From Hippocratic to Hypocrite

Analyze this. A friend of mine took his brother in law for a heart check up since he was complaining of uneasiness in his chest. A routine ECG performed on a fit 37 year old rang a few alarm bells. Further tests proved to be worse; the situation turned out to be very complex with the person requiring some 12 grafts. The consulting doctor asked for the person to be admitted to a hospital (let's call it hospital A) immediately and ordered administration of blood thinners till such time the operation could be performed.

Naturally; my friend's family made calls to some of the best heart surgeons in the City and this is what they experienced. The preferred surgeon (let's call him Dr. X) outright communicated his regrets to even review the case for at least 3 weeks despite it being an emergency. At the insistence of the consulting doctor; Dr. Y agreed to meet to discuss the case. On reviewing the papers Dr. Y called the consulting doctor and gives him an earful with a couple of swear words thrown in for good measure. "What case have you sent me? You said this was a simple case and I thought I will be done in a couple of hours. This is such a complicated matter which may require a day worth of surgery plus lots of study time. You know I have commitments. Anyway; I am examining this just because it's you who have sent it; and by the way I love your ring tone - send me the link." How nice - D2D friendship in play; and all of it in front of the concerned family that is sitting before him in agony with bated breath. He turns to my friend's family and tells them "You have actually reached me at a very bad time. See; there is a wedding in my family coming up  - which will keep me occupied for the next 15 days and I need at least a week to study the case. So effectively, the earliest i would be able to operate would be in 30 days". "But Doctor! he may not survive 30 days" is what my friend said. "Young man; are you God? It's up to God to look after him for 30 days and then it's my job to save him after that. If he has to go sooner then it is God's will. Now let assume for a moment I operate without the required preparation; he certainly will not survive. the odds are stacked against him. So; make up your mind in the next couple of days. You see; if there is anyone who can save him apart from God - it's me and God will not be the one performing the surgery; I will. Actually; to be honest with you; if it was left to me - I would advise you not to go through with the operation". the words were shocking coming from him.  "See, there is a less than 50:50 chance of his survival and irrespective of the result; you will end up paying me an amount that would buy me a Rolls Royce. So the cost benefit analysis really does not work in your favour". He could not be serious saying all this. "Your choice. If you do decide to go through; then please deposit a cheque of Rs. 3 million with my secretary on the way out - and the rest of the amount will have to be paid before the operation in........ you understand" he said pointing to the cash counting machines (yes machines) in his office.

My friend's father was hysterical when he left the consulting room, not able to believe all what he had heard. My friend decided that whatever happens; Dr. Y would not be the operating surgeon. A day later he called up a very influential friend in our circle (call him Mr. J) and he got an appointment scheduled with Dr. X in 3 days time. (Yes the same Dr. X from paragraph 1). "Why did you not tell me you were friends with Mr. J? I would have seen you that day itself - even if it was very late. Never mind, now that we all are here, let's see what the matter is" He went through the papers and kept shaking his head sideways and compressing his facial muscles in disapproval. My friend's family expected a repeat performance of what they experienced in Dr. Y's office. Fortunately, they were spared that line of speech - maybe because they were referred to him by Mr. J. "Look; I am sure you know it but the case is very complicated, and I don't really know what will be the result till I actually start operating. It will need at least 12 to 14 hours and we will schedule the operation in 7 days time. I cannot guarantee anything; and please don't expect any miracles. There is also a chance that he may not be able to live his life the way he is used to now even if he survives. But, he is in my hands and I will try my best to keep him alive first if that is possible. Meet my assistant and he will help you with the process here on. Since this is a special request; you do understand that there would be special fees under the circumstance. I operate in hospital B so let's arrange to move him from hospital A at the earliest". My friend nodded and decided to engage the more humane "God of Life". He wondered what options would he be left with just in case Mr. J had not exerted his influence to get the appointment with Dr. X; or what if an ordinary person with limited financial resources had come across Dr. Y? There was so much anger and disgust in his voice at the authoritative arrogance with which both the doctors discussed the case with him and his family showing scant respect for any kind of sensitivity to what the family may be experiencing at the time.

They called up hospital A for a discharge of the patient and reasons for the same. Hospital A declined to discharge the patient for another 3 days as the hospital wanted to run pre-discharge tests since the person admitted was in a critical condition. No amount of argument including waiver of liability worked in the matter. On discharge a bill amounting to exhausting the entire "mediclaim" (Medical Insurance) limit was handed over to the family. The "joys" of cashless hospital bill settlement. Anyway, the person was shifted to hospital B where preop. procedures were initiated 48 hours prior to surgery. There was relief in the mind of the family on "D" day that at least  the ordeal would be over one way or another in the next 24 hours. An hour prior to surgery time; the family gets a call from the hospital that the operation cannot be performed as the patient's liver is not in good shape and can create postop, complications. So, it would be rescheduled by at least 8 or 10 days till the liver condition stabilized. All that the family can do now is wait.

My own father went through a surgery late last year. The operation was to be a simple one when he went in to the OT (Operation theater) but turned out to be a rather complex one that sapped half a day. Since the attending doctor was an aunt of mine; I know the situation to be genuine. Fortunately for me; I did not face the likes of Doctors X & Y; but a humane old school surgeon for whom life came first and foremost. For me; the operating surgeon became a God for giving my 83 year old father an extension of life. My experience with the hospital (one of the best in Mumbai) was not that great. My father is one of those guys who hates taking pain killers and other medications that he deems harmful for his body - being an alternative medicine practitioner. the minute his senses revived and he was pushed out of ICU; he asked the nurses on duty what was being administered and why. he asked them to stop all what was unnecessary and under the doctor's nod those were stopped. When I discharged him I brought home a small pharmacy with me consisting of all the medicines that were indented from the store but not administered. My father thought of donating them to a charitable hospital run by "Lion's Club"; but by law medicines cannot be accepted in such way. I had not chosen the cashless route and my bill was within tolerable limits which I thought the insurance TPA  (Third Party Administrator) would clear without a bother. I was wrong; the TPA handed me a cheque of 60% of the billed amount.

Hospitals were once considered the temple of life and Doctors the representatives of God on earth. It was also accepted that there are good doctors and bad ones. The good ones saved lives and kept you healthy and the bad ones would misuse their learning to do the unthinkable. Today; the hospitals are increasing being looked at as "House of death" and doctors the refined "butchers" which they once were. (Modern medical practices have origins in this trade).  While I may have had the good fortune of accessing a great doctor and a reasonable amount of fleecing by the hospital; it has left me wondering where is the health care segment headed and why. Has the entry of private insurance companies actually driven up the cost of treatment in private hospitals? Has the high cost of medical education turned the Doctor into a financial analyst who decides on who will treat based on an IRR (Internal Rate of Return) basis rather than need? Are the Doctors now becoming more of a salesperson for the pharmaceutical industry by over prescribing tests and expensive medications even when not really needed? Is it us as a society; so used to buying favours with money that has killed the medical fraternity's conscience?

We may say what we want but at some stage we have no choice but to put our lives in the hands of a doctor and despite everything accept the consequences - good or bad. My friend is not alone in having encountered a doctor who seems to have forgotten the Hippocratic Oath. Maybe the medical profession - in keeping with the time have re-written it as the "Hypocrite's Oath" where life is commodity and only thing that matters is money.