The medicine business is in for some attention

It needed the death of one of India's most charismatic and articulate politicians -- Union Power Minister Ranga Kumarmangalam -- to train national attention on what happens at some of our biggest luxury hospitals. The government has ordered an inquiry into whether Apollo Hospital at Delhi (often equated with a five-star hotel and certainly more expensive) had misdiagnosed Ranga's ailment and hastened his demise.

One hopes that the publicity attached to the probe will also focus attention on the medical fraternity as a whole and on the common man's experience in getting accurate diagnosis and treatment.

For the record, let me say that India still has a large enough number of doctors at various levels who work selflessly at saving lives; many of them have chosen to live and work in villages where doctors, diagnostic tools, hospitals and medicines are perpetually in short supply. This article is not about such invaluable exceptions. It is about the equally large and highly paid medical community which exists mainly in the major metros and cities and looks upon their vocation as just another business focussed on maximising returns.

The initial wrong diagnosis of Ranga's acute leukemia had led to him being treated for tuberculosis as well as malaria. Wrong diagnosis, wrong treatment and unnecessary and repeated diagnostic tests is an experience shared by most individuals in a country where life is cheap and medical facilities are grossly inadequate.

To my mind, the medical profession in India gets away with enormous negligence and callousness because it operates as a tight group with close relationships/nexus between various segments. For instance, arrangements between doctors and independent diagnostic centres, medical shops, medicine companies and paramedical professionals are common and well known. A doctor usually explains his demand for diagnostic tests from a particular centre by claiming confidence only in the accuracy of its tests. A patient can fall in line or find another doctor; there is no other option.

Wrong diagnosis or treatment is so common that everybody I know can narrate at least two gory tragedies. I have had my father-in-law wrongly treated for tuberculosis after a full medical check-up in a posh Mumbai hospital. A friend, after three months of suffering, had to change doctors before she found that part of the foetus was left behind when she had to terminate her pregnancy. A colleague is enraged at a well-known eye specialist who nearly blinded his 10-year-old by poking him with an instrument when he had consulted her on his ailment. One could go on.

The interesting thing is that except for the rare person who drags a doctor to court, most people refuse to fight even when callousness, negligence and wrong treatment leads to death. They prefer to blame it on bad karma rather than a bad and negligent doctor. This is also because it is near impossible to establish charges of negligence or wrong treatment.

In fact, the Indian situation is the exact opposite of that in the United States, where constant and often unfair litigation has frightened doctors and tied them up in loads of self-protecting bureaucracy. Here, the high cost of litigation and a slow judicial process protects bad doctors. Usually, people contemplate litigation only in extreme cases when a patient dies. Except in the most brazen cases, relatives find it difficult to access detailed records or to establish that their suspicions of negligence are real and not emotional, grief-stricken outbursts.

Manubhai Shah, a leading consumer activist who heads the Consumer Education and Research Centre, makes another important point. The CERC, he says, receives innumerable complaints against doctors and hospitals, but can do little about it because no doctor is willing to testify against another in court, even when they privately express outrage about wrong treatment. It is a close community and they stand by each other and protect even the negligent ones. Without independent specialists acting as witnesses, it is impossible to prove bad medical practices. In fact, even the friend who had a foetus left inside her was flatly told by the sonographist that he would not simply not testify against the doctor because it was a question of his livelihood. This is how doctors and hospitals continue to get away.

Shah says a group of young doctors has recently expressed a willingness to form an association of like-minded doctors willing to break the taboo and testify against doctors in cases where there is clear evidence of wrong diagnosis and treatment. If this takes off, it will be a very positive development and doctors will need a lot of support and encouragement from ordinary people to withstand the inevitable pressure from the medical fraternity.

This is merely the tip of the health and hospital related problems in India. It amazes most people to know that Mumbai, India's richest metropolis, does not force hospitals to compulsorily incinerate their waste. Every few weeks there are newspaper articles about the hazards of disease infested dressing, medicine and equipment finding its way to common bins. Nothing happens.

Medicines which have been banned in most countries continue to be prescribed and freely sold in India. The CERC, for instance, has been waging an intense battle to have a brand called Cisa Pride banned in India following its ban in the US. It is a long struggle. There are scores of other drugs which need equally sustained battles to be placed on the banned list.

Another big debate has been over the re-use of disposable equipment such as syringes. There has been the suggestion that in a poor country like India, disposables can be reused for the poor. The ideas, while perfect in its logic, shows a horrendous disregard for lives if they belong to economically backward people. But like I said before, life is cheap in India.

The latest revelation from CERC, which runs a testing laboratory through an affiliate, is that even the equipment we use is unreliable. It found that out of 21 thermometer brands tested by it, as many as 20 were found inaccurate and these included four digital brands. Only the brand Ormon showed accurate temperature readings.

CERC points out that in certain diseases, an inaccurate recording of temperature may prove critical. In many of the brands tested, the response time of the thermometer was slow, creating a possibility that it would be removed before recording the correct reading. Every brand failed this test.

The significance of the thermometer tests is that it is usually the first diagnostic tool and is usually used at home. It decides whether the patient resorts to home remedies and self cures, such as popping paracetamol tablets or consults a doctor. If this is the level of accuracy of this simple tool, one can easily understand why we Indians find it is easier to rely on prayer and karma than medical diagnosis and treatment.

Sucheta Dalal

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