By Col Sudhir Rana (Retd)
I belong to an era when even a middle class boy or girl could dream of becoming a doctor. As a matter of fact, my fee at St John’s College in Agra BSc part one was Rs 75 per month while our annual tuition fee was around 250 in medical college plus about Rs 200 per annum were hostel charges. Our monthly expense including food was about Rs 200 per month. Our teachers were best of the best and were respected by one and all members of society. They were giants but had empathy for poor. The art of practice was noble and humane. Doctors did their best and patients accepted the results as their fate. The patients treated doctors as demigods while doctors felt responsible for the patients and did their best to treat and guide them.
In the 9th and 10th decade of the last century, things started changing rapidly in response to corporatisation of medical profession. The corporate hospitals owned by big buisnesses and politicians came up. They could hire the doctors and force the governments to create laws which favoured the business and not the service aspect. The patients became consumers and doctors, service providers. Huge profits generated made these hospital owners richer. From community leaders, doctors were reduced to being merely employees doing hospital owner’s bidding. Only those doctors could survive, who could give profits to hospitals. They were supposed to meet the targets in investigations and medical procedures, if they wanted to survive. Clinical medicine was out, investigations and diagnostics were in; as these generated more money.
Earlier, about 70% of medical care was being manned by small clinics and nursing homes, who took care of patients at an affordable cost. The powerful lobbies pressured governments to make laws and regulations which made it impossible for the small practitioner to survive. They had to take permission and licences from around 15 governmental bodies. Slowly, small time practitioners started disappearing and were replaced by the corporate health facilities, which could keep governments/ bureaucracy happy. As a result, health care has become unaffordable for an average Indian and doctors are now being projected as the villains. They are reduced to being employees in such facilities. Here they have to face the anger of patients and unreasonable demands from hospital owners.
Then governments under pressure from powerful lobbies created laws which prevented doctors from treating patients outside a narrow domain. Instead of empowering doctors, government made sure doctors could not practice freely. They had to get approval or get a certificate to do a procedure. Unless certified, they could not conduct life-saving procedure if they had no authorisation. A great general surgeon could not do a Caesarean section, if need arose. A radiologist needed a certificate from PNDT authorities to conduct ultrasounds of patients.
Then privatisation of medical education started in South India, which soon covered the whole country. Now you could purchase a medical degree after hefty payments to these doctor making factories. The National Medical Council which was supposed to regulate medical education was hijacked by corrupt people both medicos and non-medicos. They overlooked deficiencies in infrastructure and faculties in such medical colleges in return for favours. These so called private colleges charged astronomical fees. How can you expect a medical graduate from such colleges to become a philanthropist and work for peanuts? His father sold his land to get him in a medical college!
So, the present status is that the medical profession is hijacked by powerful lobbies and the doctors are villains and the patient is a sucker.
