In the book ‘Atlas Shrugged’ (Ayn Rand), Dr. Hendricks says why he quit being a Neurosurgeon: “I quit when medicine was placed under State control, some years ago. Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything – except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards – never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind – yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it – and still less safe, if he is the sort who doesn’t.”
Why is there so much antipathy towards doctors in society today? The anger and resentment run across all sections of the society. The powers and the law enforcers do not seem to have any special interest in protecting the doctors against public outbursts and acts of violence. The media often ends up presenting a one-sided view of many an incident with the doctor’s angle rarely addressed. It is difficult to understand for the targeting of doctors.
There is no doubt in society’s perception that it needs doctors. Whatever be the status of the person in society, whatever be his profession; a doctor’s services are something which would always be a requirement during one’s life. However, they also feel confident that the doctors do not have the unity to scare people from taking free hits in form physical violence. Nobody does that to the police or the judges or any public representative indulging in corruption or when they are just plain incompetent. There are no such qualms when medicine is concerned.
Any supposed negligence and a mob descend who might get violent. A doctor in Dhule lost his eye when a mob became violent. There are other peaceful ways of getting justice in the event of negligence. It is a fact that, unlike many other professions, medicine wants a good and early result irrespective of the monetary compensations. Without an iota of doubt, every doctor would want a positive result. What might differ is somebody might charge more for the services and somebody might charge less. But the laypeople are not ready to accept that. The expectation is the best possible treatment at the cheapest possible rates and with a minimum of investigations. There should be no mistakes too. The attitude perhaps sums up as ‘private hospital’ care at ‘government hospital’ charges.
Legal invasions into the medical domain are making medical practice trickier. We are living in an extremely legal society where evidence and documentation is becoming increasingly important. Evidence based medicine makes clinical judgements subservient to investigations, sometimes costly. In America, there is a joke that there are more lawyers than doctors when you go to a hospital. A doctor in US apparently spends one hour of dictating operating notes and ten minutes in doing the surgery. These things are trickling to India. Which is perfectly fine if there is no physical violence involved. The doctors should document their treatments and stick to evidence-based medicine. However, the investigations cost money to everyone. A CT scanner or an MRI machine costs lakhs of rupees’; the maintenance by the Engineers does not come cheap; and in a business model, there will always be a question of returns on investment.
Socialised medicine tries to cap the doctor and hospital charges along with free medicines and investigations. With some schemes, the government doctors get extra payment as an incentive for offering their expected and regular services to the poor patients. This becomes as questionable as government schemes which pays the patients direct cash and other benefits for utilising government maternity services. These poorly thought-out government schemes end up ensuing a severe heartburn and certainly a whole host of practices in the private sector, some clearly unethical. On the other side, in the corporate hospitals, the managers come to control the doctors in terms of ‘attracting footfalls’ and shifting targets. In a country where 70% of the medicine comes from the private sector, this is a sure method of killing the doctors softly. Yet, people do seem attracted to take up the profession as it happens to be the only ‘recession-proof industry.’
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