One of the main tenets of the Hippocratic oath that all doctors take is primum non nocere — “first do no harm”. While the parents in this case may have been able to prevent any life-threatening complications, even a small mistake on the operator’s part could have led to lifelong morbidity if any of the internal organs were injured, as is known to be a risk in caesarean sections. This particular case, and numerous others that are regularly reported, only highlight the increasing trend of the conversion of the “noble profession” into one of unabashed self-centredness.

Today’s doctors in general are far from being “the natural attorneys of the poor”, as conceived by Rudolph Virchow in the 1850s. Entry into medical colleges is becoming increasingly easy for those who have the money. Undergraduate seats are sold for Rs 15 to 30 lakh while post-graduate seats go for up to a crore, depending on the speciality. The field itself is becoming more and more technology-driven and technology-dependent. Most diseases are sought to be treated by industry-driven “magic bullets”. The focus is on smaller and specific parts of the body rather than on the individual as a whole. The socio-economic context of disease is completely ignored. In the earlier days, one heard of the reward of doctors as being “pots of gratitude”; today, one would be looking for “pots of gold”. In such a situation, the medical profession has become just one more way to make money — lots of it — and to “win the race”. Medical knowledge is becoming more dehumanised and disconnected from the realities of patients’ lives. This has led to the patient being perceived more in terms of “diseased organs” or “interesting syndromes”, and less as a human being, which allows a systematic disregard of patients’ rights.

The overuse of antibiotics as well as tonics and vitamins, unnecessary surgical procedures such as hysterectomies and unindicated caesarean sections, unnecessary expensive diagnostic tests — these are all industry-driven medical practices that can, in fact, harm patients

While only dramatic cases such as the one quoted in this article are reported, and lead to the occasional highlighting of the problem, the much more common unethical and irrational practices go largely undiscussed and are even considered normal practice by most unsuspecting patients.

The fact that a 15-year-old non-doctor could do a caesarean is not necessarily surprising. In many countries of Africa there are numerous programmes where village-level health workers and nurses have been trained in performing caesarean sections in regions where there are no doctors. But the aim in these cases is the saving of life in remote circumstances, not the whim of an individual. Practice of medicine in such a whimsical way, with or without the consent of the patient, is totally unacceptable. That such an event could occur reflects on the dysfunction ailing the profession.

While doctors seem to be increasingly ignoring the rights of patients in day-to-day practice, it is of continuing concern that subjects like medical ethics and patients’ rights don’t find themselves on the curriculum in medical colleges, and if they do, they are taught most disinterestedly. Thus ethics and patients’ rights are not only violated, they are not even inculcated in doctors in their formative phase.

The rights of the patient have been enshrined in numerous declarations. The World Medical Association in its Declaration on the Rights of the Patient (www.wma.net/e/policy/14.htm) has defined many rights including the right to medical care of good quality, right to freedom of choice, right to self determination, right to information and right to confidentiality. The Indian legal system has provisions in the Consumer Protection Act as well as in the Indian Penal Code that provide for redressal to patients whose rights have been violated. The Medical Council of India also defines the code of conduct of a physician (http://mohfw.nic.in/code.htm) and accepts complaints against individual physicians. However, they seem to provide little protection to patients in general.

Thanks to the tremendously mystified nature of medicine, and its instinctive identification with “modern advanced science” which is seen as inherently good, patients are usually powerless in the doctor-patient relationship. In addition to this, the tremendous trust we repose on the years of education, the white coat and the stethoscope, ensure that even if the doctors are brazenly unethical patients may not even suspect it.

Even where patients are aware that their rights are being trampled upon, they rarely attempt any action due to the already vulnerable state they are in due to their illness, the lack of alternatives, and the general inertia of the redressal mechanisms. This has led to an inefficient and decrepit public health sector and a totally unregulated and callous private sector. While such violations of patients’ rights are prevalent in the public as well as the private sectors, they are equally rampant in the so-called “informal” sector of unlicenced practitioners. It is a truism that the presence of this informal sector is due to the lack of access to formal medical systems for a large numbers of patients, which in itself is a violation of their rights.

In an extremely iniquitous society like India, every group of people that benefits from an unjust system is looked upon with resentment and suspicion. The medical profession is no exception. Regardless of the presence of extremely dedicated and competent doctors, the collapse of the public health system, the migration of doctors and other health workers from the public to the private sector, the exhibitionism of personal wealth by most doctors, unethical and irrational practices and the spineless alignment with the pharmaceutical industry have all led to a growing crisis of confidence in the medical profession.

What is required are concerted attempts to enable patients to demand their rights and strengthening mechanisms to protect these rights when they are violated. This can be brought about by facilitating widespread awareness of issues in health care, developing an attitude in the minds of people that what the doctors are providing are not charity but their right, and more awareness of the various dimensions of patients’ rights. While some attempts have been made in the West with efforts like the introduction of patient pages in most medical websites and journals, similar efforts and more have to be made in India. It would be ideal if doctors and their professional associations realise this and make the necessary amends proactively. If that does not happen, civil society and health movements will have to step in and force the government to protect the health of society from being held at ransom by the whims of a profession led astray by the lust for profit.

Gaitonde is a community health researcher and practitioner

Source : http://www.tehelka.com/story_main31.asp?filename=op070707black_under.asp