At the end of this article is a list of some of the titles of my 'scribblings' on my blog. A click on any title would open the chosen 'scribbling'.
THE NOBLE PROFESSION
hit a bad patch
Dr. T. Rama Prasad May 2024
A link to this ‘scribbling’ : https://drtramaprasad.blogspot.com/2017/04/noble-profession.html
DOCTOR … a highly respected word … full of nobility.
Somebody informs him that somebody is very ill. He picks up his ‘doctor bag’ of emergency drugs and flies to that somebody by his bicycle. Gives some treatment, holistically with the wisdom of clinical hunch and common sense. If necessary, he takes the patient to a hospital for further treatment, and would bring him back home, and gives the follow-up treatment.
The patient may be rich or poor, nearby or far away. He accepts whatever peanuts are given for his nuggets of service. He strictly follows the ‘Hippocratic Oath’ and ‘doesn’t make money in the sick room’. In case of death, he may even accompany the body to the graveyard like a family member. That’s why he is called a ‘family doctor’ aside from the fact that he treats all the family members, young or old. Full of empathy and sympathy, he constantly counsels the family members to get over health problems. Such doctors made the medical profession noble, holy and essential. This is the noblest of all the professions, and the doctor is equated to god. There is enormous scope in this ‘Noble Profession’ to do invaluable service to the humanity.
While rendering humanitarian service, doctors sacrifice quite a bit of their personal life. They risked their own lives in saving the lives of the people during the COVID pandemic. The reverence for a doctor is more than for anyone in any other profession as he cares for the sick round the clock without demanding returns -- a selfless service. It is the noble desire to do such service that is the reason for such a huge demand for the MBBS seats – 20 lakhs of students appeared for the NEET examination in 2024 for one lakh seats. If this is not the reason, look for it in the following pages.
An artist’s depiction of a hospital in COVID times.
To add a tad of glamour and gaiety to the gloomy picture of the tragedy, I painted a few figures going around dancing.
The ‘COVID medical scenario’ offered a paradox of people being afraid of hospitals and of hospitals being afraid of people.
COVID exposed deep fractures in the health systems in many countries including India. Regrettably, it may be brushed aside as a passing cloud.
SCARED of HOSPITALS & SCARED of PATIENTS
(A note to the aspirants for MBBS: After reading this ‘scribbling’ of negative narration, don’t lose your steam to study medicine. Just as of the cars, the “MBBS models” of 2030s will be different, more perfect and driven more by AI ! Read my article titled “ Artificial Intelligence in Medicine” – The Antiseptic, Vol. 121, No. 1, January 2024, Indexed in IndMED, www.theantiseptic.in / https://drtramaprasad.blogspot.com/2023/01/artificial-intelligence.html . Good or bad is part of evolution. A tryst with destiny that wasn’t to be. Wish you all a NOBLE career. )
The TRAVESTY of a PROFESSION
METAMORPHOSIS
Modern medicine, which represents the epitome of technological innovation, has wiped out dreaded diseases like smallpox, and prevented epidemics and pandemics from wiping out populations.
There have been excellent doctors, drugs and hospitals in ‘modern medicine’ which saved the life of millions of people and alleviated the suffering of billions.
Thanks to the industry, the giant pharmaceutical establishments and the huge research institutions all over the world which have elevated the ‘modern medicine’ to the enviable position that it is today. They spend millions and millions on R & D to serve the humanity by producing better drugs, creating novel equipment and formulating new protocols in medicine. We should feel grateful for the service of all concerned with this.
Around 2070s, the business model seems to have infected the medical profession. Ominous clouds had been gathering over the profession, and certain deviations have come to be considered as “normal”. The ‘modern medicine’ could have remained entirely ‘noble’ except for the societal changes -- materialistic trends, business attitudes, moral degradation, value depreciation and egoistic ambitions. Doctors and researchers are part of the society and are also human beings, vulnerable to venality. What seems to be the bane of the system globally is the fact that some in the field have largely shed their “nobleness” and started living in the ‘dog-eat-dog’ world with all the grey economy and vested interests. The industry is cleverly exploiting this ‘weakness’ through various kinds of ‘funding’, ‘grants’, ‘support’, ‘sponsorships’ and ‘offers’ – overt and covert. Many hospitals across the globe are profit-driven and run on business models, and as such 'modern medicine' is often overused and misused. In the good old days, we used to take whatever was published in medical journals as the guiding truth. But in these days of "materialistic metamorphosis," we pause and ruminate. Read my article titled "“MEDICAL LITERATURE” (https://drtramaprasad.blogspot.com/2017/03/medical-literature.html ) and the one titled “The Science and Nonsense about COVID” (https://drtramaprasad.blogspot.com/2017/04/science-and-nonsense-about-covid.html ) .
The following is an excerpt from the observation of a Bench of Justices of a HIGH COURT in India - Chennai: “A study conducted by Support for Advocacy and Training to Health Intiatives (SATHI), an NGO, states that big pharmaceutical companies bribe doctors through high value bribes such as smart phones, credit cards, e-vouchers and even female companionship... Thus, patients are compelled to pay more unnecessarily because of overpricing of drugs,” the judges said.
Before I scribble something about the surrealistic subject of "MEDICAL FEAR" among the public and the professionals, let me pen a few lines about the ongoing gladiatorial combat in the Supreme Court between two systems of medicine in India.
BATTLE BETWEEN SYSTEMS OF MEDICINE
India provides various systems of medicine, official and unofficial.
Presently, in 2024, a legal war is being fought between ‘Allopathy’ (Indian Medical Association - IMA) and ‘Ayurveda’ (Patanjali Ayurved). (It is alleged that ‘Patanjali Ayurved’ discredited ‘Allopathy’ and made false claims of cure through ‘Ayurveda’.) A scrimmage of competitive accusations, fired from their canons, seemed to have irritated the judiciary. After a few hearings of the arguments, it seems that a little war broke out between the IMA and the Supreme Court. The court is reported to have criticised the practices of private doctors about “the phenomenon of inflated bills and doctors allegedly prescribing over-priced medicine brands in cahoots with pharmaceutical companies.” In turn, the IMA chief, R. V. Asokan, is reported to have said : “It does not behove the Supreme Court to take a broadside against the medical profession of the country which after all sacrificed so many lives for the Covid war.” Reacting to this, Justice Hima Kohli is reported to have asked the IMA lawyers : “Afterall this, you do this ? The IMA has not covered itself with glory … How can you decide which way we [Supreme Court] should go ?” (THE HINDU, May 1, 2024). At last, the Supreme Court has slammed both the parties. Whatever be the system, let’s call a spade a spade. The ‘Patanjali case’ seems to be a clear example of violation of checks and balances which called for stepping in of courts to regulate the regulators for actions without fear or favour. Let’s wait for the final verdict. Ultimately, it is the judgement of the PEOPLE that matters, not of the Supreme Court, not the Government, or the professional bodies. A majority of 44,000 out of 70,000 hospitals exist in the private sector in India. This apparently speaks good of the private hospitals as people voluntarily seek treatment at the private hospitals. No doubt, there are excellent hospitals and dedicated doctors in India. But, but, but … read the following.
SCARED of HOSPITALS
No, it’s not the fear of injections, procedures or ventilators when it came to ‘COVID hospitalizations’ especially during the ‘second wave’ in India. It’s the money factor – “a-lakh-a-day with 10 days-advance” in some hospitals. Fear of death forced even low income people (who ordinarily go to government hospitals) to seek in-patient treatment at private hospitals.
The story of ‘pandemic hospitalization’ goes like this – on the morning of April 10, 2022,I read a revealing article, related to the pandemic hospitalization, written by AnandNeelakantan (famous author of Asura, Ajaya Series, Vanara and Bahubali trilogy) that’spublished in The New Sunday Express Magazine of April 10, 2022 -- https://www.newindianexpress.com/magazine/voices/2022/Apr/09/standardise-private-hospital-ratesto-stop-exploitation-of-patients-2439271.html . The following is an excerpt from that article 36 :
“ … The corporatisation of the medical profession is the greatest tragedy that occurred to Indians. The coronavirus pandemic laid bare the fangs of this monster for all to see. The private hospitals made a killing, literally and figuratively, during the pandemic, while the government hospitals gasped for breath. Most Indians are one medical crisis away from abjectpoverty, and the pandemic medical bills of both who survived or were dead stripped many of their life savings. Every PPE kit, every injection syringe and pills were used as a means to suck out money. It wasn’t that such exploitation was happening for the first time. Anyone who had the misfortune of being a patient or a patient’s relative would have experienced such heartlessavarice from private hospitals at least once in a lifetime. The pandemic presented an opportunity for a windfall for private hospitals. It was a bumper crop season, where they made money irrespective of whether the patients survived or died. Many doctors have now become no better than salesmen struggling to meet their monthly and quarterly revenue generation targets for the corporates who employ them. Every possible test is forced upon the hapless patients,whether they require it or not. …” 36
One may read the full article of Anand Neelakantan to know more about the scenario of the BIG hospitals in India which ratcheted up tariffs enormously. 36 The situation seems to be in stark contrast to my “PAY WHAT YOU CAN Clinic” where one may pay whatever one wishes for the service (https://drtramaprasad.blogspot.com/2017/04/what-you-can-clinic_30.html).37 Of course, for running a clinic like this, I am respected as a FOOL or a PHILOSOPHER !!!
In addition, one may read my blog ‘scribblings’ titled “Modern Medicine – the Good, the Bad and the Ugly” ( https://drtramaprasad.blogspot.com/2017/04/modern-medicine-good-bad-and-ugly_30.html ) 27 and the one titled “MEDICAL LITERATURE” (https://drtramaprasad.blogspot.com/2017/03/medical-literature.html ) and the one titled “The Science and Nonsense about COVID” (https://drtramaprasad.blogspot.com/2017/04/science-and-nonsense-about-covid.html ) .
FIASCO
Often, a spree of investigations, numbers, graphs, procedures, images and admissions could well find diseases where there are none. That makes one stay awake all night with wide glassy eyes, worrying about the future of his family ! Fraudulent research in MODERNMEDICINE. What a fiasco ! That’s the drama scripted by the BIG industry and the BIG insurers who chart the navigation of 'Modern Medicine' and Medical Education. Read about it in the articles cited above, and especially the text under the subheading “Modern Medicine Fiasco” in my article titled “HCQ, Ivermectin, Coronavirus and Frauds” :https://drtramaprasad.blogspot.com/2017/04/hydroxychloroquine-hcq-and-coronavirus_29.html .
IS THE SCIENTIFIC MEDICINE RESEARCHED, DOCUMENTED AND PRACTISED BY THE "NOBLE PROFESSION" ENTIRELY GENUINE AND BELIEVABLE ?
ART of MAKING MONEY
One COVID patient was billed $1.1 million in the US and another was billed Rs.16 lakh in India. These two bills may be genuine and reasonable for the service rendered, and the “seemingly high charges” may be necessary to make the hospitals economically viable and sustainable.
But the General Insurance Council moved the Supreme Court against alleged 'profiteering' by private hospitals in India. It was mentioned that, when objected, in one case, the bill of Rs.14 lakh was brought down to less than 4.5 lakhs ! 22 And it was reported that somelaboratories and some private hospitals had an unholy nexus to promote hospital admissions --by generating fake ‘COVID positive’ lab reports to drive patients, terrified by the lab results, into hospital beds for exploitation ! Not unexpectedly, clever people hurriedly started COVID HOSPITALS (“to make hay while the Corona shines !” – pun intended), many being certifiedwithout the requisite facilities (in the ‘LicenseRaj’). Corona is the outermost part of the SUN which shines and also is the virus. And, oddly, a few had converted their hospitals into“COVID-FREE HOSPITALS” (meaning that no COVID patients are admitted to prevent spread of COVIDinfection to others in the hospital) to attract non-COVID patients. Let us hope that all this would be the 'swan song' of the avaricious elements. Yes, we did have our misfortunes, and let's hope that that's 'water under the bridge' now.
Here is an excerpt from my article titled “Disastrous Second COVID Wave in India” and published in the medical journal, The Antiseptic of June 2021 – Vol. 118; No. 6; Indexed in IndMED; www.theantiseptic.in (This is one of my 28 published articles on the COVID-related subjects) :
“ … No doubt, there are kind-hearted souls who practise medicine with humanism and sacrifice, but the ‘second wave’ made the ‘once-upon-a- time-noble profession’ seem like an unholy business in India. This is the horrendous facet of the ‘second wave’. … Chaos and confusion prevailed everywhere with overwhelming demand for treatment, hospital beds, drugs, medical materials and burial space too. Acute shortage of oxygen took away numerouslives. People died in ambulances outside hospitals while waiting for beds. Heartrending and urgent appeals for help went in vain. Relatives couldn’t do anything but watching the dear ones gasping for air. … The ruthless black market that fends on the artificial demand, clamour and patronage by some professionals is mutating faster than the virus itself -- shameful exploitation in the times of despair. Greed has become more infectious than the virus itself.Even hospitals, hospital staff and doctors jumped on the bandwagon to swindle and exploit helpless and hapless patients and their desperate kith and kin. Getting a hospital bed through a ‘backdoor’ route in Bangalore costed more than Rs. 30,000 and it might cost a lakh or two per day for treatment, while people were standing on a bed of shrieking cadavers. Hefty bribes of Rs.2 lakh were demanded for a bed in ICU in Jaipur – a male nurse was arrested whorevealed his links with two doctors working at the hospital. People sold their assets, including their cattle and sheep, in an attempt to save their near and dear. Most of them mourned at graveyards.” 4 Read the full article to know more about the tragedy.  |
It’s the ‘HOSPITAL FEAR’ that has set in now.
SCARED of PATIENTS
Across the country, in recent times, people attacked doctors, even murdered a lady doctor (in Thoothukudi on Jan 2, 2012), and vandalized hospitals for alleged professionalnegligence (30 incidents in Tamil Nadu alone during the last 6 months of 2011). I am writing thishere to underscore the FEAR phenomenon among the public and the medical profession as well due to the rot in oursystems. 27, 23 For further reading go to the last few pages of my BLOG scribbling titled “Modern Medicine – the Good, the Bad and the Ugly”-- https://drtramaprasad.blogspot.com/2017/04/modern-medicine-good-bad-and-ugly_30.html .
Due to the fear induced by the Consumer Protection Act, 1986 and the landmark judgement on the 1995 case – Indian Medical Association v. V.P.Shantha -- some of the private doctors have been avoiding to treat “seriously ill” cases “out of wisdom.” The fear of public reaction makes them not to put themselves at risk. Due to this new phenomenon, several lives might have been lost. And, should doctors, like lawyers, be kept out of the Consumer Protection Act ? It needs to be revisited.
The doctors in the public sector can’t avoid treating.As many as 44,000 out of the 70,000 hospitals in India are in the private sector. Why don’t the people prefer to go to the 26,000 public hospitals? That’s a different story. It’s like missing the woods for the trees ! And, should doctors, like lawyers be kept out of the Consumer Protection Act ? It needs to be revisited.
The story of the government doctors is like this : “ … For the vast majority, who cannot even dream of insurance, the only refuge is the government hospitals. It would require loads of idealism for the harried government doctors, striving under the duress of overwork, fighting the system, dealing with the shortages and medicines to keep going without a nervous breakdown. Sooner or later, the lucrative private practice will tempt many of them. Thisvicious cycle is growing into a cyclone of social crisis.
… The trust between doctors and patients has broken irreparably. Being a doctor has become a thankless profession. It is also true that many doctors prefer to satiate their greed for money than gratitude from their patients. … (Neelakantan)”.
Consumer Protection Act, 1986;
The Clinical Establishments (Registration and Regulation) Act, 2010 & various other legislations;
Unfair criticism
Ridiculing cartoons in media
Should one get into “Medical Practice” to be burdened with all these “Non-medical Problems” ???
In the good old days, doctors had unfettered freedom to decide on medical matters, sans the present day 'Acts of Regulation'. Of course, they conducted in a noble way, in letter and spirit. ETHICS, that's what mattered. In contrast, see what happened in May 2024, despite a myriad of "Clinical Establishment Regulations." In Delhi, fire broke out in a "New Born Baby Care Hospital" killing six newborn infants and leaving five more battling for life. A police official said : "During inspection of hospital and examination of staff, it was found that there was no fire extinguisher, improper entry exit, absence of emergency exit, deployment of BAMS doctor etc. So, stringent sections were added to the FIR" (TOI, May 17, 2024). A healthy kidney was removed instead of a diseased one. Blood samples were swapped to protect a killer. Read below about them.
This painting may represent an artist’s surrealistic vision of a‘COVID HOSPITAL’. The picture looks like a WHIRLPOOL. One who getsinto a whirlpool gets sucked deeper and deeper into the waters and may never come out of it. Magnify the picture and see. There are blood stains all over, blood transfusion line, syringes, some 14 chambers, some people dancing, etc. How is this painting related to HUGE COVID HOSPITALS that Ananda Neelakantan may be referring to in his article cited above ?
One brainy staff member of a hospital answered in just one word : "RATHASARITHRAM" which may mean a surrealistic scenario of'bleeding' the patients through 14 and odd specialities of a giant corporate hospital, while the owners dance with joy and the patients dragged deeper into the whirlpool !!!
This could be the microcosm of the profit-oriented private medical sector in many countries, fueled by BIG INDUSTRIES. In countries like America, it is done in a sophisticated and “transparent” manner to the accompaniment of insurance companies while in some countries it is done through mastery of the art of accounting and fabrication.
HIPPOCRATES, the ‘Father of Modern Medicine’,460-377 BCE, must be turning in his grave.
Doc was a god then; viewed with suspicion now.
Then sacred; now scared.
Treatment was simple and straightforward then; now it’s complex and confusing.
Why this change ? Who is at fault ? Where is the FAMILY DOCTOR ?
We need to ponder and cogitate.
Go to : https://drtramaprasad.blogspot.com/2017/04/modern-medicine-good-bad-and-ugly_30.html and https://drtramaprasad.blogspot.com/2017/04/hydroxychloroquine-hcq-and-coronavirus_29.html for answers.
NOBLE, INDEED
At the other end of the spectrum, there are many genuinely charitable hospitals and doctors rendering cost-free service of high standards. There is an odd one in Hyderabad which has an 80-bedded well-equipped and well-caring facility to give advanced palliative care to terminally ill cancer patients during the last lap of their journey, entirely free-of-cost ( https://www.kusumatrust.org/project/sparsh-hospice/ ).
And, there are noble doctors and hospitals renderingnyeoman service at a reasonable cost. But they are few and far between. On the whole, the scenario is a sea of mediocrity with a few islands of excellence. It would be a Herculean task to clean the stables of malpractice.
There are innumerable philanthropists, doctors, nurses and paramedical workers who sacrificed their life for the health of the people. Though they are of different groups, they are all part and parcel of the ‘NOBLE PROFESSION’. Their services must be remembered at least, if not rewarded and awarded. No doubt, there are numerous students who want to study MBBS course to do such charitable service, to do research or to advance academically, but the educational system is not praiseworthy for them to pursue as revealed below.
RICKETY MEDICAL EDUCATION & ETHICS
Deteriorating standards in medical education and ethics is a matter of grave concern. Recently, in March 2024, one State Health Department formed a committee to probe a flurry of complaints by students about POOR QUALITY of teaching at 11 medical colleges. And, it is reported (May, 2024) that the National Medical Commission had sent notices to several medical colleges (both private and government) across India of a fine for deficiencies in faculties and clinical material. It’s an open secret that over a very long period the deficiencies were made up by ‘ghost’ faculty members and patients as and when ‘Inspection Teams’ arrive (https://www.drishtiias.com/daily-updates/daily-news-analysis/state-of-medical-education-in-india .). It's obvious that one doesn’t teach ethics in medical schools. Public trust in the quality of the ‘Noble Profession’ thus melts away.
It seems that all the concerned have been immune to criticism even by overseas voices whose tone can be heard in the following quotes
(The matter in the small print below is the one that matters most – a must read)
Once, the Editor-in-Chief of the British Medical Journal (BMJ) said : “Corruption in healthcare is a global problem and not just limited to India. The problem in India is that there is a system where there is corruption in governance generally, and corruption in medicine is just one part. That created an additional challenge for the doctors who might think we got to behave in this way in order to just exist. What we will be saying is that the doctors need to stand up and say that this is not ok and their professional bodies need to stand up and say it is not ok. The private medical schools that are burgeoning in India need to be properly overseen so that the new generation of Indian doctors coming through have proper ethical and moral codes and as said in the editorial, if that doesn't happen, there are ways in which other countries in the world where Indian doctors want to go and practice can say we won't accept you unless your bodies make the necessary changes. …” ( http://timesofindia.indiatimes.com/home/stoi/all-that-matters/Stop-corruption-or-other-nations-could-turn-away-Indian-doctors-Fiona-Godlee/articleshow/44372779.cms (October 5, 2014). )
And, a ‘British Medical Journal’ publication on September 3, 2015 ( http://www.bmj.com/content/351/bmj.h4312 / http://www.bmj.com/content/351/bmj.h4312.full.pdf+html ) reveals the well-kept secret of the unethical revenue targets set for doctors working in India’s profit-driven hospitals that lead to expensive but unnecessary tests and surgery that also comes with the risk of harm.
And, it may be recalled that the president of the Medical Council of India (MCI) was arrested by the CBI, and the President of India signed an ordinance on May 15, 2010 to dissolve the Executive Council of the MCI. The president of the MCI who was supposed to be the highest controller, guardian and watchdog of the standards of medical education and ethics of medical profession all over India was alleged to have gorged in enormous sums to the tune of Rs. 1,800 crore (as reported by media) to facilitate official recognition to some substandard medical colleges through illicit means. One is completely flummoxed by the scandalous 'Mother of medical scams' of the 'Father of medical ethics’ ! This episode appears all the more squalid as it involves the highest guardian of medical education and ethics who embraced hubristic power. The famous Latin query “QUIS CUSTODIET IPSOS CUSTODES ?” (meaning: “Who watches the watchmen ?”) is very relevant to the systems wherein it is often the wrongdoer who is authorised to correct the wrongdoers. And it is like Satan quoting scriptures !
The ‘Sydney Morning Herald’ (Feb 28, 2015) published an article titled “Indian doctors shed light on massive medical procedure scandal” based on a report by an NGO, SATHI (Support for Advocacy and Training to Health Initiatives) ( http://www.smh.com.au/world/indian-doctors-shed-light-on-massive-medical-procedure-scandal-20150228-13rg1f.html#ixzz3k1s7ioEn ). It mentions:
“…For years, Indians have suspected that doctors operate unnecessarily, order unwarranted tests and procedures, take kickbacks for referring patients and behave like rapacious robber barons rather than carers. Now the horror stories that used to form the subject of dinner-table banter - such as cardiac surgery prescribed for a shoulder pain that got better with exercise - are coming straight from the horse's mouth.
They (doctors) have told the Pune-based NGO which produced the report, SATHI (Support for Advocacy and Training to Health Initiatives), that private hospitals have become so commercialised that maximising profit underpins every aspect of treatment. … Having made massive investments and faced with intense competition, many hospitals try to recoup their investment through such unethical means, including setting revenue ‘targets’ for doctors to meet.”
The Honorary Secretary, PPLSSS of the Indian Medical Association, TN, wrote in a publication of the Indian Medical Association, TN that “... Acquiring medical degree is now become very easy. But empowering knowledge is not that much easy. Degree can be purchased knowledge cannot be. As you know, little knowledge is always harmful. ” (TIMA News Letter, vol.03, issue 11, December 2010). To know more about the “Great Medical Education Bazaar” in India go to http://www.thehindu.com/opinion/open-page/the-great-medical-education-bazaar/article4841270.ece . And there is a much bigger “bazaar” for paramedical courses offered by institutions with no proper facilities for educating and training.
Even more than 35 years ago, Dr. V. S. Ramaswami, MBBS, BSSc, MPH (Johns Hopkins of USA), wrote a lengthy letter to me on September 9, 1987 : “Dear Dr. Rama Prasad, … I have always read with pleasure as well as admiration your writings in THE HINDU. … Medical and other professions have reached their lowest ever levels … A generation of teachers has been wiped out and so there is none eager or competent to teach and none eager to learn …” Dr. Ramaswami was a professor at various medical colleges in India and abroad, at a time when ‘kidney rackets’, ‘organ transplant brokers’, ‘oocyte goondas’, etcetera didn’t yet emerge.
The Ground Reality : However hollow or shallow it is, the MBBS degree is considered as a STATUS symbol and a stepping stone for PROSPERITY, in India. That’s the reason why it has become a very expensive commodity. And, a speciality is chosen by many for its potential to generate money.
COVERED with GLORY or GUILT ?
Hippocrates may be flabbergasted when he reads my article titled “MEDICAL CONFERENCES” -- https://drtramaprasad.blogspot.com/2017/04/medical-conferences-clinical-meetings_30.html -- which may slightly unveil the academic facade of the 'NOBLE PROFESSION' and reveal its weakness. The strength is in the BIG INDUSTRIES which sponsor the BIG CONFERENCES !!! One can see the invisible pilot in the cockpit. Many hospitals across the globe are profit-driven and run on business models, and as such 'modern medicine' is often overused and misused. In the name of “Evidence-based Medicine” needless exhaustive investigations, procedures and surgeries are carried out, creating a delusion of relevance.
More and more people are subscribing to the “animalistic doctrine of ‘Work – Consume – Die’ culture, dressed in subtle and gross deceptions.” Good and bad is present in every field, but we can’t ask for a replacement of a limb or life as in the case of a car or a machine when the repair work fails. On April 23, 2024, a 26-year-old man died after a botched surgery to reduce fat in his body (bariatric surgery) which costed him about five lakhs of rupees. The hospital was sealed for deficiency of facilities, but will the young and active man come back to his home ? (TNIE, 09.05.2024)
While we cannot expect the professionals to be insulated from the defining materialistic ethos of our times, a reasonable humanitarian attitude would restore the ‘noble’ image of the profession. When greed is the principal motivator, concepts like ‘health for all’ lose all the meaning. No amount of spin and gloss would hide the bitter truth.
TRUST and SUSPICION
Magnification of the negative happenings by media led to enormous erosion of TRUST & POSITIVITY, and alarming amplification of SUSPICION & FEAR. Trust collapsed. Scary. Everybody is scared. People are scared of huge bills of needful and needless hospitalization, and needful and needless investigations, procedures, medicines, surgeries, etc. Hospitals are scared of bankruptcy if they can't make much money. Senior specialists are scared of losing jobs if they don't generate much money for the hospitals. Patients are scared of such hospitals and doctors. Doctors are scared of patients -- violence and medico-legal issues. Doing the needless things is justified by the protocols based on the scientific "Evidence-based Medicine." Not doing them may land a doctor in a legal quagmire though.
In fact, doctors in America are more afraid of patients, as suing doctors had been a regular phenomenonthere. The doctors do more investigations in order to protect themselves legally, and are very reluctant toprescribe anything without recoded medical evidence in favour of a diagnosis. One with an ordinary head ache may land in a CT scan machine. The patient is not hesitant as the bill would be paid by the insurance company. In some countries, they do all this to fill forms, in some they do to fill pockets. Whatever it is, it fills the coffers of the industry ! Read my article titled “Over-prevention, Over-investigation, Over-diagnosis and Over-treatment” published in the medical journal, The Antiseptic of November 2023 – Indexed in IndMED, www.theantiseptic.in,Vol.120, No. 11 ; https://drtramaprasad.blogspot.com/2020/02/over-healthcare.html. Also read : Rama Prasad. T.,COVID medical literature – the Good, the Bad and the Ugly. The Antiseptic, 2022 September; Vol. 119; No. 9; p:07-19; Indexed in IndMED – www.theanntiseptic.in ; https://drtramaprasad.blogspot.com/2017/03/medical-literature.html .
NOBLE PROFESSION BARRED
A proposal to bar doctors to participate in medical conferences or academic meetings sponsored by pharmaceutical companies and other allied health sector firms was made by the National Medical Commission (NMC) in August 2023. There were high-octane protests by the vested interests which forced the government to keep the proposal in abeyance. So, the people started asking : "Why ? What's the background ? What's the connection between the industry and the ‘Noble Profession’ ?" No amount of spin and gloss would hide the bitter truth. Yes, the medical scenario in India is a very complex one puzzling every one. In an article in the British Medical Journal, Dr. Kamran Abbasi and Dr. Richard Smith wrote : "Doctors and drug companies must work together, but doctors do not need to be banqueted, transported in luxury, put up in the best hotels, and educated by drug companies. ... How did we reach the point where doctors expect their information, research, education, professional organisations, and attendance at conferences to be underwritten by drug companies ?"
Anyway, BIG THANKS to BIG PHARMA & the INDUSTRY for developing life-saving drugs & equipment, and the overall progress in ‘Modern Medicine’. But, now, we seem to have reached the point where a doctor may have to say : “Trust Me, I’m a Doctor.”
REMEDY
We need to ruminate on this issue of distrust among the profession and thepublic. Blindly distrusting doctors and hospitals can breed unwarranted scepticism. Maintaining a balanced perspective is crucial in evaluating hospitals or doctors. Magnification of lapses and the resultant reactions foster mutual distrust. There is always someone who puts two and two together and makes it five. This is applicable to both the parties -- the public and the professionals.
After all, in these materialistic ‘Kaliyuga’ days, most of the people and establishments need money. Even temples for that matter – they needed to put a price tag on various ‘dharshans’, ‘sevas’, ‘abhishekams’, ‘pujas’, etc. Read my scribbling titled“God, Religion and Universe” at https://drtramaprasad.blogspot.com/2017/04/god-religion-universe_29.html. Everything comes at a price, so does medicine -- this does seem to be the philosophy of the day.
There are black sheep in all the professions. The concern is about their prolific growth in recent times in the ‘Noble Profession’.
WHY STUDY MBBS ?
Is the “HERD PRESSURE” due to “MONEY PRESSURE” ? No amount of spin or gloss would hide the bitter truth.
One lakh MBBS seats; 20 lakh NEET candidates -- in 2024 -- in India
The Ground Reality : However hollow or shallow it is, the MBBS degree is considered as a STATUS symbol and a stepping stone for PROSPERITY, in India. That’s the reason why it has become a very expensive commodity.
"NOBLE SOULS" SHUN RURAL LANDS
Here is an excerpt from my ‘Scribbling’ titled “Medicine in Rural India” (the full text may be accessed at https://drtramaprasad.blogspot.com/2017/04/medicine-in-rural-india_30.html ):
“ …Doctors shun rural areas for various reasons. Some of them are: lack of good education facilities for their children, limitations on upper level social life and entertainment, lower end quality of life, unavailability of decent residential accommodation, low grade infrastructure in rural health centres, low professional satisfaction, lack of prospects for academic advancement, very limited scope for private practice, etc. Hence, most of them wouldn’t happily settle down in rural areas. … The presence of doctors and facilities is very much skewed -- the urban areas are better served than rural areas. Though most of the population in India is in the sprawling rural hinterland, most of the spending on healthcare is in the urban areas. And most of the doctors prefer to live in urban areas and much of the good medical infrastructure is in the urban zones. More than 75 per cent of the doctors are in urban areas where only less than a third of the people live. This is the main cause for the imbalance and the deficient health care services in rural India, notwithstanding the setting up of the National Rural Health Mission. Even if, under the “Universal Health Coverage” (UHC) of the 12th Five-Year Plan, 129 medical colleges are added by 2017 and even if the availability of doctors is increased to 20 from the present 7 per 10,000 population, the distribution of the doctors may not be equitable as envisaged by the UHC. Even if India reaches 3.5 : 1,000, as is in the US, still there will be a dearth of doctors in rural areas, for obvious reasons. Some of the Indian professionals serve the rich urbanites abroad for various reasons as mentioned in my writing titled “To live in INDIA or ABROAD” -- https://drtramaprasad.blogspot.com/2017/04/to-live-in-india-or-abroad_28.html
It is well said that “the road to hell is paved with good intentions.” Year 2017 – 479 MBBS medical colleges; 67,218 intake of MBBS students; 1: 1,000 doctor-population ratio (WHO’s recommended ratio); 10,22,859 MBBS registered doctors. India produces the largest number of doctors and specialists in the world. Quality ? It is reported that a new generation of 'half-baked' specialists jumped on to the bandwagon of specialists in the private sector soon after getting PG certificates, without much experience.
POOR Indian doctor;
RICH foreign ambition !
A dilemma
LOVABLE RURAL FOLK ... February 10, 2018
Yes, rural are really lovable folk. Most of them have a refreshingly rural and innocent background. They have blind faith in gods, and doctors as well.
After a few decades, we may see no more of such good plain-hearted rural folk. And, even now, we rarely see the good old grand grandmother of ‘topless’ (‘blouseless’) era ! The women of that generation cover their upper bodies with a piece of a cloth only (end piece of sari) wrapped around without any underclothing like bra or blouse.
Today (February 10, 2018), one frail-looking grandmother in that 'topless' attire (see the attached photo) walked into my consultation chamber, accompanied by her grandson, but not needed to be assisted by him to walk in. She (Gowandayamml) fluently talked in the grand old style ... said she got the appointment with great difficulty (limited consultations today, as I had to spare some time to attend my granddaughter's 'food court bonanza' at her school). At the end of the consultation, she wanted a 'cough syrup' (most of the 'cough syrups' are used unnecessarily and for psychological satisfaction, and to the great delightfulness of drug industry !). I gave her a sample bottle of a cough syrup, free of cost, of course ... and lo and behold, her face was lit up with happiness. Little pleasures ... little things matter in life ... read the 'Scribbling' titled 'Richness & Happiness' on my blog. She narrated at length of her previous visits over decades and profusely thanked me for keeping her fit (in fact, it is her good old lifestyle and her constitution that kept her fit, not me !). I asked her whether I may have a photo with her. She was amused and laughed. I called the receptionist to take a photo. The lady of the old school put up a serious pose for the photo. Receptionist, Nandhini, asked her to smile ... in vain ... perhaps, the grandma thought that one should not move or smile when the camera clicks (In our school days, photographers used to instruct us not to move or smile when they take group photos in the school, with those bulky 'plate' cameras with a long exposure time !). I shall give her a print of the photo when she visits me again ... curiously, we both are of the same age group by the calendar, though seem not to be by the images ! Finally, the plain, simple, candid and 'topless' granny left my chamber. After a while, she came back with money (hundred rupees notes) in her hand to put into my tiny 'Pay what you can' hundi, as consultation fee. I had to persuade her a lot not to give any consultation fee, saying that it's a great pleasure for me to treat her free of cost ... again there was a flash of a cheerful smile across her face. This is the most pleasant reward we get in medical practice -- the cheerful smile of satisfaction.
With Gowandayammal on February 10, 2018
And, a speciality is chosen by many for its potential to generate money.
MONEY ERODED NOBLENESS
Here is an excerpt from my ‘writing’ titled “RUN ON MONEY” (the full text may be accessed at https://drtramaprasad.blogspot.com/2017/04/run-on-money_30.html ) :
“ … A huge amount is invested on education to earn ‘high-yielding’ degrees and training. And hence, naturally, a high yield is expected from a huge investment, whether it is at a personal level or at a corporate level. It certainly makes good business sense. Same is the case with some of the huge hospitals. They have to run on pure business models – profit-driven ... and naturally so to thrive, as it is an investment of gargantuan proportions. So, they have their own problems, especially from the point of view of enormous capital inputs, heavy expenditure, frightening 'evidence-based' medico-legal problems and fierce competition. Added to this is the enormous increase in expenditure to fulfil the mandates by regulatory bodies and legislation. And, some hospitals are smarting under funny crunch. For them to be economically viable, they seem to be constrained to resort to do needless investigations, admissions and even surgery, hazardous though. And, all the expenditure is passed on to the patients, rich or poor. … I hasten to add that we should not outright blame the doctors and private hospitals entirely, for two reasons. First, it is the money-centred educational system which made them doctors, at a huge cost, as mentioned above. Second, it is the unsound economic background of many in the country, in general, which constrains them not to be very charitable, especially when they have to clear the huge loans taken for their education and establishment, and to fulfil the expectations of family members. And it is gratifying to note that all the doctors are not of the same kind. Many doctors are very kind and helpful to the society, sacrificing personal comforts.
For a more analytical comment, read my 'scribblings' titled ‘Medicine in Rural India’ and 'The Good, the Bad and the Ugly of Modern Medicine' and 'HCQ, Ivermectin, Coronavirus and Frauds' on this blog, and some of the articles published in The Antiseptic (medical journal) -- Rama Prasad. T., COVID medical literature – the Good, the Bad and the Ugly. The Antiseptic, 2022 September; Vol. 119; No. 9; P: 07-19; Indexed in IndMED – www.antiseptic.in ; Rama Prasad, T. The Science and Nonsense around COVID. The Antiseptic, 2021 November; Vol. 118; No. 11; P: 8-14; Indexed in IndMED -- www.antiseptic.in ; Rama Prasad, T. Disastrous Second COVID Wave in India. The Antiseptic. 2021 June; Vol.118; No.6; P: 20-27; Indexed in IndMED – www.antiseptic.in , etc.
It is lamented that the relentless march of the “industry-guided” medicine is a major threat to "common sense-guided" medicine. We may confront an Armageddon of sorts !
“Clinical Establishment rules and regulations” seem to be present mostly on paper.
NOBLE hospitals run by NOBLE professionals.
All these three incidents are reported within a few days in May 2024 which are related to the NOBLE PROFESSION. Some more of such cases were reported in the same month. These could be the few of the numerous cases (which are mostly unreported and swept under the carpet). These are not just one-off cases to be ignored.
It seems that even the highly qualified “PROFESSIONALS”, holding key posts, push the “NOBLENESS” to the back seat. It’s reported that Dr. Taware of the alleged blood sample fraud was also suspected to be involved in a ‘kidney racket’ at the same hospital (TOI, May 30, 2024).
This disaster shocked the country and made media write articles like the above one because of the condemnable and elaborate attempts by the aristocratic family, the police, and DOCTORS to cover-up the killing of two young techies (https://www.thehindu.com/news/national/pune-porsche-car-crash-a-speeding-car-two-deaths-and-a-cover-up/article68237051.ece ).
An anecdote about “GORU”
During my childhood, one of my schoolmates had huge nails. Her name was Gowri. We nicknamed her as ‘Goru’ (‘goru’ in Telugu means nail of a finger or toe ). They used to say that her huge nails caused a problem in her heart. It might be a case of ‘Digital Clubbing’ (abnormal nails present in some ‘Congenital Heart Diseases’). After one summer vacation, ‘Goru’ didn’t come back to the school. It was learnt that she died due to the nail / heart problem, and that treatment could not be availed as they didn’t have money to pay for it.
Perhaps, this incident prompted me to look at everyone’s nails from that time which might have led me to report the first case from India of ‘Yellow Nail Syndrome (YNS)’ from India in 1980 (published in an American journal, CHEST) and the first case in the world of ‘Yellow nails & Covid’ in 2023, published in an Indian journal, THE ANTISEPTIC - https://drtramaprasad.blogspot.com/2017/04/yellow-nail syndrome_28.html
And perhaps, the preventable death of ‘Goru’ due to the inability to pay for the treatment motivated me to start my ‘PAY WHAT YOU CAN’ Clinic (PWYCC) half-a-century ago where patients may pay whatever they can. No fixed fee ( http://drtramaprasad.blogspot.com/2017/06/pay-what-you-can-clinic.html ). The credit for these case reports on YNS and the starting of my PWYCC should go to ‘Goru’. Thanks to “Goru”.
-- T. Rama Prasad
More at : https://drtramaprasad.blogspot.com/2017/04/dr-t-rama-prasad.html
This is not an ad, it’s about an odd service.
GREETINGS from
‘PAY WHAT YOU CAN’ Clinic
“Thena thyakthena bhoojithaha”– Ishopanishad
( Translated by Prof. B.M. Hegde as: “Rejoice in giving.”)
True to this quote, I have been rejoicing at what little I could give. Defying stereotypes, this clinic has been in existence for a very long time, sans glitz, blitz, ads, microphones, speeches and noise. As a matter of my policy, publicity is shunned. The reason is simple. Good work needs no noise and nonsense. My ‘SCRIBBLINGS’ on related topics may be accessed at: http://drtramaprasad.blogspot.com
My consultation fee is not decided by me. It is the patient’s pleasure. The patient may pay (donate) whatever he can and what he wishes. If one is short of money, he or she need not pay anything. The money may just be put into the ‘hundi’ box kept outside the consultation room. And the money thus received is used for charity to help the needy, the poor and the less fortunate. If interested to know more about this facility, go to: http://drtramaprasad.blogspot.com/2017/06/pay-what-you-can-clinic.html . And, if you wish, you may also 'contribute what you can' through bank (Dr. RAMA PRASAD T, A/C No. 451075868, INDIAN BANK, IFS CODE IDIB000P155, PERUNDURAI, Erode District, Tamil Nadu - 638052 ).
"We need not run after money. If we are meritorious and compassionate, money would run after us, and it eludes us if we run after it.” -- T. Rama Prasad
“Richness is not having lots of money. It is the feeling that one has enough of it. Contentment sans comparison is what makes one really rich.” -- T. Rama Prasad.
Facebook: T Rama Prasad Twitter: @DrRamaprasadt Telegram : Dr T Rama Prasad
Consult your local doctor before rushing to me
Most ailments can be cured at local level
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ABOUT THE AUTHOR,
Dr. T. Rama Prasad
“ Dr. T. Rama Prasad is the WORLD RECORD holder of authoring 28 articles related to COVID-19 in 30 months, published in a medical journal (The Antiseptic – www.theantiseptic.in -- Indexed in IndMED), and reporting in the same journal the WORLD’sFIRST CASE of ‘Yellow Nail Syndrome’ associated with COVID-19, PT & DM (https://drtramaprasad.blogspot.com/2017/04/yellow-nail syndrome_28.html ). Interestingly, he reported the first case of YNS from India in an American medical journal long ago in 1980. He wrote his first article in the premier journal, The Antiseptic, four decades ago. Many of his articles written over half-a-century may be accessed at https://drtramaprasad.blogspot.com/2017/04/dr-t-rama-prasad.html & https://drtramaprasad.blogspot.com/2017/04/my-in-newspapers_28.html & https://drtramaprasad.blogspot.com . He is the former MEDICAL SUPERINTENDENT (Special) of R.T. Sanatorium & Perundurai Medical College and Research Centre.”
Introduction |
In the words of Prof C H Sivaraman, FRCP (London): “ ... Dr. T. Rama Prasad belongs to a distinctly different and unconventional species of doctors. He speaks sparingly and does not even display his qualifications or merits, but his innumerable published writings (he calls them ‘scribblings’ though they are ‘pearls of wisdom and knowledge’, sprinkled with a bit of humour and sarcasm) which received wide acclaim talk eloquently for him. The ‘Pay what you can’ Clinic where services are available for which one may pay whatever one can is a facility run by Dr. Prasad for a very long time which could be a world record. Dr. Prasad is called a ”god” by his patients, and many of them named their children after his name “Prasad” -- that is the height of recognition of goodness of a human being... “ |
Interests |
Journalism, Ornamental horticulture, Aesthetics, Social responsibility. |
Dear Dr. Rama Prasad
I am sure the world will be a better place, if people understand your writings ... ‘EXCELLENT’ is the word. I cannot find any other word in this language to describe what you have written without any pretensions. You have brought out some home truths to those who care to read your website ... You are a great thinker, writer and crusader ... As usual, your messages are incisive, to the point and make lots of sense, much better than my articles …
... You are not only GREAT, but are a true missionary in medicine. May your tribe increase for the good of mankind. ….
Love,
-- Padma Bhushan Prof. B. M. Hegde, (awarded Padma Vibhushan in 2021)
MD, FRCP (Lond), FRCP (Edin), FRCP (Glas), FRCP (Dub), FACC (USA), FAMS, Former Professor of Cardiology, Middlesex Hospital Medical School, University of London, UK, Former Vice-Chancellor, Manipal University, India, Affiliate Professor of Human Health, Northern Colorado University, USA, Editor-in-Chief, The Journal of the Science of Healing Outcomes, Chairman, State Health Society’s Expert Committee, Govt of Bihar, India and Padma Bhushan awardee of 2010. www.bmhegde.com
Professor Hegde, the veteran medical educationist, author and orator, wrote a book titled “WHAT DOCTORS DON’T GET TO STUDY IN THE MEDCAL SCHOOL.” Every medico needs to study that book.
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COVID medical literature – the Good, the Bad and the Ugly
Author : Dr. T. Rama Prasad
Rama Prasad. T., COVID medical literature – the Good, the Bad and the Ugly. The Antiseptic, 2022 September;
Vol. 119; No. 9; P: 07-19; Indexed in IndMED – www.antiseptic.in
https://drtramaprasad.blogspot.com/2017/03/medical-literature.html
AA
In a very rare gesture of appreciation, the EDITOR of the journal published the following note at the end of my article:
“ From the Editor........
The Editor wishes to suggest to the Readers of ‘The Antiseptic’ who are interested in having correct, complete and comprehensive knowledge of the current literature on Covid, to read the above article by Dr. T. Rama Prasad, written as is usual, in beautiful, flawless and inimitable English, with numerous apt quotations.
He further wishes to thank Dr. T. Rama Prasad profusely for choosing to publish all his ‘very interesting to read’ articles on Covid in ‘The Antiseptic’ and hopes that he (Dr. T. Rama Prasad) continues his benevolence.
Go to : (1) https://drtramaprasad.blogspot.com/2017/04/perundurai-is-gem_28.html
(2) https://drtramaprasad.blogspot.com/2017/04/perundurai-medical-college-sanatorium_29.html
30.12.2019 -- COVID was just detected !
You may know a little about the past of this medical college & the sanatorium by clicking on : https://drtramaprasad.blogspot.com/2017/04/perundurai-medical-college-sanatorium_29.html
Left to right:
(1) Dr. T. Rama Prasad, Former Medical Superintendent (Special) of RT Sanatorium & Perundurai Medical College, (2) Dr. S. Prabhakar, Erode District Collector, (3) Thiru Thoppu N.D. Venkatachalam, Ex Minister & Perundurai MLA, (4) Dr. S. Geethalakshmi, Vice-Chancellor of the Tamil Nadu Dr. MGR Medical University, (5) Prof. Dr. M. Rajendran, Dean of the IRT Perundurai Medical College, (6) Thiru V. Shanmugan, Chairman of The Nandha Educational Trust.
To see some more photos of this Graduationn Day, click on : https://drtramaprasad.blogspot.com/2017/04/graduation-day-2018-perundurai-medical_28.html
In 2024, with the ‘COVID HOSPITAL PAINTING’ in the background
“Behind every successful man, there is a woman.”
To see the Woman Power, go to : https://drtramaprasad.blogspot.com/2017/07/rajyalakshmi-international-womens-day.html ;
by
https://drtramaprasad.blogspot.com/2017/04/noble-profession.html
“What are they doing ?”
“Elementary, my dear Watson.”
The following is a list of some (more than 100) of the titles of my 'scribblings' on my blog. A click on any title would open the corresponding 'scribbling'. Start the “VOYAGE”with the title “RAMAYAAN”which is at the end of this list. These are only scribbles for the general audience to pass some time, not for experts. The expressions may be biased and the narration may be a crashing bore on negative aspects. Taste a bit of the bitterness before leaving.
Dr. T. Rama Prasad -
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o ▼ April (111)
§ Science and Nonsense about COVID
§ WORLD CANCER DAY ..February 4, 2017
§ GRADUATION DAY -- 2018, Perundurai Medical Col...
§ "AHIMSA"
§ OMICRON
§ QUOTES
§ POLLUTION, Disease and Deepaavali
§ SILENT, ISOLATED and INSULATED
§ To live in INDIA or ABROAD ?
§ KMCH
§ FISHES
§ SUNDAY LUNCH ... Dec 3, 2017
§ BAHUBALI
§ DIABETES
§ MY ART
§ CANCER
§ DOGS
§ GOD-MEN
§ CODUP
§ LOCKDOWN MEDICINE -- too toxic ?
§ YOGA
§ HCQ, IVERMECTIN, CORONAVIRUS and FRAUDS
§ SWINE FLU -- A (H1 N1) influenza
§ PERUNDURAI MEDICAL COLLEGE & SANATORIUM campus
§ RAJYALAKSHMI RAMAPRASAD and PLANTS
§ GIRL CHILD : GOLDEN CHILD ; WOMEN POWER
§ ASTHMA, ALLERGY, COPD and ILD
§ RAPE
§ MARKETING TRICKS & INNOVATIONS
§ MODERN MEDICINE -- the Good, the Bad and th...
§ SHIVA, KRISHNA, Ramanuja & Ramanujan
§ OUR LOVE STORY & good old days
o ▼ May (2)
· ▼ 2019 (1)
o ▼ January (1)
· ▼ 2020 (3)
o ▼ February (1)
o ▼ April (1)
§ RAJYALAKSHMI RAMAPRASAD and RADIOGRAM
o ▼ June (1)
§ CORONAVIRUS COVID-19 (SARS-CoV-2)
· ▼ 2022 (1)
o ▼ October (1)
· ▼ 2023 (1)
- ▼ October (1)
·
o ▼ August (1)
§ RAMAYAAN
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