LETTER FROM BANGALORE
Unkind cuts
In January 2000, the Bangalore Neurological Society organised an oration
named after Dr RM Verma, one of India’s great neurosurgeons and the pioneering
spirit behind the NIMHANS. The society honoured Dr Sunil K Pandya, who needs no
introduction to the readers of this journal, by inviting him to be the first
orator.
Dr Pandya chose to speak on the subject closest to his heart; “ Medical
ethics in India : then and now.” As he referred to it at the stage where, after
discussing ethics in the past, he moved on to the present- day ethics, “we go
from the sublime to the ridiculous.” Dr Pandya pointed out that the state of
medical ethics was terrible in his own city, Mumbai, and he understood that it
was pretty much the same in Delhi as well. However, he believed that in
Bangalore and in the South, things were not so bad. Being new to Bangalore at
that stage, I rather believed him. Subsequent events have shown me that,
unfortunately, for once, Dr Pandya was off the mark!
For the vast majority of patients and doctors, the term “medical ethics”
instantly conjures up the word “cut practice” in their minds And not without
good reason. Topics like euthanasia, surrogate fertility and xenotransplantation
are often considered esoteric and do not interest many. Indeed, a considerable
number of friends have told me that they skip reading articles on these topics
in Issues in Medical Ethics. A radiologist friend in this city says to me, no
doubt referring to my long association with a cancer hospital in Bombay, “You
should do something about this cancer first”. My good friend has not yet
succumbed to the tricks of the trade, and his limited practice is the evidence !
Cut practice, however, affects everybody, be it the patient undergoing an
expensive MRI scan or a patient undergoing routine biochemical investigations -
or the honest doctor. Those in diagnostic work (such as I) but who do not have
hospital attachments (unlike me) are probably at greatest risk of being at the
mercy of mercenaries. Thus, when I was exploring some outside waters, so to say,
it came as a bit of a shock to me to hear the question: “How much do you offer?
The going rate is 25 per cent.” Truly, this gives new meaning to the phrase
“cutting edge” of science!
What is the solution? It appears from the experience of this journal,
regretfully, that attempts to awaken the conscience of the doctor are, by and
large, a waste of time. While an infinitesimal percentage may decide to reflect
on the matter after reading these pages, it is likely that the majority will
learn only one way: the fear of the media. Judging from Dr Mani’s and Dr
George’s comments in the National Medical Journal of India and IME, the exposure
that The Hindu gave to masters of the cut- practice has succeeded in reducing
this evil. Perhaps Bangalore (and of course, Bombay and Delhi) need the same.
Comic relief, however, comes from Delhi. A Delhi Medical Council has just
been constituted (I write this in the absence of a column along these lines from
Delhi) to address cases of negligence, because in the words of a spokesman,
“Doctors do not even know that they should not take commissions.” I am touched
by this display of honesty and ignorance and hope that this group will fare
better than I expect them to. The track record of all our other medical bodies
is unimpressive, to put it mildly.
* * *
Cut practice is, of course, what doctors are not supposed to indulge in. Let
us look at the example set by a master surgeon - one practising a different type
of cut [!], so to say. I have been fortunate to lay my hands on a delightful,
ancient book entitled Doctors and patients by John Timbs [London, Richard
Bentley and sons, 1876 ]. It appears that John Hunter, the founder of modern
scientific surgery, once agreed to operate on a patient for a fee of 20 guineas.
When the patient turned up two months later, Hunter learnt that the better part
of this time was spent by the patient’s honest but unfortunate husband to raise
the money. Hunter promptly returned 19 guineas so “ that they might not be hurt
with an idea of too great an obligation.” He also held the operative part of
surgery in the lowest esteem because “to perform an operation is to mutilate the
patient whom we are unable to cure; it should therefore be considered as an
acknowledgement of the imperfection of our art.” The times, clearly are a-
changing!
* * *
A letter in the previous issue of IME made me think. In it, Dr Sethuraman of
JIPMER, Pondicherry, makes the comment that this journal appears to concentrate
on the negative aspects of our ethical practices while ignoring the positive. I
reflected that, if this were true (and it probably was) we were guilty of the
same thing that people, including me, were often critical of – that the media
hyped bad news at the expense of the good. Hence, I shall endeavour, wherever
possible, to at least end on a happy note. While it is the duty of the journal
to point out erroneous practices so as to apply corrective measures, it is
equally important to acknowledge good practices. The latter may influence the
impressionable youth and will serve to give credit to ethical doctors.
I am happy to learn of an organisation in Bangalore called the Indian
Association for General Practitioners. The small group which runs this show is
unlike many specialists and superconsultants I know: they keep abreast of the
latest relevant literature and they are ethical! In their bimonthly journal,
edited by Dr BC Rao, I see a plea made by the secretary, Dr Jayaprakash to his
colleagues to avoid depending on the drug companies for sponsorship of CME
programmes. He suggests that doctors should pool their resources and conduct
meetings without sponsors. I find it commendable that this small group is
working towards practising what so many of us should have done long ago. May
their tribe increase !
Sanjay A Pai,Consultant
Pathologist, Manipal Hospital, Airport Road, Bangalore
560017
