Sickness in Health Care

Transcription

1 FOR PRIVATE CIRCULATION ONLY 68 Pages Subscription: `.900 p.a. THE MAGAZINE FOR PRODUCTIVE AGEING August Sickness in Health Care

2 FIRST WORD Register for Safety Pune was recently jolted by a brutal attack on an elderly couple inside their bungalow. Keshav Gokhale (78) and his wife Mrunalini (70) had befriended a young man just a few days ago after meeting him while buying groceries. The man seemed very helpful and even accompanied them home. Next, the Gokhales invited him for dinner. Just a couple of days later, this unidentified man gained entry into the house, hit the couple on the head with a glass bottle and a pressure cooker lid and decamped with the lady s gold bangles worth about Rs 65,000. The Gokhales suffered severe head injuries and had to be hospitalised. The incident is one of many that are now taking place with alarming regularity. Taking cognizance of this issue, the Pune police have stepped up their efforts to take care of senior citizens living alone. As a preventive and protective measure, the police have appealed to all senior citizens to register their contact coordinates with them. These registered members will be issued identity cards and their details will be noted by the control room so that any complaint is immediately taken care of. Special attention will be paid to those whose children are abroad and have no relatives to rush to their aid. The social media too is being used to create groups through Whatsapp. As of now, there are 44 such groups in all the police stations and have as many as 1,356 members. Further, awareness is also being created once again among the elderly about a dedicated special emergency phone number so that they can avail of quick assistance. Of course, it is another matter that many senior citizens call on this number to complain about such matters as non-delivery of LPG cylinders, electricity problems, water shortage, etc. Meanwhile, installation of closed Huned Contractor circuit television cameras (CCTVs) and intensified patrolling by the police are other measures now being enforced. The fact is that Pune is not alone when it comes to such brutal incidents of attacks on senior citizens. Therefore, the need for better monitoring, control and action is in every city and town - especially since most of us live in apartments, isolated from other people. There is less and less of community living nowadays and it s no longer surprising to find that you may have no idea about who is living next door. Therefore, join senior citizen clubs and keep in regular touch with one another. Also, don t trust strangers, however helpful and concerned they may seem. Run a check on people you may want to hire such as housemaids, gardeners, drivers,. etc. Be alert, always! 2 3 3

3 STAR LETTER LETTER August 2016 VOL 21 ISSUE Huned Contractor CHENNAI: 132,(Old No.52-A), AK Block, 7th Main road, Anna Nagar, Chennai dignityfoundation.chennai@gmail.com 205, 2nd Floor, Gagandeep Tower, Opp Bank of India, Paldi Cross Road, Ahmedabad Phone : dfamdavad@gmail.com Address the PF-related pension issue In the May and June editions of Dignity Dialogue, although there were articles on monetary issues of senior citizens, the subject of PFrelated pension was not addressed. You would no doubt feel that this issue is insignificant because it relates to income of only Rs 1,000 per month. However, a purview of the mathematics makes the importance clear: A person who, after 30 years of service, retired in the year 2000, earned a monthly pension of Rs 650 under this scheme. Here pension is as applied to other government schemes and should respond to increases in cost of living. With a yearly inflation of 6%, over a period of 15 years this amount should increase to Rs 1,250 because the compounded cost increase is 250%. The LIC says this pension is an annuity and is therefore a fixed amount not subject to any increase. But, as with other retired groups such as OROP, etc., it is changeable by legislation. In view of the above points, you would agree that a minimum monthly pension of Rs 1,000, which is what has been promised, is most reasonable. And yet the government has not provided any confirmation. Amidst the post-budget doles being announced by the government, this matter needs immediate and serious attention. Harish Rao toteach@rediffmail. com D. Mallikarjuna Rao M Recalling Mahatma Gandhi s words With reference to the article titled A Speech that Inspired a Nation in the May 2016 issue about US President Abraham Lincoln and his rousing speech, I would like to draw a parallel in the Indian context. Taking a tough stand against the British rulers, Mahatma Gandhi brought forth a new nation conceived in liberty and dedicated to the proposition that all men are created equal. Here is a portion of his stirring speech: Now we are engaged in a great uprising, testing whether our renewed nation or any other nation so conceived and so dedicated, can long endure. We are on agreat battlefield of a war without violence. We have to dedicate a portion of that field as a final resting place for those who gave their lives so that this new nation might be born and live forever. It is hence also fitting and proper that we should do this. But in a larger sense, we cannot dedicate, we cannot consecrate, we cannot hallow this ground. The brave men, living and dead, who struggled, have consecrated it already. The world may little note nor long remember what we say here today but it can never forget what they did here. It is for us the living, rather, to be now dedicated to the unfinished work which they fought here. It is rather for us to be dedicated to the great task remaining before us that from his honoured deed we take increased devotion to that cause for which they gave their last full measure of devotion; that we here highly resolve that these should not have died in vain, that this nation, under god, shall have a new breath of freedom, and that true democracy - government of the people, by the people, for the people - shall not perish from the earth in our land, India. Adi F. Merchant vijayxerox@hotmail. com

4 LETTER Life s a journey This refers to your The Joys of Travelling (June, 2016). I am driven to think aloud a bit. Isn t life itself a journey, sweet for some, sour for some, and a mixed bag for many? Life is like a train journey with, often perhaps, many a change en route, and of course with accidents too! At birth I boarded a train and, naturally, met my parents, and I believed and hoped that they will always travel along with me. However, it took time to realise that at some station my parents, one by one, will step down from the train, leaving me to myself on the journey alone. As time went along, other people did board the train, and they were all significant i.e. there were my siblings, friends, children and most importantly, the love of my life, continuing the journey with me. My father left me soon after the death of my elder brother when he was 10 and myself only 10 months! Accordingly, my mother was father to me as well. The troubles she took to educate me and mould me into a good human were unfathomable. As many alight, one by one, first my mother and then my only sister, they have indeed left a permanent vacuum almost a breakdown of the train. Others will, perhaps, go so unnoticed that we don t realise that they have vacated their seats! The mystery to every one of us, obviously, is that we do not know at which station we each one of ourselves - will alight. It is indeed important to realise this because the time comes for all of us to alight and step down and leave our seat empty when we should leave behind beautiful memories for those who will continue to travel on the train of life. SH Subrahmanian mani@enablery.org Iconic movies that thrilled us all All the world s a stage; and all the men and women merely players; they have their exits and their entrances; and one man in his time plays many parts. This is rather true as far as movies are concerned. In the world of cinema we have come across many memorable movies and that gives us fond remembrance when you grow old. Such iconic movies make us think about the various touching scenes, remarkable sequences of events and great acting. As a common man we think about the historic movies which ran for years and made a mark in our life forever. Actors play to the gallery and we audience give them marvellous applause for the screenplay, dialogue and even comedy. There are many iconic movies that have now been published in the form of a list. Let us have a look at it to rekindle our fond memories. To enter the fray of iconic movies, first comes Enter the Dragon. Bruce Lee gave the film life with fights and fists and that were of high order and we flocked to the theatres to see the action, watching the fights unfold from the edge of our seats. Then came Jurassic Park which gave you the reality of animal life and its enchanting existence in the world with stateof-the-art special effects. The film on Mahatma Gandhi was a guiding force and we found Richard Attenborough directing the film with such attention to detail and backed by several touching anecdotes from the India s freedom struggle. The film had an emotional connect with our memories of the fight for independence. Titanic took us to the sea and the tragedy on high waters. It moved us to tears. In India, Sholay touched our heart and soul and the acting of Sanjeev Kumar was truly of high calibre. The film ran for years before Dilwale Dulhaniya Le Jayenge set a new record. King Kong was fun too with the antics of the monkey man. Then, Sound of Music turned out to be a huge hit with its melodious songs. On Indian soil, there were three more films that hit a high. One was Mera Naam Joker. The film revolved round the role of Raj Kapoor as a loving man working in a circus and winning the heart of all women. The film was lengthy and I remember there were two intervals during its screening. The second was Deewar which changed the fortunes of Amitabh Bachchan. The third, in more recent times, was 3 Idiots with Aamir Khan displaying a very fine performance. There are many other such iconic movies: Indiana Jones, Gone with the Wind, The Silence of the Lambs, Ocean s Eleven, Cleopatra, It s a Mad Mad World, Lawrence of Arabia in English and Guide, Johnny Mera Naam, Ek Duje Ke Liye and Raja Hindustani in Hindi. C K Subramaniam cksumpire@gmail. com Keep up the good work Thank you very much for publishing my views on the 21 rules of old age in the July issue as well as my poem titled Everlastingly. There was also good coverage of the Frontiers in Medicine programmes held in Pune and elsewhere. It was so kind of you to send an extra copy of the same issue. I can share it now with my friends and keep it in the Golden Nest library where I usually share the old issue of Dignity Dialogue after I finish reading them. It is really very creditable and marvellous to see how Dr. Sheilu Sreenivasan has managed to maintain a high standard of DD all throughout the past 20 years without fail in spite of several ups and downs in the editorial department. Kusum Gokarn gokarnkusum@ gmail.com

5 COVER STORY 10 SICKNESS IN HEALTH CARE Dissenting Diagnosis is a book that makes for compulsive Cover reading because story it digs a tunnel into the commercial exploitation 08 of a noble profession and exposes the devious ties among the doctors who make up the medical fraternity in order to make money at the cost of the patients. Huned Contractor meets one of the authors and delineates the latter s experience as an insider FOR PRIVATE CIRCULATION ONLY THE MAGAZINE FOR PRODUCTIVE AGEING August Sickness in Health Care ` PROFILE 16 GLOBAL MAN OF PEACE Even at the age of 98, Dada J P Vaswani tirelessly continues to propagate love, harmony and understanding across the world, writes Usha Karnani POINT OF VIEW 19 ARE WE BITTEN BY THE BUSYNESS BUG? We need to enjoy life and not live like maniacs always in a rush, says Monica Fernandes TOTAL RECALL 21 THE LAST TRAIN TO DELHI Ravindra Kumar Puri recalls a train journey his family undertook during the troubled days of the Partition in 1947 TRAVEL 23 AN EXOTIC TOUR OF LAS VEGAS Arvind Narvekar describes the fun he and his family had in the city of casinos and theme hotels PERSPECTIVE 28 THE SOUND OF SILENCE Lalita Kodikal dwells on how silence can make our life more fulfilling and complete HOBBY 31 LEARN MUSIC ONLINE If you already are an amateur musician and would now like to devote time to learning new songs or instruments, you can do so through an online platform, suggests Sakina Das FEATURE 33 CULTS AND BLIND FOLLOWERS There are many organisations or cults all over the world, including India, which promise deliverance from this sinful world, sickness or failures. Chanakya writes about some of the well-known ones SPIRITUALITY 42 THE ABSENCE OF THE SELF Spiritual bliss can never be attained when you are constantly aware of trying to achieve it, opines Sumit Paul LIFE 48 TAME YOUR TEMPTATIONS Our biggest fault is that we easily succumb to temptation, says V Anand Kumar REGULARS Letters 4; Culinary Delights 60; Book Reviews 50; Special Interest

6 COVER STORY Sickness in Health Care Dissenting Diagnosis is a book that makes for compulsive reading because it digs a tunnel into the commercial exploitation of a noble profession and exposes the devious ties among the doctors who make up the medical fraternity in order to make money at the cost of the patients. Huned Contractor meets one of the authors and delineates the latter s experience as an insider One of the recently published books that is taking India by storm for the sheer boldness of its contents is Dissenting Diagnosis authored by Dr. Arun Gadre and Dr. Abhay Shukla. With sales crossing more than 8,000 copies in a very short time, the book provides revealing insights into the medical profession as is practiced in the country with ethics bowing out in favour of greed. The biggest stakeholder in this rapidly corrupting sector is the pharmaceutical industry which is not only churning out all kinds of medicine simply to keep the revenue growing but is also responsible for eroding the medical code of conduct by presenting doctors with lavish gifts and sponsoring their vacations and educational trips in favour of prescribing specific drugs. Adding to this rot are the private hospitals that are managed like big business houses where doctors are given targets to attract increasing profits through unnecessary tests and hospitalisation even when not required. Dr. Gadre is a gynaecologist who practiced in the drought-prone areas of Dr. Abhay Shukla and Dr. Arun Gadre rural Maharashtra for 20 years. With the support of his anaesthetist wife, Dr. Jyoti Gadre, he ran a small private hospital, witnessing first-hand the degeneration of the once noble medical profession. Unable to stem the rot and fatigued by practicing in a resource-poor setup with rising patient expectations, he left private practice and joined an NGO in Pune. Dr. Gadre is the author of 17 books in Marathi, including six novels, and has received several literary awards. Dr. Abhay Shukla is a public health physician with a postgraduate degree in community medicine from the All India Institute of Medical Sciences, New Delhi. He has worked on health issues in collaboration with people s movements and grassroots NGOs in Maharashtra for two decades. He is a senior programme coordinator with SATHI and is a member of advisory boards for the National Human Rights Commission. To elaborate about the book, it not only exposes everything there is to the medical profession through the anecdotes of 78 doctors from across India but also provides food for thought by suggesting tips for regulating the private medical sector in India. It also advocates moving towards a system for universal health care. As the authors put it, Today, due to the large-scale commercialisation of health care, there is widespread confusion, distrust and suspicion, and an uneasy relationship frequently prevails between private health care providers and patients. The asymmetry of information (and consequent power) is profound and being aware of this fact, patients often feel vulnerable and helpless. A solution would be to replace the negative spiral with a positive one, which would benefit both patients and rational, ethical doctors. The book, in a very forthright manner, raises several issues. As one doctor states, Pune, which should have 50 public hospitals like Sassoon Hospital, has only one, although new corporate and multispeciality hospitals are coming up daily. These are bright and glittering. In some ways, they are like shopping malls. Sometimes they have even been registered as so-called charity hospitals, but their only objective is profit. Such hospitals deliberately foster the impression that they provide highquality services, which justifies their high costs of care. A pathologist from a metropolitan city says, In corporate hospitals, each patient may be seen by multiple specialists. An orthopaedic is called because the hands and feet are aching; a neurologist for numbness in the hands. They come and look at the patient and their charges are added to the bill. Is it useful for multiple specialists to examine a patient? This question is never even asked. Commenting on the recent trend of asking patients to go through several tests, Dr. H V Sardesai of Pune states, In corporate hospitals, investigations are not based on what the patient s illness is, and whether there is a need for specific investigations. Given any complaint, they produce a list of investigations that must be done. A surgeon from a metropolitan city observes, Totally unnecessary surgeries are being performed in corporate hospitals. During investigations, they may see a small stone in the gall bladder. It is not causing the patient any problems. But they

7 COVER STORY scare the patient into going in for a surgery. I know of a case where the patient was charged Rs 1.5 lakhs for an inguinal hernia surgery done by laparoscope (surgery for inguinal hernia is one of the simplest operations). A gynaecologist from a big city is of the opinion, People s sensitivities have become numbed due to certain corporate hospitals. Once bills in these hospitals started mounting up to Rs lakh, people began to consider our bills of Rs 40,000-50,000 as trivial. These hospitals are like malls. Our society does not need them. Instead, all tertiary health care should be provided by the government. A skin specialist from a big city comments, Public relation officers (PROs) of many corporate hospitals keep roaming around to visit doctors; they entice doctors to send patients (to their hospitals) by tempting them with cuts. Nearly everybody indulges in this practice. It must be legally banned. Another big-city doctor, a general surgeon, notes, Labour leaders at factories in our city are now in the pay of corporate hospitals. They agree to arrangements for the health care of workers to be covered by the employer at a particular corporate hospital. A general practitioner from a small town offers more on the topic: Corporate hospitals often engage in marketing in a variety of ways - buy one, get one free, discount week, full-page advertisements, mostly full of falsehoods. They throw parties for general practitioners, and they give them cuts. On top of this, they supply liquor to keep politicians in their thrall. Some corporate and large hospitals admit bogus patients under the Rajiv Gandhi Health Scheme (a publicly funded health insurance scheme). They give the admitted person money, and plenty to eat and drink. They prepare records showing that an angioplasty or angiography has been done on that person, when actually nothing has been done. I wonder how the government comes out with such schemes, without first regulating private hospitals. Without regulation, the basic objectives of such schemes are lost, and they become mechanisms for corporate hospitals to loot public funds. An ophthalmologist from a big city says, Corporate hospitals maintain everything five-star style, but forget about the patient. When the patient comes, they give him lemonade or tea. They advertise that they have the latest hitech optics shop. The patient melts because of the free lemonade, and he buys a pair of spectacles that have an actual value of Rs 200 or so for Rs 3,000 5,000! The inhouse optician is the main income avenue of corporate hospitals. Sometimes they offer a free check-up. The scheme has a 20% off offer, just like in a mall. The whole atmosphere is designed to tempt. Corporates can implement government schemes and insurance schemes. We run small hospitals, our reimbursements are delayed, and we don t have the time to keep making trips back and forth to get our payment from the insurance company. Corporate hospitals vie for tie-ups with large public sector companies. And the officials are more than eager to oblige. These public enterprises give exorbitant reimbursement to their emp-loyees; Rs 5,000 for just a pair of spectacles, of course made available from corporate hospitals. If a patient goes with my referral note, he gets 30 to 40% off on an MRI (because I do not take any commission). One patient forgot to take my note. He was charged the full amount, and a cut went to some third party, says Dr Rajiv Dhamankar, practising paediatrician in Alibag, Maharashtra. The book has been published by Random House India and is priced at Rs 399. Sponsorship of Medical Education by Pharmaceutical Companies Must Stop Excerpts from an interview with Dr. Arun Gadre, co-author of Dissenting Diagnosis What prompted the writing of this book? I was a practicing gynecologist for 20 years and I ran my small nursing home in a drought-prone place called Lasalgaon in district Nashik. The first 10 years were like a dream came true. I earned less but the satisfaction was immense. The faith of the patients helped me take up serious cases like uterine rupture even though there was no blood bank. However, gradually commercialisation started strangulating ethical doctors. Though it did not affect the practice, patients began to lose faith in the medical profession due to very scary experiences from the commercial segment that was growing at a fast pace. Multispecialty and corporate hospitals started functioning like any other industry and with only a profit motive. I left Lasalgaon since I knew I wouldn t be able to fight this rot each day of my life. I joined an NGO called SATHI in Pune which has been working on health policy issues since the past 15 years. Once we were discussing about the plight of patients in the private sector when someone suggested that we should come out with documentation of patients stories. Adding to that, I suggested documenting ethical doctors frustration. At that time, no one believed that practicing doctors would speak against their own profession. But I was confident they would since I knew at least more than

8 COVER STORY 20 doctors who would speak their mind. And that s how the process began. The number grew through a snowball effect and through contacts provided by the Jan Swasthya Abhiyan - a network of doctors, NGOs, activists, and academicians involved in policy advocacy. The book blows the lid off a cauldron of secrets in the medical sector. Did you not feel that it would be personally harmful to get into such a controversial area? Not really. First of all in the entire book I did not give a single anecdotal experience. There are 78 other doctors from across India who have narrated their experiences and thoughts. Out of these 78, 35 even consented to declare their names! So I had a team with me. I was not alone. Apart from the financial burden that such modes of treatment places on patients, does it also aggravate their ailments through unnecessary tests and medicine? The ailments do not aggravate as you are suggesting but the so called ruse of yearly check-up is drawing even normal people into the trap of corporate and big hospitals. Some of the doctors have given anecdotal experiences about how even a small insignificant renal stone found in sonography done under the ruse of yearly investigations is utilised by big and corporate hospitals to convert a perfectly normal person into a patient for revenue generation. Why is the government dragging its feet in curbing this malpractice? First of all, there was a huge resistance from doctors to get regulated. Secondly, the government itself is pushing for passive privatisation. After the 1990s when the government accepted the policy of privatisation under pressure from the World Bank, it even started charging user fees from public hospitals. The government funding for public health care has been stable at merely 1.2% at the best. The corruption, top to down bureaucracy and insensitive staff is repelling even to the poor as compared to the unregulated private health care sector. The policy of public private partnership is being promoted in the corridors of the policymakers. Even health care is looked upon as an industry, thereby helping increase the gross domestic product (GDP). The government passed the Clinical Establishments Act in However, under pressure from lobbying and opposition by doctors associations, the process got stalled. The standards were finalised only recently. In short, there is lack of political will. How has been the response to this book? Have there been threats of litigation, etc.? The response is terrific. Nearly 8,000 were books sold within one and half months of its release. Since the book explains in detail the methodology of the study and has categorically asserted that all doctors were voicerecorded and consent was obtained, there have been no threats of litigation. Apart from getting responses from doctors across India, what was the biggest challenge in writing this book? There were no other challenges except, as you said, getting doctors to state the truth about the medical profession. Does this happen in other countries too? Not exactly. India is the only country in the world where the private sector is so huge and still not really regulated in any form. Even in the US, insurance regulates the massive private health care sector. In the UK and Canada there is Universal Health care System wherein at the point of service delivery no monetary transaction takes place. Thus, there are mechanisms of social regulation. Is there any noncorrupt medical policy and practice that India can adopt from any other country? Corruption is a social virtue but yes, Universal Health care System, as explained above, is the only system practiced in nearly 40% of the world and is the best system to lessen malpractices. The basic relationship between a patient and a doctor is that of faith. Won t this book erode that faith? What has been the response of readers from outside the medical fraternity? Actually it is other way round. Readers have responded that they now have some credibility to their opinions about what is happening in the private health care sector in India. The second part of the book is on solutions written by my colleague Dr. Abhay Shukla. There is one chapter on patients rights in the private health care sector and on how to identify an honest doctor. I am getting feedback that the book is empowering patients. Yes, faith is required. But alas, now when commercial doctors are exploiting it for greed, unfortunately the good old days have evaporated for both patients as well as for ethical doctors. The pharmaceutical industry appears to be the biggest culprit. What can be done to bring them to book? The Medical Council of India has already drafted the guidelines. However, a few important things need to be done. First, the MCI guidelines should be made compulsory for prescribing generic medicines. Second, the government must provide generic medicine shops at key central junctions in every city. Third, policy change must be done to ensure that the cost vis-à-vis the maximum retail price (MRP) difference would never exceed say 20%. Today it could be even 500%! Lastly, sponsorship of medical education by pharmaceutical companies must stop. Doctors need to pay from their own pocket to get continuous medical education