How doctors are trapped in the system.

 

Many of my readers complain that I do not point out the deficiencies and faults of doctors that they feel is behind the mess. I do not agree to the extent of the popular perception because I envisage the role of the system in shaping them.

The doctor traditionally became a part of modern medicine because she or he wanted to genuinely help people. Disease had become a part and parcel of society (thanks to the extensive more than a century old small pox vaccine campaign that has a list of 62 adverse effects associated with it), and people were moved enough to study medicine and do their bit to alleviate pain and suffering.

Modern medicine appealed to the heart because it offered an easy way out. Just diagnose a disease based upon a classification of symptoms and prescribe medicines to cure it. It was a short cut compared to the labyrinth of theories offered by traditional methods that required understanding and intuition to understand why the body was expressing such symptoms, and the responsibility of the person to rectify what was wrong in order to recover.

The results were instantaneous at first. The symptoms just disappeared upon medication. The cold vanished, the cough cured, the diarrhoea stopped and pains subsided. What more did one need?

However the first doctors soon found out that the drugs had adverse effects too and they became wary of prescribing. They also studied the alternative views and realized that disease had a cause other than germs and viruses. They mostly waited out the disease rather than stop the process and harm the patient.

They spent at least an hour with every patient trying to understand the cause of disease and if at all they prescribed something it was about bringing a little comfort. Thus their fees were higher than the cost of medications they prescribed. They often fell back on home remedies and prescribed ayurvedic formulations that they observed were very effective.

But then things changed. The pharmaceutical industry had developed medicine as a business model and they were wary of doctors that cared for their patients and wanted cures. Cures are bad for business.

So certain steps were taken. The State run medical colleges were the culprit. Therefore private medical colleges entered the picture in large numbers. State run clinics and hospitals faced competition as private players opened hospitals with all facilities offered for handsome payments. Medical representatives were hired to entice the doctors with handsome commissions against fulfilment of targets.

This was not all. The doctors were reminded that they are but practitioners. They are to obey rules. The rules encouraged long prescriptions and an array of expensive tests that too had handsome referral payments. They were forbidden from prescribing anything other than what pharma came out with. They were well and truly caged.

Still many stayed out of the trap. However with diseases spreading the canard was spread that it required an MD to manage the complications. MBBS doctors became second grade and were shunned by people who wanted to purchase health.

Obtaining an MD degree was easy in private medical colleges. You had to pay through your teeth but you got a degree. Soon there were only MDs and the MBBS disappeared.

The intent to join medicine changed. The increased income made it a good career option. Now people became doctors because their well off parents invested in their children's career hoping for good returns. The rest took hefty student loans hoping to clear them once they started earning.

A good MD degree costs a fortune. Currently you invest over Rs 2 crores. The doctors join swanky private hospitals that pay well. The clinic is now a side business. The doctors depending on their own clinics face a grim future because the general population is attracted by the 5 star hospitals and setting up a clinic is pretty expensive too.

The doctor's position changed too. From practitioner the job profile now was target achievers. MBA graduates rule these hospitals and the doctor receives a long list of targets to achieve to earn that fat salary. The doctors sweat it out as they have loans to repay. Many of them continue because they have adopted high society lifestyles and have high monthly EMIs to meet.

Medicine today is about sales, profits, targets, commissions, incentives, gifts, perks, and promotions. The patient is an opportunity to achieve all of that. Tests are prescribed needed or not, medicines are prescribed needed or not, surgeries are performed needed or not, patients are shifted to ICUs needed or not, hospital bills are high as they contain products and services that are never delivered.

Many patients bear with it because the insurance company pays. The premiums are high but less than the hospital bills. It is another thing that what is purchased, most being not needed, destroys health and also takes life. Those without insurance exhaust their savings, sell their property and go bankrupt.

The system has both the doctor and the patient in their pocket. The governments gain from revenue and look the other way as the economy is important. If the $ 13 trillion pharma empire collapses the economy would collapse and unemployment would reach a peak. Therefore 74% of deaths in society happen to be from chronic disease, 50% of people go bankrupt, and 66.5% lose jobs and go bankrupt because of disease (the last two are US figures; land of the best 'healthcare').

What the doctors are guilty of is not organizing themselves to oppose the obvious harm. But then powerful medical associations exist to punish them and cancel their licence if they do. Privately the doctors dread the mafia and submit.

Doctors wallow in misery because there is no job satisfaction that comes from curing people. Disease management is a cobbler's job. It is stressful and the knowledge that you are not doing any good eats one from within whether one admits it or not.

Faced with this situation the doctors suffer from what has been termed *cognitive dissonance.* They believe in the lies of pharma and pretend that all is well. There is no other way. They cannot live a lie. Therefore they pretend that the lie is the absolute scientific truth. Pharma provides them all the forged studies and outcomes they need to convince themselves.

Currently it appears there is no hope. The doctors are incapable of rectifying themselves. The honest ones know it is impossible to check the dishonest. Many have responded to the adage; if you can't beat them join them. They carry on waiting for the day the entire thing would collapse. That collapse is inevitable and probably very close.

Analysis of the article in Hindi by Dr Umesh Jaiswal.

यह लेख आधुनिक चिकित्सा प्रणाली की गहरी आलोचना करता है और इस तर्क को प्रस्तुत करता है कि डॉक्टर स्वयं इस भ्रष्ट सिस्टम के शिकार हैं। लेख में बताया गया है कि पहले डॉक्टर सेवा भाव से चिकित्सा क्षेत्र में आते थे, लेकिन धीरे-धीरे फार्मास्युटिकल उद्योग, निजी मेडिकल कॉलेजों और कॉर्पोरेट अस्पतालों के कारण चिकित्सा एक व्यापार बन गई, जहाँ मरीज़ों की देखभाल से अधिक मुनाफे को महत्व दिया जाने लगा।

1. डॉक्टरों की मूल भावना और परिवर्तन

लेख के अनुसार, शुरू में लोग डॉक्टर इसलिए बनते थे क्योंकि वे समाज की सेवा करना चाहते थे। आधुनिक चिकित्सा ने शुरुआत में रोगों का सरल समाधान दिया, जिससे रोगी जल्दी ठीक होने लगे। लेकिन जैसे-जैसे डॉक्टरों को दवाओं के दुष्प्रभावों और बीमारियों के मूल कारणों का पता चला, वे अधिक सतर्क हो गए और पारंपरिक चिकित्सा पद्धतियों को भी अपनाने लगे।

2. फार्मा कंपनियों का प्रभाव

लेख में कहा गया है कि फार्मा कंपनियों ने चिकित्सा को एक व्यापार बना दिया, जिसमें स्थायी इलाज देने के बजाय सिर्फ रोगों को प्रबंधित (Disease Management) किया जाता है। “इलाज” उद्योग के लिए घाटे का सौदा होता, इसलिए दवाओं को इस तरह डिजाइन किया गया कि वे लक्षणों को दबाएँ, न कि रोग को जड़ से खत्म करें।

3. मेडिकल शिक्षा में बदलाव

राज्य सरकार द्वारा संचालित मेडिकल कॉलेजों की गुणवत्ता को गिराया गया और निजी मेडिकल कॉलेजों की संख्या बढ़ाई गई, जहाँ मोटी रकम देकर डिग्रियाँ खरीदी जा सकती थीं। एमबीबीएस डॉक्टरों को कमतर आंका जाने लगा और एमडी की मांग बढ़ा दी गई। इससे चिकित्सा पेशा सेवा के बजाय निवेश और लाभ का साधन बन गया।

4. डॉक्टरों पर दबाव और टारगेट

लेख के अनुसार, निजी अस्पतालों में डॉक्टरों को अब “प्रैक्टिशनर” के बजाय “टारगेट अचीवर” बना दिया गया है। एमबीए ग्रेजुएट्स द्वारा संचालित अस्पतालों में डॉक्टरों को महंगे टेस्ट लिखने, गैर-जरूरी सर्जरी करने और अधिकतम बिल जनरेट करने के लिए मजबूर किया जाता है। बड़े लोन और हाई-स्टैंडर्ड लाइफस्टाइल के कारण डॉक्टर इस जाल में फंसते चले जाते हैं।

5. चिकित्सा प्रणाली और समाज पर प्रभाव

• स्वास्थ्य बीमा कंपनियों और अस्पतालों के गठजोड़ ने मरीज़ों पर आर्थिक बोझ बढ़ा दिया।

• जो बीमित हैं, वे महंगे इलाज का खर्च वहन कर सकते हैं, लेकिन जो नहीं हैं, वे कर्ज में डूब जाते हैं या संपत्ति बेचने पर मजबूर हो जाते हैं।

• सरकारें भी इस प्रणाली का समर्थन करती हैं क्योंकि फार्मा उद्योग से भारी राजस्व आता है और अर्थव्यवस्था इससे जुड़ी होती है।

6. डॉक्टरों का आंतरिक संघर्ष और निष्कर्ष

लेख में यह भी कहा गया है कि डॉक्टर खुद इस सिस्टम से परेशान हैं, क्योंकि वे जानते हैं कि वे मरीज़ों का वास्तविक इलाज नहीं कर रहे हैं, बल्कि सिर्फ रोगों को नियंत्रित कर रहे हैं। इससे वे मानसिक तनाव (Cognitive Dissonance) के शिकार हो जाते हैं और धीरे-धीरे सिस्टम को सही मानने लगते हैं।

अंत में, लेखक भविष्यवाणी करता है कि यह पूरी प्रणाली अस्थिर है और जल्द ही ढहने वाली है, क्योंकि यह टिकाऊ नहीं है।

क्या डॉक्टर पूरी तरह दोषी हैं?

लेख का मुख्य तर्क यह है कि डॉक्टर व्यक्तिगत रूप से पूरी तरह दोषी नहीं हैं, बल्कि एक संगठित, व्यावसायिक व्यवस्था का हिस्सा बन गए हैं, जिससे बाहर निकलना मुश्किल है। लेकिन लेखक यह भी मानता है कि डॉक्टर संगठित होकर इस भ्रष्ट व्यवस्था का विरोध नहीं कर रहे हैं, जो उनकी एक बड़ी गलती है।