In Dubious Health

How did your exam go, I remember  asking a close friend the day he finished his MBBS finals. A guy with a funny bone, he said, “I should get a distinction in surgery because I am marrying the HoD’s daughter.” There was a mischievous glint in his eyes, but we felt envious. “You’ve got it made, mate,” we said. The HoD owned a nursing home and his son-in-law could inherit his flourishing practice. So we were surprised when our friend went off to the Armed Forces Medical College (AFMC), Pune, to do his postgraduation in orthopaedics and then joined the Army Medical Corps.

Why the army? “Because army men are likelier to break their limbs and ensure a steady stream of patients,” he deadpanned. He rose quickly and acquired a reputation as a fine surgeon. I learnt this when, years later, we found ourselves both posted in Lucknow. Army personnel from afar would camp in Lucknow to be operated by him. When he received a decoration, I mischievously, and loudly, asked him at a party if he’d treated the defence minister’s wife. He laughed, but a colleague of his was offended, and told me that I should have known that before my friend was posted in Lucknow, the inf­ection rate in the army hospital was as high as 80 per cent; within three months of his joining, it was down to zero.

After a decent interval, I asked him sheepishly how he’d done it. “It’s nothing really. I follow the basics. Many doctors don’t,” he said with a wave of his hand. When he was posted at the defence HQ as deputy director-general (procurement), I asked him why he’d taken an administrative job. Cheerful as always, he said, “Somebody has to do the job and I have the domain knowledge to decide what is needed.” But in less than a year, he’d sought and obtained a hospital posting. He warded off questions, saying, “I realised it’s not my cup of tea.”

A year later, he reluctantly shared his experience. He’d not bargained for the corruption in even routine purchases. His objections to high prices, low quality and undesirable suppliers were resisted. “The joint secretary,” he shared, “would strike deals with suppliers, bulldoze their bids at meet­ings and then write on the file that fur­t­her negotiations should be conducted to seek lower prices or more favourable terms.” A clever alibi, should an inquiry be held. Luckily for my friend, he took early retirement and busied himself tending his garden.

As a journalist, one did hear of  pharma firms offering doctors junkets and expensive gifts. I remember a dis­traught pharma sales manager shar­ing a message from his headquarters. Several lots of expired medicines were being sent to him, it brazenly said, for distribution in government hospitals. Unethical practices are ram­pant but very little is reported. These days, pharma firms, I’m told, even sponsor articles in medical journals: they get articles published for doctors playing ball, ensure invitations to seminars and build up their practice. “We’ve been reading for years how beneficial red wine is for the heart,” says a doctor, laughing, “but it now seems several doctors promoting the so-called research either owned wineries or had shares in them.”

I once found Dr Devi Shetty, the cardiac surgeon, using imported distilled water and wondered why he couldn’t use the Indian stuff. He wordlessly produced four bottles from his cabinet and pointed to foreign bodies in all of them. Quality control in India, he said, left a lot to be desired.

The Medical Council of India (MCI), confides the secretary of a private medical college, expects the doctor-teachers in place before giving approval for admissions. “We have no option but to rely on brokers who arrange for doctors and equipment for the MCI inspections. They all go back the next day,” he confesses. Laughing at my horrified expression, he adds, “One doctor even held a press conference to complain that he’d not been paid what was promised.”

Photograph by Tribhuvan Tiwari

Another doctor confirms that MCI inspections are farcical. Knowing how a muster of teaching doctors is conjured up for MCI inspections, while inspecting a medical college in Maha­rashtra, he called for their income-tax deduction certificates. The management said the doctors were paid less than Rs 1 lakh a year, therefore no income tax! When he inspected the ope­ration theatres, the equipment was gleaming—straight from the dealers! And when he checked the operations register, there was only one doctor’s name and mentioned a few minor operations. The explanation: the other doctors didn’t have the patience to fill up and sign the register! An adverse report, the MCI inspector says, is no deterrent. A fresh—and pliable—team is sent after an interval and the college gets clearance. Scores of such medical colleges, he says, are run by politicians.

The country is short of doctors. With only about 50,000 MBBS seats available, an expert group had recommended that the country needs to immediately set up 187 more medical colleges. But can these medical colleges be set up? When I told a  medical superintendent at Apollo Hospitals that the Tatas were keen on setting up a medical college, he dismissed the idea. I insisted I was privy to a discussion between the MD of a Tata company and a vice-chancellor, but he just laughed. “I get calls every month from several private medical colleges req­uesting me to just forward the CVs of doctors eligible to teach. Believe me when I say it’s not easy to get a professor of anatomy (a first-year subject),” he declares. The CVs were apparently for the files to be presented at MCI ins­pections. In Chandigarh, a senior doctor at the Postgraduate Institute of Medical Sciences confirms that there are doctors who make a pile simply going round the country offering their expertise for inspections.

I recently spent several hours at the All India Institute of Medical Sciences (AIIMS) in Delhi. The number of patients was scary. But what I had not bargained for was the professionalism of at least half a dozen young doctors, who examined me, asked crisp questions, admonished me for not rolling my eyeballs when directed, wrote out reports and gave instructions. It was very impressive and made me reflect that all’s not lost. The old question also reared its head. Why are there so few medical colleges and hospitals which inspire confidence?

Not too many big, transformational ideas have cropped up in this country to revolutionise medical education and healthcare. Doctors will have to force the system to change and bec­ome more ethical. They can’t expect bureaucrats and politicians to do it for them.