Regd Office: c/o Manisha Gupte, 11, Archana, Kanchanjunga Arcade, 163, Solapur Road, Hadapsar, Pune. 411028, India
t: 020 6875058 w: www.mfcindia.org e: masum@vsnl.com
The National Office bearers, June 12, 2012
HQ Indian Medical Association
New Delhi
Dear IMA office bearers,
We are writing this letter in context of the apology recently demanded by IMA from actor Aamir
Khan, regarding the episode on 27 May 2012 of his show ‘Satyamev Jayate’ (SJ) dealing with certain
practices of the medical profession. We write to you as members of Medico Friend Circle (MFC,
www.mfcindia.org) and Forum for Medical Ethics Society (FMES). MFC is a nation-wide, 39 year old
platform of pro–people doctors and health professionals, scientists and social activists, involved in
improving health care, especially for the deprived sections of people. FMES is an association of doctors
and health professionals which has been actively campaigning for reform in the healthcare system and
medical education, and has been publishing the Indian Journal of Medical Ethics since 1995.
We very much appreciate that you want to uphold the dignity of the medical profession. However we feel
that denying or minimising the importance of the issues raised by this show and demanding an apology
from Aamir Khan is definitely not the most appropriate way of upholding the dignity of doctors. Instead,
IMA should seriously try to reverse the current widespread unregulated commercialisation of health care
in India, and should contribute to the process of health system reforms for eliminating the distortions in
medical practice. This would be immensely beneficial to patients and would also raise the dignity of the
medical profession manifold. Instead of ‘silencing the messenger’, we need to listen to the main message
of this show and take steps to address problems which are very real.
We would not go into the details of the content and form of this show. We would rather point out that the
critical issues raised regarding cut practice and commissions, irrationality in investigations and surgical
practices, distorting influence of pharma industry on prescribing by doctors, and inflation of patient bills
consequent to all of these, are extremely widespread. This has resulted in massive problems related to
both cost and quality of medical care for the people. There is no point in dismissing these issues as just
being related to a few ‘black sheep’ in the profession. Besides the evidence from various studies on
cesarean section rates, injection practices, prevalence of hysterectomies and sex selective abortions etc.,
most practising doctors admit in private that malpractices are a pervasive trend and not limited to a few
isolated individuals. In fact distortions in medical practice induced by unregulated commercialisation
have become systemic problems.
Given this reality, let us move beyond the ‘few rotten eggs’ type of defensive arguments focused on
individuals, and look at the systemic problems which include-
· Astronomically high ‘donations’ charged by mushrooming capitation fee medical colleges is a
major influence which is pushing crass commercialisation of medical practice, besides placing
medical education beyond the reach of many deserving poor and middle class students.
· Widespread cut practice, intense competition and defensive medicine are causing
dissatisfaction among many doctors, not only their patients.
· Pressures are imposed on doctors by hospitals, inducing them to advise more than necessary
investigations, procedures, intensive care admissions, hospital stays.
· There are continuous tensions between doctors and patients over payment issues, and even
occasional outbreaks of violence against hospitals.
medico friend circle
Regd Office: c/o Manisha Gupte, 11, Archana, Kanchanjunga Arcade, 163, Solapur Road, Hadapsar, Pune. 411028, India
t: 020 6875058 w: www.mfcindia.org e: masum@vsnl.com
These are serious problems going beyond just a few individuals, which are a product of the increasingly
commercialised, market oriented nature of medical care in India today.
As good physicians, if we go beyond just addressing the ‘symptoms’ and make a ‘comprehensive
diagnosis’, it will be obvious that all these disturbing features are due to a system of unregulated
commercialisation of medical care, which has emerged over the last few decades. Instead of being
foremost healers and protectors of their patients’ health, doctors are increasingly forced to become hardnosed
businessmen, often in order to repay large scale loans, to ensure their practice, and to remain ‘in the
system’ despite the fact that many would not have liked to depart from their principles. In this situation,
the increasing numbers of 'black sheep' - and much larger numbers of ‘grey sheep’- are the inevitable
products of this system. Of course there is a role for individual responsibility, but such an entrenched
system cannot be changed just by giving moral lectures to individual doctors, by asking them to follow
rational principles in isolation. Instead of this, large numbers of discontented individuals, doctors as well
as ordinary citizens, need to come together and start changing this system through a large scale social
process.
Of course, commercialisation and linked distortions are seen in all professions. But doctors' organizations
are best placed to reform the medical profession and health care sector, thereby contributing to wider
social reform. In fact IMA’s stated objectives include “improvement of Public Health and Medical
Education in India”. Hence we would suggest that instead of rubbishing the SJ episode and ignoring its
main message, IMA should treat this as a ‘wake-up call’ for the medical profession as well as for wider
society, and we should all start a process at two levels. We need to initiate social regulation of medical
practice (which would include elements of self-regulation by the profession and active involvement of
citizens, not just bureaucratic regulation) to ensure rational care and patients rights. Further linked to this,
we need to move from a market-centred model of health care, towards a socialised system of universal
health care.
This letter will not go into details of how such social regulation of medical practice and further, a system
for universal health care (UHC) might be developed in India, which could ensure decent and secure
livelihood for all doctors (though not super-profits for any!) and access to good quality, free health care
for all residents of the country. IMA office bearers would be aware of UHC systems which are
successfully working in a wide diversity of contexts: developed countries like Canada, Australia and
Scandinavian countries, as well as developing countries like Brazil and Thailand. Of course we will need
to evolve a UHC model that is appropriate to Indian conditions which will require broad based debate and
inputs from all stakeholders, especially from the medical profession. This process has already been
initiated by the High Level Expert Group on Universal Health Coverage (HLEG-UHC) appointed by the
Planning Commission, which has published a detailed report which would be taken into account while
developing the upcoming 12th Five year plan. We may differ of the details and specifics of the model, but
we need to accept that Universal Health Care is now emerging on the national agenda, and we should all
start engaging with this process.
Such a UHC system would eliminate widespread commercialisation, cut-throat competition and insecurity
among the majority of doctors, while ensuring them a decent income and basic security. The price of not
moving towards such a system is colossal, not only for patients from all classes of society, but also for the
vast majority of doctors who would like to practice their profession nobly and rationally, but are being
sucked into a money-centred system which trumps humane principles and rational practices. The potential
rewards of such an alternative health care system would be similarly enormous for our entire country of
medico friend circle
Regd Office: c/o Manisha Gupte, 11, Archana, Kanchanjunga Arcade, 163, Solapur Road, Hadapsar, Pune. 411028, India
t: 020 6875058 w: www.mfcindia.org e: masum@vsnl.com
1.2 billion people, including our doctors who could once again become respected and honored
professionals, instead of presently being often viewed by people with suspicion and even resentment.
In short, the time has come to do some genuine introspection and alternative thinking, and to address the
widespread problems instead of denying them. On the lines of the call for ‘Physician, heal thyself!,’ the
time has come to say – ‘Physicians, heal thy system!’
Yours Sincerely,
Executive Committee, Medico Friend Circle
Managing Committee, Forum for Medical Ethics Society
