The doctor's rant. . . . . on CORRUPTION et al.

Read this forward..... thought I'd share it on my blog.
Dunno who the original author is..... whoever s/he is.... THANK YOU!

Guys this may take some time to read but it's worth it!..... an article by an eye surgeon on corruption in Indian Doctors:
This article is also a test of how our society tolerates the truth.
Recently read a flash news about eminent doctors taking cuts / referral fees. There cannot be any justification. But if a whole system based upon corruption, a whole society facing inflation expects only one of its components to be sane, it’s insanity.
Hence these thoughts. . . .
I apologise in advance if this hurts some feelings. This isn’t a placebo though.
For the “nautanki” people who appear so shocked to hear about corruption in the medical field, here’s the naked truth:
 There is corruption in every aspect of every field including religion, law and judiciary, government, politics, police, press, military, film industry, YOUR FIELD, and also medicine, as the doctor is a part of this very same society, not from Mars. There is corruption in every aspect of the medical field: referring a patient, lab tests, CT/MRI, Surgeries, Cross referrals, almost everything.
But as in every field, there are people who do it by choice, there are some who have to be a part of the system to survive in India, and some who refuse to be a part of it all, facing many other problems including a perpetually low income.

Think simple: why would a person with highest of merit, hardest of hard work, tendency for helping others want to become corrupt? Not by choice. No one becomes a doctor for greed (Someone might attempt, but these people drop out in the first six months or a year: Those not dedicated to a hard life cannot endure medical education in India).
Every doctor wants to do good to his patient and also live a decent life. After a lifelong meritorious career, why should he be expected to toil in villages / rural areas without any rewards for it? Why should he not want his kids to go to the best schools? Why should he not want a decent lifestyle? Why should one give up a lucrative career in the west and return to the homeland feeling patriotic, to just be told that in your own country you are doomed to a life of sacrifices just because the society expects so?
“Someone who wants money should not become a doctor” said a dropout actor who is seen doing all immoral things (from peeing openly in a garden for press in real life to cruel crimes and revengeful murders on film, while running a show to change India to an ideal country.. I hope he and his family only use Indian things, medicines etc.). Why?
Why should a doctor not want money for a decent life? Why should he endure the humiliation of so many non-meritorious people from his class living in luxury because they chose not to be a doctor, while he chose the noble profession?
 Listening day-in and day-out to patient’s problems, tears, cries, allegations, threats, and expectations, not ever having a peaceful sleep for a week at a stretch, not eating on time, not having enough time for family, why should a Doctor NOT want to earn well?
We are not supposed to refuse a case in emergency. Does the Judiciary or the Police or the Politicians behave in a similar manner?
We are fined crores for medical negligence. What if the Judge is wrong? What if the police are wrong? What if the politician is wrong? What do they pay even when proven wrong? Why the presumption that the negligent doctor’s intention was bad? Negligence is possible in all fields (reactors/ bridges/ buildings/ food/ trains/ public transport), can cost life in many, how come the doctor alone pays in crores for a life that he was attempting to save, while in all other cases the motive was profit, not saving life…?

How come the judges decide the amount of fine? In a recent case, the fine was in crores. If the patient had survived, would the court have ordered the same payment for the doctors? Doctors save millions of lives. Some through heroic / exceptional efforts, without thinking of rewards. If a young patient is saved, shall we charge according to the income he can make in his future? Then, why this criteria for fines?
The world has become a global village. People travel to the developed world often. Highly specialised doctors in India are expected to be at par with their western counterparts. They often are, because half the world travels to India for medical advice.
But the Indian community is yet to awaken to the Doctor’s fees. An average specialist in the developed world charges between 10,000 to 30,000 INR for the first consult. Appointments are very difficult to get. They don’t work out of 8 am -4 pm slots except in emergencies (some honourable exceptions). And yet they get so many benefits from the hospitals they work at, and also from the government. THEY SEE NO FREE PATIENTS. Most doctors live in luxury in the western world.
 An Indian doctor on an average charges 200-1000 rupees for an OPD patient. Sees many free patients (almost 40-50%) everyday. Continuously has to be occupied with:
 1. Patient’s health and benefit
 2. Relative’s expectations, their anger (many think that every patient must get well irrespective of his / her health status). Many hold the doctor responsible for their illness / failure to improve/ complications.
 3. Continuous suspicion: Many patients think Doctors are out to loot! Every investigation is with an intention to get more profit out of the patient. They want the best, but like “sabji”, they want to bargain.
 4. There is also a widespread belief that pharma industry is actually serving the doctors, not patients.
 5. Google searchers who think they know better medicine just because of what they recently read about a tiny drop in the ocean of medicine. They eat up a lot of time, but don’t want to pay for that additional time.
 6. The very relatives who shout at the doctor seldom know what medicines the patient is taking: it is all supposed to be the doc’s responsibility.
 7. So many Toms, Dicks and Harrys coming over and threatening: this is everyday nuisance in ALL casualties in India. There is no sensible Director in Bollywood to have realised a Doctor’s plight while working under threat in casualty. Everyone loves the populist “Doctor-Threatening” hero!

Next comes the seemingly innocent weapon (the secret bleeding wound in many a Doctor’s heart!!),
“But Doctor, You are like God / Next to God. The whole society respects you”
That respect is divine for us, that respect and the satisfaction of doing something godly by saving lives, helping people live better lives alone keeps us from going on and not quitting the profession for better incomes. Don’t you think we had the option of making more money had we used our talent elsewhere, especially in today’s IT world?
But that respect does not substitute for our children’s fees. Not for our rents, electricity, travel or  ANY other expense. Almost all doctors and their family members end up paying full bills for themselves at the very hospitals that they work in… with some minor exceptions. Everywhere a doctor goes, he pays the same money that any other citizen does. There isn’t a separate queue for a doctors anywhere in any office just because he / she has patients waiting. There is no pension. There is no security. I can show you some highly successful (in patient care) ethical doctors who can’t pay for their own treatment TODAY!! If a doctor is sick, his / her income is zero as long as he does not work: No one cares if he has treated hundreds for free.
 The respect does not substitute for the stress a doctor bears: of years of listening to and attending pain and tragedy, years of sleepless life, fasting days, lost precious time with dear ones.. as with anyone else, the DOCTOR ALSO HAS ONLY ONE LIFE… WHICH HE CHOOSES TO SPEND HELPING OTHERS.. is it a crime to be living well for such a person?
And if Doctors are next to God, very respectable, how come their mistakes become villainous immediately when something goes wrong?
As for the other side:
There are corrupt doctors, corrupt practices. But please understand, a single doctor did not create them, nor did a group plan them These developed over time as the system evolved. One had to fall in line or quit the profession for want of a better life.
 Like in every field, there are some rotten apples. They ruin the reputation of themselves as well as the doctors around them. But a single doctor cannot do anything. Those who try to change the system are boycotted, thrown away, maligned. There are some continuously fighting this.
Every doctor cannot afford to start a hospital of his own. He has to choose a speciality hospital which has all the facilities to practice his speciality. These come at a price. I appeal to the people who feel bad about investigation prices to just enquire the rates of the machines/ skills/ licences/ manpower/ maintenance required to make these facilities available. The government makes it compulsory to attend to many of its employees free / at subsidized rates, and never pays.. who will pay for them?
So hospitals have their systems. A single doctor cannot change them. Also, not all hospitals are corrupt.
The Medical councils do not have any protocol / system to protect a doctor who faces vindictive attitude from hospitals if he / she wants to argue. Many specialists DO NOT RETURN TO INDIA OR HAVE ALREADY LEFT INDIA AFTER RETURNING due to this one reason. Because specialist practice is based upon referrals, and where most of the referral system itself is corrupt, one has little hope of survival especially in a decent city / town.
Doctors who want to run their own hospitals face same bribery, same licencing scams, same corrupt government practices that any other business does. The rates are probably higher, and the regulations stricter.
Doctors are a weak vote bank., hence not on priority of any party. It is more practical for the politicians to openly criticize the doctor / profession in hope of gaining public sympathy / attention. No one wants to attend to their problems, which are many.
The medical council never protected any doctor against court cases or hospital victimising them for fighting against corruption. The regulations made are ancient, primitive. When a whole medical system is corrupt in almost every step, they have taken the approach of superficial actions against individual cases: typically populist and sensationalist. The medical councils KNOW every aspect of corruption, but have opted to fit in some screws where the whole building needs extensive repairs. One’s degree and education of fifteen years becomes meaningless in the eyes of medical council just because there is delay in renewal of licences. How can rules be applied only partially in a system? While many people practice without degrees or knowledge, the councils choose to target the qualified for not renewing their licences: a process that involves acquiring CME points, the money for most such events, travel etc. comes from pharmaceuticals, the patient pays. They do not have the online option of CME / licence renewal like most western countries, even in this advanced age! So a doctor is expected to leave his town and practice, get involved in events sponsored by pharmaceuticals, travel with help from pharma companies, stay in hotels with their money so as to renew his licence. But not online. And there is no compulsion that he has to attend the event for his specialty. So a Neurologist could attend a gynaecology event just for CME points and its okay for the renewal of his Neurology licence!! One can easily get such CME credits without attending the event! There has to be an online option, or a rethinking of this whole business. And an option to do it without involving pharmaceuticals.

Average number of books read by a specialist to get to where he is. . .

The whole Medi-claim business in India is a fraud: they don’t pay for
1. OPD consultation / investigations of a patient: even if serious.
 2. Patients with genuine illness, but without injectables or surgery.
 3. When they do not understand the diagnosis or the fact that some cases do not have a proper diagnosis.
 4. Emergency / Critical care / Specialist charges etc.
 5. Even when they pay, it is their choice how much.
This results in many a wrong practices, or the patients can't afford treatment at all.
So in a medi-claim case, no one benefits except the company: Patients, Hospitals, Doctors all lose. Still, the Medical councils do not want to do anything. In fact, they don’t have a say.
Add to these:
Incessant calls / emails/ whatsapp messages for any enquiries that pop up in the patient’s or relatives (usually the cousin in America) mind at any time of the day or night: and bitter words to follow if reply is delayed. (That doctor has advised so so… what is your opinion?... I just read on Google about stem cell therapy to improve my anger… what say? Etc. etc.).
Then there are sons and daughters who stay in US / UK etc., but leave their parents back in India. They expect the same care but at a low price, and also a daily update by the treating doctor. NO WESTERN DOCTOR GIVES OUT HIS CELLPHONE or EMAIL ID TO PATIENTS, THEY KNOW THIS, but they talk from there as if from the top of a mountain. They don’t want to come and attend to their dying parents, but vent out this guilt in the form of anger towards the treating doctor: Do everything doctor, don’t worry about the money. I am unable to come to attend to my MOM because of business meetings/ no tickets / kid’s exams etc. I lose my patience here often.
If a Judge / lawyer is ever reading this article. Your Honours, please consider these when you next fine crores to a doctor (even if insured, he has to pay huge):
A doctor should not be held negligent if
1. The patient does not follow advice as written.
2. Patient continues to drink / smoke / eat tobacco/ or does anything that the doctor has prohibited.
3. Does not follow up as directed (most patients miss their follow up dates: doctors are supposed to jump from illness to illness).
4. Does not show the same care towards his own life that the doctor is expected to take.
5. Has not given all correct information about himself / herself  and/or  his/ her illness
6. Hidden some information from the treating doctor.
7. Has lost treatment details.
8. Self medication / cross consultation without knowledge of the earlier doctor, resulting in multiple medications.
9. Has had unknown allergies / reactions in the past.
There should be a doctor’s board for each speciality which opines about every particular medico-legal case before the court makes its final decision.

I always wanted to be a good doctor, like most other colleagues I know. I have always heard the courts of justice demand that one speaks the truth. Here it is. Hope I am not punished for speaking the truth. I am not always correct, I am sure some of my friends will correct me. I will keep learning too.
A warning: If the whole medical system becomes non corrupt, patients will end up paying far higher consultation / surgical fees than what is paid now. This is inevitable. Add the legalities to everything, and many specialists will become non-affordable / non available to most. The many "phukatchands" who get free treatment now, will be denied that.
Or the next generations will see less and less specialists opting to settle in India.
I love my profession. I love my country. I love my patients too.
But I also deserve a good life. It is time I stop thinking I am God because the society has presumed so.
 May God confer best of health upon all humanity. May God guide me to always do good to my patient.

!NCREDIBLE !NDIA

Amidst all the hullabaloo of the ongoing Commonwealth Games..... the corruption, the lackadaisical attitude of our authorities and the absolute debacle (that it was gonna be, but so far hasn't been.. THANKFULLY).... I thought I'd share my version on why India is truly Incredible and why we are "like this only" !


Amul, at their very best, yet again !!!

 We Indians are so cynical that, had those nincompoops (at the Commonwealth games) done at least a respectable job (at not only organising the CWG but also "hiding" the "under-the-table" business of theirs), we wouldn't have made a big deal about it as, the "supposedly brilliant" end-result is what would've mattered to us!!! Because, obviously, everyone in India knows the "what, where, why, how and when" of CORRUPTION..... we are like this only !!!
Anyways, back to my anecdote on why this country never fails to amaze me.
I'm currently preparing for my entrance exams and study at a library a l'il distance from home. The lib has a huge ground facing it and, according to my sources, there's a huge fair organised there every year during the Navratri/Dussehra festival. Currently this fair is in its "construction/organising" phase and I get a direct view of the frenetic activity happening there. Now this is your typical Indian "mela" replete with all sorts of see-saws, merry-go-rounds, giant wheels, mini-shooting range and what not. I guess you get the point....and am sure you've been to at least one such mela in your life ( the last time I went to one such mela was during my rural posting in Internship around a year ago, what fun!!!.....but that's another topic altogether ).


The Ferris-wheel in its "preparatory" phase with the "mango-people" working relentlessly 


Now getting to the point....... actually observing a mela take shape is, truly, a fulfilling experience, I must say. The amount of hard work one puts in, is truly undervalued, at least in our country. Just watching those puny little men from some remote village in north India sweating it out in the Mumbai sun, assembling that huge giant wheel and that huge "dome-of-death" ( or whatever that motorcycle-stunt thingy is called ) from scratch , piece-by-piece, WITHOUT A MACHINE...... and that too for what.....some measly 150 bucks a day..... WHO DOES THAT?.......... The "common man" in India.....the "aam-aadmi" or "mango-people" (as popularised by some Bolly movie)..... it may not be much of an experience, the way I've described it. But day in and day out watching these "invisible", "behind-the-scenes" men work really hard, so that the other "common-men and women" of our country have a great time, represents the true spirit of India for me. Despite inadequate lighting post-sun down, these men are still at it, working on that sheer monstrosity called a "giant-wheel" (which could very well be called India Eye by me, akin to the London Eye or Singapore Eye or whatever eye...have you). That is the "spirit" of this wonderful country called India.


Lo behold ! The Ferris-wheel all ready ! Also, don't miss the "dome-of-death" behind


And what astonishes me further is...... this library that I study in, is less than 50 feet away from this "site of action"..... and we are continuously exposed to the "din" outside..... and yet Indian students preparing for God-knows-which entrance exam continue to study, oblivious to that construction outside, maintaining an inner calm, not complaining..... but continuing to do what we do best..... EXCEL AT EVERYTHING WE DO WITH WHATEVER LIMITED RESOURCES WE HAVE !!!
And that's my !NCREDIBLE !NDIA for you.....
Kudos to the mango-people...... JAI HIND !

BHOPAL GAS TRAGEDY: Justice Delayed.....Justice Denied !

On December 2,1984 at around midnight, there was a leak of Methyl Isocyanate (MIC) gas from the Union Carbide India Ltd. (UCIL) Pesticide Plant in Bhopal, resulting in the exposure of this toxic gas to over 5,00,000 people.....and there you have the largest industrial disaster to date!
The earliest reference to the Bhopal Gas Tragedy that I can gather, was from our Science textbooks in Secondary School. Obviously, at that time I hadn't realized the magnitude of the problem (what with the text matter limited to a few lines in our textbooks).....but now, reading various articles on the net and in the newspapers have actually opened my eyes to the great disaster that it was.
Estimates vary on the death toll; some say around 3,000 and others around 15,000. Others estimate that around 8,000 died within the first few weeks and another 8,000 have since died from gas-related ailments. And the foibles continue, what with epidemiological reports showing eye problems, respiratory difficulties, immunological disorders, neurological disorders, cardiac failure secondary to lung injury, female reproductive difficulties, etc. among those affected and birth defects among children born to affected women.
So what had happened exactly?
The UCIL factory was established in 1969 near Bhopal. It produced the pesticide "Carbaryl" (Sevin). In 1979, a "Methyl Isocyanate" production plant was added to the site. Now, MIC is an extremely toxic gas, which can cause damage by inhalation, ingestion and contact in quantities as low as 0.4 ppm. Proper care must be taken to store MIC because of its ease of exothermically polymerizing and its similar sensitivity to water. MIC, an intermediary in carbaryl production, was used instead of less hazardous but more expensive materials (other manufacturers like Bayer made carbaryl without MIC, though at greater manufacturing costs).
On the night of December 2-3, large amounts of water entered a tank containing 42 tonnes of MIC (during cleaning work; while some claim due to bad maintenance and leaking valves).....causing exothermic reactions and pressure changes leading to a release of large volumes of toxic gases into the atmosphere. The gases flooded the city of Bhopal, causing great panic as people woke up with a burning sensation in their chests. Thousands died immediately from the effects of the gas and many were trampled in the panic.
Various factors complicated the issue.....Besides the poor maintenance and various "money-saving" approaches adopted at the plant, the problem was made worse by the plant's location near a densely populated area, non-existent disaster-management plans and shortcomings in health-care and socio-economic rehabilitation.
Over two decades since the tragedy, many civil and criminal cases remain pending in US district court, Manhattan and District Court, Bhopal against UC (now owned by Dow Chemical Company) with an Indian arrest warrant also pending against Warren Anderson, CEO of UC at that time. As the UC boss, Anderson knew about a 1982 safety audit of the Bhopal plant which identified thirty major hazards. Rather than fix them in Bhopal, only the Company's identical plant in the US was fixed. Neglecting these hazards in Bhopal caused the deadly explosion.
On June 7 2010, seven former employees of UC (all Indian nationals) were convicted of causing death due to negligence and were sentenced to two years imprisonment and fined Rs. 1 lakh (approx $ 2000). All were released on bail (surety of Rs.25,000) shortly after the verdict. APPALLING, to say the least !!!
Surveys and laboratory analyses from water sources around the plant still show contamination of the ground-water (with pesticides). A recent analysis (by BBC) actually showed traces of Carbon Tetrachloride (a liver carcinogen) from a water sample taken from a hand-pump located within a 3-km radius of the plant.
And the main reason why this incident was almost completely ignored for the past two decades is because it had nothing to do with celebrities or well-known politicians or their kith & kin.....but with the "aam-aadmi" (ordinary citizen) of this country.
Kudos to us all!!!!

References: http://en.wikipedia.org/wiki/Bhopal_disaster