Open letter to PM By Dr T.S Kler

Letter dated Oct 1, 2014

This is regarding a recent sting operation on some path labs that give cutbacks to referring doctors. I am surprised to know that the Union health minister, Dr Harsh Vardhan, was not aware of it. This practice of giving money to referring doctors is pretty old in this country and I think everybody knows about it; even many patients are aware of it. It is not only path labs and other diagnostic centres, which do this. Nowadays a large number of doctors in big private hospitals in Delhi are sending cutbacks to referring doctors. Even some private hospitals are officially giving referral fees to physicians, quoting one excuse or another. The government has asked MCI to investigate this problem. I do not know the credentials of the present MCI, but everybody knows how corrupt some of the previous MCIs have been. It is just like an anti-corruption department being one of the most corrupt itself. Mind you, sting operations have found out only the tip of the iceberg. The rot in ethics in medicine is rampant. We are ourselves to blame when patients doubt every opinion of ours and go for second third opinions. Many times people do not agree for a particular treatment even in an emergency, like the advice of urgent angioplasty in the case of an acute heart attack, again due lack of faith in the treating doctor. This often results in damage to the heart with bad consequences for the patient.
So the biggest problem is lack of faith in each other and it is justified because of many people telling lies to their clients. With the result we do not believe our builder, property dealer, our sari-selling shopkeeper, our goldsmith, our police and even our doctors and other medical personnel. All this is due to a severe rot of ethics and honesty in our country. I do not know the reasons for this pathetic situation, but certainly I blame the seniors in every home and department, who have not led by good example to their juniors and our children have not received good values. They tend to do the same as they see their seniors doing.

Why blame the medical profession only. Are the MCD, police, Delhi Jal Board and government honest? Is it not unfair on the part of Indian society to expect doctors to behave like gods when others are thieves? Well, I don’t subscribe to the view that doctors should behave the same way as others do. I certainly believe that if God has made a few of us doctors and entrusted us with the job of looking after fellow human beings, God has already kept us above other people. I think we should not let God down. I have not seen any doctor, even an RMP, dying of hunger even if he is 100% honest. My submission and request to the whole medical

profession is to keep the dignity of the profession intact, which God has provided us.

So my dear health minister, finance minister and Prime Minister, what is the solution? Well, I don’t have quick-fix solutions. We need a lot of thinking and introspection. I can think of a few suggestions:

1. Bring transparency in every government and nongovernment functioning.

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2. Privatize. It is not the government’s job to run factories, run an airline, which is in a mess. Nobody in the whole world can understand why the government is not privatizing Air India. The government’s job is to make good, efficient policies, lay down minimum standards for everything we do, whether it is a hospital or industry, lay down proper checks and audit everything by specialists. In India there are no checks, no audits. Anybody can do anything. Whatever we do, whether angioplasty or CABG, there should be random checks by proper authorized people. I also strongly believe all health professionals, including doctors, should be made to sit for an exam every five years, so that they keep themselves up to date.

3. I think the biggest reason for corruption in India is black money. we need to abolish this menace. This is where I request Mr Jaitely to think out of the box. Make a rule that no transaction exceeding Rs 10,000 can occur in cash. Similarly nobody should be allowed to withdraw more than 10,000 or 15,000 from the bank in cash in one day. I am sure economists know more solutions, get them together and apply their suggestions. Get black money lying in foreign banks back to this country.

4. The government should spend more money on health (the present 3% of GDP is dismal) only a healthy nation can prosper. The USA spends 16% to 18% of GDP on health. And the government should provide primary health care to all 1.27 billion people of this country. It should focus on education, particularly quality medical education. It should spend on preventive health care; tertiary care can be left to the private sector by and large.

5. The government should make a think tank of 20 to 25 doctors drawn from different specialties under the ministry of health who will develop stringent policies for health delivery and education. Let the health minister change, but don’t change this think tank, for a sufficient length of time, maybe five years.

(Dr TS Kler is executive director, cardiac sciences, at Escorts Heart Institute and Research Centre, New Delhi)