imparting only knowledge of medicines was modified and was supplemented with additional points like giving physician’s trial samples of new drugs/ medicines. These trial packs were supposed to be given to poor patients, free of charge, by the physician. By this, doctor will also check the quality of product by seeing the improvement in the condition of patient. This tradition of free sample was later further augmented by occasional gifts on new year, eid, diwali, holi or other festival or on the occasion of new product launch. The small gifts used to be pen, writing pads, stethoscope, calendar, table top, paper weight or other utility items, which are helpful in the examination of patients by the doctors. Company’s name and medicine brand names were used to be printed on these promotional gifts. With further passage of time, increasing patients number pressure, increasing number of more than 24000 pharmaceutical companies, the need or requirement of medical health professional changes. Now doctors do not get time for up gradation of their knowledge. The pharmaceutical company’s representatives now almost illiterate and inexperienced cannot provide all the required information. So the doctors were supposed now to conduct Doctor’s Associations meetings (Continuing Medical Education (CME)/ conferences), to discuss current progress in the field of medical profession and new medicines pros and cons. But do present doctors have so much time to attend all these seminars, conferences, lecturers or time to read literature to upgrade themselves offcourse not at all. To add more on this, there accumulated a greed or hunger of more sales in various pharmaceuticals companies. This lead to various ponzy, lucrative schemes of offering big gifts, from latest and sophisticated electronic gazettes like mobile phones, laptop, tablet, AC, refrigerator, LED TV etc. to hard cash. Sponsoring trips with all boarding and lodging, in national or international tourist spot or hilly areas; with to and fro / return air tickets for doctor as well as spouse also added to the packages. As we all know that nothing comes for free. These freebies always come with a string. The pharmaceutical companies, on one hand take the promise from doctors for prescribing their products; and on the other hand will not bear the cost of these freebies. These pharmaceutical companies then simply pass on this burden to poor and ignorant patients. These poor patients think that their respected doctors have prescribed a very good quality costly medicine, that’s why they have to shell out extra money.
Today it is being seen that many doctors are living a very luxurious life due to the pharmaceutical companies. The relationship between general practitioners, medical shops and pharmaceutical companies is getting stronger day by day. Teachers in medical colleges too allow pharmaceutical companies to obtain product discovery licenses in exchange for royalties. The extra cost to medicines and other allied healthcare is added by the mushrooming medical colleges where unprofessional students are recruited by companies at an early age in the name of research for their research institutes. At present there is a flood of clinical research institutes or CROs all over India. These CROs do not perform their research work instead are becoming a problem for our country. The meaning of the research is neither understood by these companies nor the students who enroll themselves in such CRO’s on the name of research. There are many researchers in our country who have hardly seen any patient in their life but they claim to have successfully treated major diseases in front of everyone. Infact these CRO’s in league with pharmaceutical companies target patients who can run a lifelong business and thus the treatment now a day has been restricted to medication and expensive testing. The treatment is becoming increasingly dependent on medicine and modern medical resources. Due to the ever-increasing pressure from companies, doctors have learned to write a full page prescription of medicines and a handful list of tests for every disease. If the structure of the body is slightly different from normal then the only way to do it is to perform surgery.
In India, around seventy percent of the population is still illiterate in medical science; more than 80% of the population cannot afford health insurance because its premium is very expensive. People do not like to seek treatment in a modern medical way, where treatment is difficult due to poor government medical system and treatment of non-government doctors and non-government hospitals has become very expensive. Gifts are given to doctors who prescribe medicines to patients from the specific companies or compel the patients for unnecessary tests, or refer them to specific laboratories or specific Hospitals and prescription with the direction to buy the medicines from the specific medical shop. Such interactions between physicians/doctors, with Medical shops and pharmaceutical industry have lead to several negative outcomes that has diminished patient’s best interests.
To conclude with, today in era of social media, both pharmaceutical companies as well as medical healthcare professionals (Doctors) are more aware about their social image. Any fraudulent activity is being quickly criticized in public and trolled in social media. So it is the time for both the parties to change this attitude and keep their stakes of serving the ailing society at best levels of highness. Doctors should remember that their respect is being toyed with and one day the patients will start saying that you are working for gifts not for patient care. Medical educational institutions too should try to inculcate some ethics to these so called future doctors during their education and elaborate them how the representatives of the companies make them do wrong things by making attractive offers. I think it is important to make students aware of the economics and medical professionalism of pharmaceuticals in addition to book knowledge at this time so that they do not fall prey to the traders of the pharmaceutical industry after completing their medical education. Education should be imparted to inculcate in them a sense of empathy for patients and respect for medical services. People should look at this department with the spirit of service and not with the spirit of profit. Cooperation and coordination are needed between many elements such as government, pharmaceutical industry, and professional organizations or associations to solve this unethical alliance of physicians and pharmaceutical industry by creating comprehensive ethical guidelines. Patients also need education about benefits of generic drugs which are more affordable and give the better results. Doctors as well as Pharmaceutical Companies too should realize themselves of their social duties and should start religiously implementation of self restraint and tread normal path of ethical and professional practice of serving society with a being human approach.
Dr. Ashaq Hussain is Assistant Professor (Selection Grade) At Govt. Degree College Chatroo
and can be reached at [email protected]