As the concerns grow that doctors' financial incentives play at least some role in their treatment decisions, there is a strong case for choosing spiritual and frugal doctors who want to bring wellness rather than the ones who want to defeat death at any cost.
M Rajaque Rahman
I recently read an online article that compared our experience of taking a patient to a modern hospital with that of driving a car into a garage for a routine maintenance. Interestingly, the analogy was not on the parameter that they both fix critical problems in what are essentially complex machines. It was on the basis of the frazzling feeling we go through in both the situations not knowing whether the suggested fixes are actually necessary.
However outrageous it may sound to compare the noble pursuit of healing the sick with the crude one of fixing lifeless machines, the comparison is not without merit. It's a taken that mechanics tend to take advantage of uninformed consumers to boost their own incomes. The emerging trends suggest some doctors are fishing in the same pond of clueless customers. Very much like the one who takes the car to garage, the patient or his attender has no knowledge to judge whether the prescribed tests and procedures are necessary or done just to inflate the bill. But unlike the advice of the mechanic, the risk of ignoring the advice of the doctor could be as serious as a matter of life and death. That way, unscrupulous doctors are better placed for a ripoff. And the harsh reality is that a large majority of today's doctors are not as godly or saintly as we would believe them to be!
A mere Google search will throw up sufficient evidence that supports the claim that doctors' financial incentives play at least some role in their treatment of uninformed patients. Most of them would be about cases in the US or other developed countries, but that doesn't mean that such unscrupulous practices are not prevalent in India. It's just that there have been not much organized activism in this area.
For example, 32 per cent of all babies born in the US today come out through C-Sections. Fifteen years ago, the figure was just 13 per cent. Reinforcing the thinking that such cuts may not always be inevitable and might possibly be driven by greed, a study revealed mothers who are doctors were 9 per cent less likely to have unscheduled C-Sections compared to non-physician mothers with similar characteristics. The bottomline is that C-Sections are typically more profitable for doctors than vaginal deliveries.
Feeding the fear that doctors are becoming more money minded is a recent study reported by Bloomberg. It reported that urologists who buy their own equipment to provide expensive radiation treatment are more likely to use it to treat prostate cancer than those who don't own such facilities. Confirming that profits urologists make from referring patients to their own radiation facilities play an outsized role in the treatment decisions, the study found that the same doctors prescribed, for example what's called intensity-modulated radiation therapy for just 13 per cent of their patients before they had their own equipment as against 33 per cent after.
The same logic also explains the rapid rise in the rate of spinal fusion surgeries in the US. Experts say that more than half of the 465,000 odd spinal fusions performed in the US in 2011 could have been without good reason.
But it's not just money though. There is a huge problem of approach and orientation. As doctors become more and more specialised, the sphere of possibilities have been curtailed. To a man with a hammer, every problem looks like a nail. Like that, surgeons like to solve medical problems by cutting, just as physicians first seek solutions with drugs. And they don't see anything beyond. Their vision become so narrowed that they can't see illness beyond the problem of pain. They end up becoming problem fixers rather than healers.
The scale of suspicion might be exaggerated, but there is no doubt that the lure for money is making doctors happy when they see sickness! The patient becomes almost like an ATM machine, with the doctors extracting as much revenue as they can.
But it will be too cruel to cast all doctors in one mold. There are doctors who heal. There are doctors who consider a pep-talk session with the patient equally, if not more, important as the medicine they prescribe. For me, there are two types of doctors. One spiritual and other non-spiritual. The first type honours the power of the spirit and aspire to become a part of its healing mechanism. They aren't rigid and procedure-driven. They take a holistic view of the patient's condition and adopt a multidimensional approach to heal it.
The other type sees illness as their opponents that needed to be outsmarted or out-procedured. If their will be done, nobody will ever die. They call it alive as long as they are breathing, even if it's ventilator induced. Sometimes, they conduct emergency surgeries on "dead bodies". They care very little about wellness. They just love to handle interesting cases. They often forget no patient ever wants to be an interesting case. Surely, interesting cases pay more.
So the wise action is to opt for the one who wants to bring good health and wellness, not the one who wants to defeat death at any cost. Remember, almost always it's the patient party who pays the cost!
Another fact about spiritual people is that they have a very strong intuitive power, a very vital quality for a doctor. They are more likely to arrive at a more precise diagnosis, and with less tests and imaging.
And there is also a curious equation. The equation of karma. And only a spiritual one can understand this equation. If we care to look, we will notice that dedicated and holistic doctors often lead a very frugal life. They understand that to keep them happy and provide for their needs, god has to make someone sick. If everyone got healthy, doctors will struggle for survival. This also means that if their needs are more, more have to fall sick. So spiritual doctors lead a frugal life as part of their holistic mission to bring down sickness.
And for doctors who lead a lavish life, and have a big loan to repay, anything that would help patients get healthy stands against their financial well-being. So they become happy when they see more sickness and when wards are full. I am not saying all doctors use this sickening logic while treating patients, but for money-minded ones, sickness is an incentive, and wellness a penalty.
Thankfully, the former tribe is not extinct yet. We have to just do a scan of the doctor before he could wheel you in for an expensive scan!