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Submitted by PatientsEngage on 28 December 2016

This pertinent question, that troubles many of us also, is forcefully raised by Dr Kamal Kumar Mahawar in his recently published book The Ethical Doctor, a critique of the health care system in India. He offers 10 reformatory guidelines that could salvage our medical institutions. Shivani Maheshwari reviews:

There is an urgent need for more books like The Ethical Doctor by Dr Kamal Kumar Mahawar in the market. Especially in a country like India where a population of billion plus has to run amuck to avail of good healthcare or to ensure one’s life is not lost in the labyrinth of a seedy, unscrupulous hospital.

It is not that Dr Mahawar’s "The Ethical Doctor" uncovers the lid on occurrences new or something that we are not cognizant of. It is not an expose. But, it is the sharp, biting critique of the Indian health care system that he fearlessly portrays in grim black-and-white that jolts. It is the harsh documentation of all that is hair-raising in the medical circles that leaves you horrified. As you leaf through the last page, you can’t help but mutter a silent prayer, “Dear God…Please grant me good health!

Meticulously researched and forcefully argued, The Ethical Doctor immerses readers into the dark, underbelly of the medical sphere inexorably. The entire gamut of unprofessional and unethical issues that plague the medical system has been unflinchingly delved into by Dr Mahawar. There are chapters dedicated each to Cuts and Commissions, Unnecessary Tests and Treatments, Drug Companies, Exploitation of the Vulnerable, Touts, Quacks and False Claims.

The backcover blurb mentions some of the most disturbing medical cases of recent times. In November 2014, eleven women died at a sterilization camp in Chhattisgarh. In June 2016, a seventy-five-year-old was left to die because he could not afford a briber of Rs 50 at a government hospital in Kolkata. That same month, a gang that duped women into selling their eggs for surrogacy was busted in Pune.

Drawing up a scenario of a Corporate Hospital, Dr Mahawar writes: “The treatment you get in many hospitals depends on the doctor’s estimate of your paying capacity. A doctor can keep you in hospital unnecessarily for days, give you one expensive medicine after another, put you on ventilator, do an operation, or anything else he can think of to maximize your bills. As a patient, you have no means of knowing if any of this is strictly necessary.”

Or, in another chapter, he brings to light the notorious nexus that exists between pharmaceutical and medical appliance companies and doctors. Doctors willingly prescribe drugs of particular companies under the pressure of gifts and bribes. They are enticed by anything from cash, iPhone to foreign trips. “Amongst doctors, there is a sort of competition. If one doctor is sent on a foreign conference trip to an Asian country, another wants to go to Europe,” he writes. He further points out the direct correlation that prevails between gifts and philanthropy from the industry to the reputation and popularity of doctor among patients and colleagues.

Dr Mahawar also enumerates many real life experiences of people he has spoken to or come across highlighting a number of clinical conditions that are especially vulnerable to abuse. He has touched upon hysterectomy scandals, kidney crimes, cardiology excesses, superfluous surgeries, and host of other medical outrageous breaches. “The purpose of this book is to look at these unethical practices that have spread their tentacles deep into the medical profession.”

However, the intention of The Ethical Doctor is not to collate a litany of medical misdeeds, declining values and corrupt practices. “This book is not about pointing fingers at any individual or group. In fact, I wholeheartedly believe individuals are rarely wrong; systems often are,” writes Dr Mahawar, urging readers to introspect and reflect on the deteriorating values in society of which doctors are an integral part and understand their difficulties. “Not for a moment would I accept that doctors are less ethical or honest than the rest of the populace.”

Looking at the way ahead, Dr Kamal Kumar Mahawar examines the roles of the government and the judiciary in policy-making in medicine and explores how the Indian Medical Association’s code of ethics is out sync with modern times. Analysing the connections between power and knowledge, and exposing the dangerous ways in which they play out in medicine, the book asks an all-important question: is it possible to be an ethical doctor today?”

The fault does not lie with the doctor alone. Dysfunctional governance, lack of proper regulations, ineffective planning, self-serving attitudes and, sometimes, overt greed – are some of the reasons why the health care infrastructure has become infested with a number of unethical practices, he writes.

In the last chapter, Dr Mahawar completes a full circle. He emphatically draws up a list mechanism that could possibly help clean the medical setup. Like the Ten Commandments that are a set of 10 biblical principles relating to ethics, Dr Mahawar too identifies 10 reformatory guidelines that could repair our medical institutions. Some of his recommendations include radically transform the Medical Council of India, Establish Indian Institute for Clinical Excellence, set up an Effective Clinical Establishment Regulator, Role of the Government, Private Hospital Reforms, Indian Research Database and the Role of the Media.

Drawing parallels with other countries, he says that an Indian doctor behaves differently in a foreign land. He knows of many doctors settled in UK and other countries, ‘who take a moral high ground for being upright’. “But the credit is not their for the taking. The credit goes, instead, to the well-grounded systems in place in those societies and their conducive environment.”

Some critics have alleged that it was possible for Dr Mahawar to pull together this book together because he lives and practices in England now. It would have been near impossible for a doctor in India to rake up malpractices amongst one’s own fraternity and profession. However, Dr Mahawar has to be credited for taking a bold, dispassionate stand on a subject that deeply affects each and every Indian.

Dr Kamal Kumar Mahawar’s The Ethical Doctor may not have shaken the medico profession and authorities as desired, but it has definitely created ripples and drawn attention on the malaise so deeply entrenched in the medical professiona across the length and breadth of the country. We need more such books that will hammer and scoop out maladies and shameful practices ailing the medical professional. There is always strength in numbers. Only then can the credibility and reputation of one of the noblest profession in the world be respectfully restored in India.

Excerpt

Radically Reform the Medical Council of India: Currently, the MCI is ineffective in every single domain of responsibility it shoulders. It needs radical transformation. So much so that I think we should dismantle the current body and create a new, autonomous MCi with a considerably smaller council. The council should have equal representation from doctors and others in society and its members should be appointed through a robust selection process overseen by another independent panel (similar of GMC of UK), rather than elected from amongst the existing pool of doctors (as is currently the case). The MCI also needs to be fortified with resources in order to be able to carry out its responsibilities. There is no reason why it could not be partly or completely funded through annual fees paid by doctors.

(Dr Kamal Kumar Mahawar works as a Consultant General and Bariatric Surgeon with National Health Service (City Hospitals Sunderland NHS Trust), United Kingdom. He is actively involved with research and is the editor of several reputed scientific journals. He has had the opportunity of reflecting on a range of ethical and systematic issues that plague health care in India.)