There is a movement for prescribing only generic drugs to the patients. The short-sighted policies of the government come to the fore. The ground work for generics must be strong like in the US or the European countries where the assurance of quality is complete for the doctor. There is a huge deficiency of drug inspectors in the country; and the drug inspection process is not entirely free of corrupt practices. Only about 1% of medicines subject to quality checks in the country apparently. In such an event, how can the doctor have a comfortable assurance that the treatment he is prescribing will work?
The doctors are under extreme pressure from violent attendants; sharp lawyers; expectations of maximum efficiency with minimum cost; maximum costs of running clinics with no sort of concessions from the labour department, electricity department, municipal corporations, bio-wastage departments, the health department and so on and so forth. Apart from the regular taxes on income, a doctor running the smallest clinic has the burden of an overwhelming number of taxes and fees from the government. There is in fact no kind of concession for a medical establishment. I run a small clinic and I have yet to come across a concession which benefits my clinic in any form. In fact, most of the charges are at a premium as compared to the rest of the population.
It is all fine if medicine defines as a business model. However, when it comes to the charging of the patients and offering their expertise and services, there is a capping on the earnings for ‘humanitarian’ reasons. Most doctors have fees which are generally in tune with the existing societal conditions. A top-notch surgeon in a corporate hospital would still be accessible to a good number of poor and lower middle-class patients. But the same cannot be perhaps true of an equivalent capacity lawyer. A top lawyer like Jethmalani would be beyond most of the Indian population. The business model in medicine is only when it comes to taxation. The popular idea of the people and the government would be that doctors should go barefoot while delivering quality treatment of the highest care not expecting any money in return. Maybe, they would be better off in the old barter system when they would get rice, vegetables, and fruits in exchange of their services. And an occasional ice-cream for an extremely well-done job.
The whole idea of generic prescriptions is a danger to the doctors once again. Whatever be the motivations of the doctor, there is no argument on the fact that most would want the patient to get better. That is the basic definition of the doctor and it stays the same despite all pressures. A doctor would certainly want an assurance from the government, the drug controllers, and the drug companies that the medicine he writes will have proper quality. It is certainly not his responsibility as he has no way of knowing; and the responsibility of generics should shift away from the doctor. Also, a doctor should take a written consent before prescribing generics that if the drug does not work, it is not the doctor’s responsibility and the patient should take his fights and direct his angers at the drug approving authorities.
From the way things are unfolding, it looks that the power of prescription is now transferring from the doctor to the chemist. There are hardly any qualified pharmacists in most of the country. Unqualified people run most pharmacies who have profit as the sole motive. The economics also appear that it is the retailers who make a large profit with some benefit to the patients with prescription of generic drugs. The doctors should not be responsible for any reduced or untoward effects of the medicines. This fact should be clear to the government and the public clearly.
I feel sad for the patients and doctors whose relationship has taken a further beating with this issue of generics which is sure to generate a lot of apprehension and friction. There is no doubt that generics are good for the patients who spend a lot on medicines; but most doctors are resisting the idea. It is not out of profit-loss motives, but out of the fear that the country’s manufacturers and drug enforcing authorities are still not ready to assure the quality of the drugs. The firing of the angry gun, in case of problems, might be at the wrong target, the doctors in this case.
Published in April 2017 in The Hans India. (Link not found)
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