Trust-Deficit, Bane of Modern Medical System by R. Chandra Prakash

Dr. B. M. Hegde, former Vice Chancellor of Manipal University, had once said “Faith in a Doctor Cures the Patient Fast”. A lot of research is being carried out in fathoming the mysteries of Mind in determining the body responses in a given situation. Placebo treatment, treatment of so called psycho-somatic problems like hypochondria, and providing emotional support to the terminally sick are some of the examples.

But this ‘Faith in a Doctor’, which in other words the ‘Trust in the Doctor’ so central to medical care, is in deficit these days.

Commercialization of Health Care

Medical system in the developed countries have undergone fundamental transformations. Medical research has revolutionized each and every medical field. United States of America has been leading the world in medical research, be it drugs,  or technological support or even medical education.  United States  being a predominantly a private sector oriented economy, health care has remained in the private domain. It could also be the reason for great strides in every medical field. Situation is not much different in Canada and many European countries which are  moving away from the state sponsored health care system. Consequently, Medical Insurance plays critical role in the health care industry of these countries. Obviously, health care  is nowadays commercialized profession.

Under these circumstances how far medical practitioners are capable of fulfilling their Hippocratic Oath, [
A pledge to prescribe only beneficial treatments, according to his abilities and judgment; to refrain from causing harm or hurt; and to live an exemplary personal and professional life], is only a matter of conjecture.

Tip of the Ice-Berg

Getting vaccinated is a routine practice in most of the developed countries. People get routinely vaccinated as a preventive measure against several seasonal illnesses. Health care system world over carries out vaccination against life-crippling diseases like Polio, Tuberculosis, Hepatitis, etc. But the cause for the  trucker’s devastating strike in Canada a couple of years ago, which  had led  to imposing of Emergency in the state of Ottawa, was Corona virus Vaccines. The truckers were asking two questions: 1: ‘How do we know Corona virus vaccines are safe?’ 2: Are there no other better treatments?’ Even in the United States of America citizens in millions had refused to get vaccinated, or even wear masks. There were similar protests even in few European countries.

Truckers’ revolt was only  a tip of a huge trust-deficit in the entire health care industry. And this trust-deficit is not confined to  corona virus vaccines alone, but is spread across the entire spectrum of western medical system. The situation is no  different in India.

Indian Scenario

India has been witness to a gradual dismantling of government’s  free health care  support to the citizens. This has lead to systematic increased privatization of medical services. Some of the government schemes like Ayushman Bharat Yojana, are  trying  to enable the poor and the lower middle class  to access the private medical care.

However, one cannot shy away from the fact that the government’s health care system is crumbling due to bureaucracy and all round deterioration of moral values. At the same time the commercial health care system is equally guilty of practicing ‘pure profit’ orientation over ‘service’. Therefore, the plight of the sick is proverbial ‘between the stools’.

Cost of  Medical Education

As per the Economic Survey 2019-20 there is a shortage of doctors in the country and the doctor-population ratio is 1:1456 against the WHO recommendation of 1:1000. No surprise that there is great demand for medical education. But due  to limited seats and very high cut off merit bench marks in government run institutions, and high costs of privately run medical educational institutions,  today more than 20,000 Indian students are found to be in war torn Ukraine pursuing medial education.

Now the doctors have to acquire higher degrees to become very minutely specialized. Consequently, there are multiple specialists for a single body part. There are Consultants, Interventionists and  a Surgeon specialized in individual body parts. Each one of them undergoes a long period of specialized education and training. The socio-economic costs of such long and specialized medical education and  training for a developing economy like India are very high. By default they inject unethical medical practices.

Practices being “Unethical”

Medical students are taught Generic names of medicines, however as doctors it is the brand names that are prescribed. Even when government supplies Janaushadhi generic medicines which it claims to be of equal quality standards and  cost as low as 10% to only 50% of the prices of their branded counterparts, (which are boons to patients with life-style diseases such as diabetes and hypertension), doctors prefer to prescribe branded medicines. How far this practice is within their Hippocratic Oath is anybody’s guess.

Very recently, Supreme Court ruled that “medical practitioners were forbidden from accepting “gifts” and  “freebies”. It was  disallowing  Rs.4.72 crore  of a  pharma company incurred towards gifting freebies such as hospitality, conference fees, gold coins, LCD TVs’, fridges, laptops etc to medical practitioners  “for creating awareness about the health supplement manufactured by it” claimed as an expenditure item in the business account while calculating the tax on profits. Public knowledge of such nefarious practices sabotage the trust of the patients in the entire medical profession.

Use of modern diagnostic tools and methods are common practices. But when such investigations become suspect due to underhand dealings between the practitioner and the diagnostic labs, the faith in the medical profession gets corroded. But it is common knowledge that some labs do give cut backs, and sometimes their results might even be tilted against the patients.

The Bench Marks on many diagnostic norms are themselves suspect these days. The ‘healthy levels’ of Blood Pleasure, Blood Sugar, or even Cholesterol are nowadays suspected to be manipulated to favor the pharma companies.  They do endanger the trust in the health care system.

Seeking “Second Opinion” has become a common practice among the patients and their caretakers. This is nothing but expression of lack of faith in the first diagnosis.

Expiry dates on the drugs is yet another area of suspicion. There is an awakening that drugs do not lose their potency, but shorter expiry dates help in keeping the manufacturing process, and consequently the  profits, rolling.

In nutshell, trust-deficit sabotages the delicate link between the patient and the medicine. When faith is lost, even the best medicine might not become effective. One cannot but fully agree with Dr.B.M Hedge that Mind is as important, if not more, as Medicine.

Though one should hasten to add that there are doctors who are wedded to their Hippocratic Oath and are rendering yeomen services to the society. I have  several decades long personal relationships with stalwarts in the medical profession, and I have no hesitation in stating that  Mysuru is  lucky in having a living  tradition of such illustrious medical practitioners who have been practicing their profession in a manner which enhances the Trust of patients.