The mindset of the erstwhile British colonial rulers in India can be felicitously illustrated from the words of Thomas Babington Macaulay as he produced his memorandum on Indian education in his address to the British Parliament on 2nd February 1835:
“We must at present do our best to form…a class of persons, Indian in blood and colour, but English in taste, in opinions, in morals, and in intellect.”
The healthcare dispensation of this day is a testament to how well the conceptions of the erstwhile colonial masters have fructified.
The British were the ones to introduce free market principles into healthcare ‘service’ which earlier revolved largely around charitability and political and social largesse. Along with introducing concomitant concepts of modern medicine that the Raj could credit itself for, the active British policy on medical practice in India was to rip out healthcare from its moorings in service to humanity and tether it to laissez faire principles.
Various schemes introduced by the British such as the Subsidised Rural Medical Relief Scheme (SRMRS) and the Honorary Medical Scheme (HMS) encouraged the growth of independent (rather unregulated) private medical practice across cities and villages in India.
This today, along the tastes bequeathed by the British masters to their indigenous successors, forms the substratum of what some would call an ‘exploitative’ healthcare industry.
Perhaps our Hon’ble Prime Minister, in his recent address from London named “Bharat ki baat sabke saath”, failed to appreciate the broad underpinnings of the current situation of private medical practice in India as he insinuated at the unholy nexus between doctors and pharmaceutical companies.
As part of what one would regard a high minded conversation offering pious hopes of change, Modiji pointed at doctors going to lavish conferences in places like Dubai and Singapore for more than furthering patient interests, with little realisation that over seven decades of skewed policies have begotten this vile culture.
As easy as it is to believe in a willful complicity of doctors, it requires a careful contemplation to understand how the present market of medical practice leaves few ways for a doctor to say no to such unholy nexuses.
The Menace of Unregulated Medical Practice
Decades of encouragement to unregulated medical practice has created an environment where such nexuses have become accepted means for aggrandizement and gaining legitimacy.
Today, it is common for a doctor to be rated and their success gauged by the number of such conferences they attend and by the favours they are bestowed upon by pharmaceutical behemoths.
An upright, young doctor wanting to build a thriving practice in any urban locality today is compelled to consider underhand options to be of any consequence and standing among his peers, and cut-throat competition between providers in urban areas often pits considerations of propriety against considerations of survival, in which the latter is bound to emerge victorious.
Educational medical conferences degenerating into ceremonious repasts in opulent destinations are a result not of inherent greed of a certain breed of professionals but of years of pursuing laissez faire policies in healthcare.
The public health sector in India as we see today is not even a sad apology of what it was envisioned to be seven decades ago, a design which could have easily avoided the ills of the present system discussed here.
Rather, years of under-regulation and under-investment in health have stripped it down to a marketplace where healers joust for illnesses and patients, and leaving any stone unturned in this process could mean being an unfit competitor. Unfortunately, such issues hardly find their way into popular debates.
Inglorious Period for Medical Practice in India
The present years mark the most inglorious period for medical practice in India, with gruesome cases of violence on medical professionals surfacing on a regular basis.
In light of this, it is important that both sides of the story be told, especially by our Pradhan Sevak in whom the entire nation reposes its faith.
There can be no denying that the vile practices that prevail in the medical profession today plunge many into poverty each year and need to be checked, but the same has to be achieved without endangering the medical profession.
It is indeed disappointing that while Modiji recognizes the spirit of the common man in the fight against corruption by saying: “Mera samanya desh ka nagrik imandari ke liye kasht jhelne ko taiyaar hai”, he somehow de-recognizes doctors as a part of his “samanya nagrik” cohort.
It needs to be remembered that painting the entire fraternity with the evil brush will only provide a strong disincentive to the upright mind to join medicine and further worsen the state of healthcare.
Rather, the policy of “sabka saath, sabka vikas” must also apply to doctors and actively engage in bringing the medical fraternity and the laity on the same page.
(Dr Soham D Bhaduri is a doctor based in Mumbai. He is currently the Editor-in-chief of The Indian Practitioner (a foremost peer reviewed medical journal). He has written articles on healthcare in a number of publications including The Hindu, The Indian Express, The Wire, The British Medical Journal etc. He can be reached at soham.bhaduri@gmail.com)
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