How commercial forces have transformed doctors from caregivers into revenue generators, eroding public trust
By Fiaz Fazili
As a collective whole, doctors are regarded as noble professionals both by society and by their peers. They remain the most trusted profession among the public, which has been the case for many years. Why are doctors no longer considered as noble as they used to be? I have a few points to make.
Corruption within the medical profession can have serious consequences, as it can compromise patient care, undermine trust in healthcare systems, and lead to suboptimal health outcomes. Several factors contribute to the entry of corruption into medical practice, and there are remedies to address these issues. This piece explores some common causes and remedies for corruption in the medical field.
The death of empathy in medical practice
Today, looking back at the most profound part of my identity and purpose, I find medicine at a crossroads due to the indiscretion and dishonesty in which consumerism, commercialisation, and moral degradation have engulfed the medical profession. The term healing has taken a big hit; going to hospitals is not without the fear that a doctor is no longer considered a “messiah”.
In the first place, from time immemorial, medicine has not been a money-minting profession, but in their day-to-day practice, doctors are committed to integrity, compassion, altruism, continuous improvement, excellence, working in partnership, and empathy with patients, families, and members of society. Have those oath-practising professionals kept the Hippocratic oath in abeyance? Where do you say “yes”, and where do you refuse to compromise on conflicts of interest, exploitation of name, fame, and finances? Where do you draw the line and say, “No, this is my limit of what I can / can’t do”?
Awareness about the nexus between pharmaceutical companies, diagnostic centres, and corporate hospitals is widespread; the pressure on doctors to prescribe as many costly investigations and tests as possible, and to perform indicated or non-indicated interventions to earn a pre-specified revenue for their hospitals, is common. Sometimes, such stories pile up one atop another, and some read like stray gossip, which, even if true, I find hard to swallow. The idea that senior doctors, regarded as icons (names withheld), indulge in unethical practices is shocking to me.
How many doctors working in five-star hospitals shortchange patients to keep management happy and enrich their own pockets? Involving healthcare workers in malpractice has long been an area of concern and importance. However, we still need to understand how patients perceive undesirable events of exploitation during their hospital stay—getting charged a percentage on total hospital bills, kickbacks when doctors prescribe tests (the laboratory conducting those tests receiving commissions), unnecessary surgeries, emergency interventions on the virtual dead body, or charging patients large amounts for ICU beds, consumables not even used, prescribing drugs outside price controls to claim higher margins, frequent unnecessary visits, doctor’s fees, and the costs involved in being on the panel of a prestigious hospital. There is give-and-take involved, with separate billing codes used to inflate bills and generate commissions, as has been reported in the media.
Where do things go wrong in diagnosing the malady? To be a doctor in medicine is a dream to be achieved and a goal to be cherished. It was a real source of enthusiasm and joy when I joined medical college, being among the privileged few selected from thousands of aspirants into this noble profession. An opportunity to contact humanity, understand pain and suffering, and motivate oneself to address it creates positives in your career.
Why I lost my good name?
Our identity as noble professionals is built on morals, values, behaviour, ethics, and relationships that underpin the trust the public has placed in doctors as “healers”. The commercial forces have steadily encroached upon our understanding of medicine and health, causing the moral foundations of the medical profession to lose their influence on physicians’ behaviour.
In some regions, regulatory oversight of healthcare providers may be insufficient, allowing unethical behaviour to go unchecked. Low salaries and inadequate reimbursement for medical services can lead some healthcare professionals to engage in corrupt practices to supplement their income. Lack of emphasis on ethics and professionalism during medical training can make practitioners more susceptible to unethical conduct.
The influence of pharmaceutical and medical device companies—through gifts, incentives, and sponsorships—can compromise clinical decision-making. Underfunded, overburdened healthcare systems, with low salaries and inefficiencies, may create an environment where corruption becomes a means of survival for healthcare professionals.
Remedies:
– Strengthen Regulation: Implement and enforce stringent regulations and oversight mechanisms to hold medical practitioners accountable for unethical conduct, including regular inspections and investigations.
– Fair Compensation: Ensure healthcare professionals receive fair and competitive salaries, reducing the financial incentives for corruption.
– Ethics Training: Incorporate ethics and professionalism education into medical curricula and provide ongoing training for practising healthcare professionals.
– Transparency and Accountability: Promote transparency in healthcare transactions, such as drug procurement and hospital administration, to reduce opportunities for corruption. Encourage reporting of corrupt practices and protect whistleblowers.
– Reducing Pharmaceutical Influence: Implement policies to limit pharmaceutical companies’ influence on practitioners, encouraging evidence-based prescribing and discouraging unnecessary or biased use of medications and devices.
– Strengthen Healthcare Systems: Invest in infrastructure, improve resource allocation, and reduce bureaucratic red tape to minimise corrupt practices.
– Public Awareness and Advocacy: Engage the public in understanding the consequences of medical corruption and promote a culture of accountability. Encourage patients to ask questions and demand transparency.
– Professional Associations and Peer Review: Medical associations can play a crucial role in setting ethical standards, conducting peer reviews, and holding members accountable.
– Whistleblower Protection: Ensure whistleblowers are protected from retaliation and have legal recourse against those seeking to harm them.
Addressing corruption in the medical field is a complex and ongoing process. A combination of legal, ethical, and systemic changes is necessary to reduce its occurrence and maintain trust and integrity in healthcare systems.
Now, the doctor-patient relationship is that of a service provider and consumer.
Initiating the Cure
Medicine must evolve from business-centric care to patient-centric care.
What needs to be done?
Public-private partnerships (PPPs) in healthcare in India have seen a growing trend, with reputed multispecialty brands providing transparent, affordable care—moving away from multistorey hotels and catering outlets. The skills, talent, and competency of our own doctors are comparable to those from outside; our hospitals, including private ones, are still more affordable and resist profiteering through unfair means. Try them first before venturing outside—believe me, there is much exploitation outside, which most of us do not understand until we become victims of the commercialisation of health.
In the end, we cannot outsource or buy our way to the solution. Our identity as noble professionals is rooted in moral values, behaviour, ethics, and relationships that underpin the trust the public has placed in doctors as care providers or healers. I am a doctor, but I am also a patient. I was born in this land and will continue to fight for a collective responsibility so we can make the system honest and fair, restoring trust and integrity in me and my profession.
How soon?
The choice is ours.
The writer is a Senior Consultant Surgeon and an expert on healthcare policy, planning, and standards to improve patient care.
dr**********@***il.com