Doctors loot! Really?! Part 2

The Doctor has to take the flack for the allegation about the Astronomical [?]Charges in the health care because he is at the forefront. The very face of the Medical Profession. What really goes into it apart from him, either nobody knows or rather nobody wants to know!

To understand the breakup of charges, rather a big sum for a common man, one has to go into the economics of the Medical profession.

Right at the outset one has to know that even though it’s Noble profession in the eyes of the common man, none of the Corporations, Municipalities, for that matter even the so-called well-wisher Government of the people, for the people, does not think so. All of them charge all the Clinics, Hospitals big or small, or any other heath establishments like Diagnostic centres or Maternity Homes, for all the amenities provided, like water, electricity and other taxes like property tax, professional tax, at the “Commercial” rate! No concession here because it’s a Noble profession! The flak does not stop here. To start a nursing home even on the smallest scale, the Doctor has to procure umpteen numbers of licenses from hundreds of authorities. And once you enter the maze there is no way out. The inauguration of a prestigious hospital was stalled for more than a year because some officer in the corporation was not releasing the necessary certificate unless his palms were greased and because that did not fit in the policy of earnest proprietors, the hospital stood tall but vacant for a year or so! And mind you because you have to renew these licenses every now and then, lot of ‘Grease’ goes in the process!

Mind you, here we still have not considered the cost of the land or establishment. For a student coming from a modest background to purchase 200 sq ft gala to start his clinic or consulting room on a commercial basis is well nigh impossible in cities like Mumbai and/or Pune. At the most he can have lots of dreams in the eyes, zeal and zest to work hard, enormous hopes but pockets, still empty! From where does the lad in his twenties going to raise the money in crores? Banks offer loans, but not without their pound of flesh! Here I am talking strictly about the meritorious ones and not the ones for whom their fathers buy the degrees to run an already ready four-storied hospital or the ones, the pets of the government for whom everything is reserved from admission in an undergraduate course to PG degree and the jobs those are offered on the platter!

In bigger hospitals Doctor is the only answerable commodity, A Class four worker with the strength of Union backing him, knows ‘What’s NOT his work, but if you ask him, ‘What’s his work’, you draw a blank! Everybody has fixed hours of duties except Doctors, because theirs is a ‘Noble Profession’, they have to be on their toes even if the rest has eluded them for days together! In a poor area I have made umpteen number of night visits with peanuts as the fees because I myself was very well aware of the fact, that even if I ask for my legitimate rational fees, most of the patients are just not in position to afford them, thus I had to forgo it many a time, losing my precious sleep in the bargain because mine is a ‘Noble Profession’ and I am not supposed to get my dues as that amounts to looting!

If the patient has to pay from his pocket for the investigations, even if most necessary to diagnose the ailment, he is most reluctant and so will ask hundred times,

’Are they necessary, have they to be done now?’

I then have to be extremely patient and say.’ If not, why would I ask for them and you are having complaints NOW, so earlier the better.’

The same patient, if is insured will insist on getting the investigations which are absolutely not necessary. ‘I have never claimed before, so let’s get MRI done.’ ‘MRI for common colds? What for?’ is my exasperated reaction.

Second most expensive item in health care is ‘Investigations’. The most popular notion amongst the half-literate junta is, If Investigation comes negative, MONEY is WASTED! It’s extremely difficult to get the investigations done in such class!

Two important branches without which I as a consultant just can not come to conclusion are 1. Pathology with Biochemistry and 2. Radiology.

There are certain diseases, rather complications of diseases, which can be treated only on Biochemical parameters. Diabetic Coma for instance. The internal chemistry is so fucked up,[Sorry to use the word, but cannot recollect the apt alternative], that every minute, every hour Doctor has to keep on assessing the status very keenly, by asking for umpteen number of biochemical tests, that too repeatedly. Naturally the cost mounts. But the firm opinion is Doctors loot!

A drop of blood can give so much information about the person by doing myriads of tests, which may be or may not be having satisfactory treatment, but it’s going to cost all the same. To start pathological laboratory not only one has to have immense expertise but has to invest in the lab equipment in crores!

And if you talk about radiology? A single doctor just cannot afford to have highly sophisticated machinery. So in radiology either they have to have group practice or it’s institutionalized. Now here the economical mathematics is easy to understand.

If a particular instrument or equipment, say like Gastro scope costs about Rs 100,000/- and if it performs a finite number of procedures,[with each procedure few fibro-optic fibers break] say 100, then each procedure IS going to cost Rs 1000/-. Plus the doctor has to pay for the maintenance. He has to purchase a new one after the magic number of 100 is crossed, so provision to buy the new one has to be made from the procedures done by the previous one. Pay of the assistant, rent of the operation theatre where the procedure is performed and last but not the least, the fees of Doctor himself! Why not! So from the total sum spent by the patient, the Doctor gets the minimal!

And that’s why most of the time the equipment and instruments in government hospitals are defunct. The poor resident has to perform procedures 10 times more with the same machine because of the patient load and so the result….! Plus there is so much apathy about getting the machines repaired that it may take even six months just to float the tenders!

Third, and the largest chunk of the expenses is taken away for Medicines, but about that later…..