Mentors Comments:

• One has to present an account on worsening patient-physician relationship in India, explain what Medical ethics is.
• Start by defining what you understand by Medical ethics.
• In the main body, explain that Medical ethics deals with the right choices of conduct in the field of human health. It deals with the distinction between what is considered right or wrong at a given time in a given culture. Medical ethics is concerned with the obligations of the doctors and the hospital to the patient along with other health professionals and society.
• Mention the issues concerning the doctor-patient relationship.
• Explain how ethical conduct can improve this relationship.
• Suggest solutions as to how these relations can be revived.
• Conclude that the doctor-patient relationship is one based on mutual trust and respect between the two parties thus it is important to keep the relations revived.

Answer:

Medical ethics deals with the right choices of conduct in the field of human health. It deals with the distinction between what is considered right or wrong at a given time in a given culture. Medical ethics is concerned with the obligations of the doctors and the hospital to the patient along with other health professionals and society.

In India, the doctors are considered as equivalent to gods (“Vaidyo Narayano Hari”). Medical profession which was once a respected line of work but today is corrupted at every level, from medical education to medical practice, and in both the private and government sectors. It calls for doctors, the government and the public to act against dishonest doctors, restore the dignity of the profession and work for the benefit of society.

Issues concerning the deteriorating patient-physician relationship in India:

• The situation has become so bad that patients today approach the doctor with mixed feelings – of faith and fear, of hope and hostility. This leads to a distorted doctor-patient relationship, with high chances of exploitation both ways – doctors may fleece patients and, if some lacunae are exposed in treatment, patients or their relatives may blackmail doctors.
• Such unethical practices may no longer be cause for comment. But there are many reports of doctors actually committing crimes – distorting medical reports in medico-legal cases, providing false certificates to protect criminals, sexually assaulting their patients, and even trading in human organs
• It goes without saying that such criminal doctors are in a minority. Unfortunately, their number seems to be increasing
• There are reports of doctors amputating the limbs of poor people at the bidding of the begging mafia. Poor people who resisted the extraction of their kidneys have reportedly been operated upon at gunpoint. The list of such practices is endless. It starts in medical college as MBBS seats are sold for lakhs of rupees. This is merely the tip of the iceberg.
• Rampant corruption exists at every level, from medical college admissions, getting a degree, to registration with the medical council. Question papers have been leaked and “jockeys” have written medical examinations on behalf of students.
• Medical college managements are known to charge unofficial “donations” in addition to official fees. Students have been reported to bribe faculty to get good reports, and doctors have been reported to pay bribes to get registered with the state medical council
• Sex determination tests are performed though they are illegal. Doctors are known to prescribe unnecessary diagnostic tests, hazardous drugs and inappropriate surgical procedures, all for the kickbacks they receive from the healthcare industry
• Against the recommendations of the WHO that the total health expenditure should be 6.5% of the gross national product (GDP), India spends only 4.8% of GDP on health. Further, public health expenditure is just 1.2% of GDP, or barely 25% of the total health expenditure; the rest of the money is paid by patients directly to private doctors and hospitals
• The dubious functioning of regulatory bodies of the medical profession, namely the Medical Council of India (MCI) and the Indian Medical Association (IMA), has helped spread corruption in the profession.

Measures needed:

• Medical humanitarianism: The morale of the doctors needs to be boosted. Regular training and support should be given to imbibe the feeling of sympathy and compassion among doctors.
• Need for respectful interaction: Doctors should be encouraged to effectively communicate with the patients to instil confidence in them. Doctors should be aware of the patient’s medical history, habits and routines for effective treatment, thus reviving the culture of ‘family doctors’.
• Focus on Emergency Medicine: Introducing dedicated and trained EM residents who are sensitized and taught to handle tough situations, charged relatives, and “breaking bad news” is the need of the hour to enable better handling of emergency rooms and trauma centres.
• Strict enforcement of guidelines, code of ethics: There is an increasing need for culturally sensitive physicians and ethical committees in hospitals and other healthcare settings.
• Imbibing confidence among the doctors: Doctors must be assured of their safety and security. Steps like having security guards, installing CCTV cameras, pasting chart of guidelines for patient’s kin on hospital walls in regional language, etc. should be initiated by hospital management.

The doctor–patient relationship is based on mutual trust and respect between the two parties. However, the rapid changes in the medical field and the corporatization of the health-care system have strained the age-old good relations between the patient and the doctors. Thus, there is a need to uphold the legal, ethical, and moral liabilities for both the doctors and the patients. Few of the Gandhi’s Seven Sins – ‘commerce without morality’ and ‘science without humanity’ highlight the need for reviving the spirit of medical ethics in India.