Falling standards in medical professionalism : Hard reality or an aberration?

Falling standards in medical professionalism : Hard reality or an aberration?

I am one of those privileged ones who are friends with quite a number of medical doctors and have seen them work passionately and untiringly almost all times, some times at the cost of their own family and personal life. It was therefore but natural for me to firmly and convincingly believe that the Indian Doctors work true to the ancient traditions of the “Hippocratic Oath” - emanating from the Greek medical texts, which in its original form mandated a new physician to swear, by a number of healing Gods, to uphold specific ethical standards. Hippocrates - the Greek Physician dating back to 400 BC- considered as father of modern medicine (allopathy), laid down the criteria for a perfect physician as ; observant, humane, learned, orderly, thoughtful, purity of mind and ability to gain more knowledge for its application. The Hippocratic oath mandates the Doctors to work with “Dedication and honesty for the benefits of sick: With purity and with holiness I will pass my life and practice my art, into whatever house I enter, I will go in to them for benefit of the sick, will abstain from every voluntary act of mischief and corruption”. It further expects the Doctors to be “Proficient and deviate from evils, and that they will follow that system of regimen which, according to their ability and judgment, they consider for the benefit of their patients, further they will abstain from whatever is deleterious and mischievous, and will give no deadly medicine to any one if asked nor suggest any such counsel”. A noble thought, which perhaps rightfully equates Doctors the saviours of life with the almighty - the life giver.

Notwithstanding the reports - aplenty - appearing in newspapers highlighting falling standards and gross neglect of patients by hospitals and medical practitioners, and often used phrase of “kalyug” while describing the falling standards in medical practices, I was one of those who never alluded to this belief, rightly so I thought keeping in mind many ideal doctors that I am privileged to be associated with. But then the hard reality is “Doctors are many in title but very few in reality”. I came face to face with this hard reality recently at my native place, while I had to deal with a harrowing experience of utter neglect by a Hospital and the doctors associated with it, while providing treatment to the one who is a cause for my existence. I am forcefully restraining myself from naming and shaming the hospital and the doctor who most unfortunately work diametrically opposite to what their noble profession and the Hippocratic oath mandates them to do so. I am also restraining myself to make it personal against the hospital and the doctors, even though it rightly warrants. I am posting this as an introspection for the larger medical fraternity - who truly deserve admiration, reverence and respect- to isolate and name and shame those in their fraternity, who through their unbecoming act to make ill gotten money are bringing to shame the entire medical fraternity. Some hard facts to substantiate my hypothesis follows.

In one of the reports published in the reputed Lancet “the Indian healthcare apathy, and its poor quality of care, kills more than lack of access to treatment facilities”. The report adds that some 2.4 million Indians die of treatable conditions every year, the worst situation among 136 nations studied for the report. Poor care quality leads to more deaths than insufficient access to healthcare. A staggering 1.6 million Indians died due to the poor quality of care in 2016.

Providing health services without guaranteeing a minimum level of quality is ineffective, wasteful and unethical. It is therefore necessary to better measure the quality of our health system as a composite entity rather than be merely content with certifying hospitals and laboratories. It may be time to talk about the lack of mechanisms for monitoring quality of hospitals and doctors in India. It may be necessary that some elements of quality, as composite measures of the health system, are ensured and monitored, which most unfortunately are unavailable.

In yet another report “almost 122 Indians per 100,000 die due to poor quality of care each year, showing up India’s death rate due to poor care quality as worse than that of Brazil (74), Russia (91), China (46) and South Africa (93) and even our neighbours Pakistan (119), Nepal (93), Bangladesh (57) and Sri Lanka (51)”. The total number of deaths from poor quality care globally is 5 million per year, which is estimated to be five times as many as the annual global deaths from HIV/AIDS (1 million) and nearly three times more than deaths from diabetes (1.4 million). This was according to the study that was part of a two-year project that brought together 30 academics, policy-makers and health systems experts from 18 countries to examine how to measure and improve health systems’ quality worldwide.

These glaring reports perhaps substantiate my appeal for the medical fraternity to introspect and make efforts to have a robust regulatory mechanism to identify and name and shame those who bring disrepute to the most respected profession.