When doctors turn money minded-an example of Dr X

Yesterday, I experienced a 'catch' in my back muscles due to which my body tilted. While analgesics did alleviate the pain, it was not better on Sunday too. After a referral by our family doctor (whom we trust blindly), I visited his clinic on Sunday. This doctor will stay unnamed on public forums, to avoid

This particular doctor has a very high rating on Practo(though I did not use that platform), and has a website/clinic seemingly focused on patient care and welfare. The notice boards emphasizes on the continuing professional education(CPE) and certifications attained by him, as also the 'sacrifices' made by doctors and the need to respect them. So far, good. It is however the aftermath of the visit which left me poorer by ~Rs 4,000 and shocked

1. A cursory 10min examination asking me to do some exercises in front of a haggled looking doctor, which concluded in his "Diagnosis" that I had come just in time to avoid slip disc. The bedside manner was not seeming ok
2. The team interested in starting treatment instead of asking how do i feel or validate issues. 
3. X-Ray not feasible since his entire team busy in operations. However, he felt confident to start lumbar traction(that too instructing the medical support staff without explicitly pointing it out). This procedure btw is not medical current practice, as per 2nd opinion. 
4. Extreme and undue hurry to admit me into bed rest even before X-Ray/MRI, in a 'premium room' with billing of Rs 6000/day(albeit including price of nursing, doctor) and no medicines
5. Starting IV drip(for which Rs 950 charged finally)
6. Drawing blood without prior explicit consent, for a battery of tests with desired billing Rs 6,500
7. Charging Rs 800 for X-Ray(Whereas the clinic standard pricing Rs 400). 
8. Finally, consultation in #1 and #6 charged Rs 2000 instead of his standard billing price on Practo of hardly 1/3rd of this. 

This doctor is successful commercially having 3 clinics in/around Mulund(E), and yet I lost all respect today for him. To protect yourself from such doctors, one should ensure that

1. Discuss the cost of treatment UPFRONT and do not mention your mediclaim coverage(Btw this doctor prominently displays insurance TPA tieups)
2. Ensure that PROS/CONS of treatment are mentioned by  him
3. Never get yourself hospitalized BEFORE diagnosis is complete and a written opinion(this can nail him for overmedication)
4. Refuse procedures like I.V/Bloodtests if not necessary 

How finance professional regulators like ICAI ICSI ICWAI are failing the public interest test

In a recent article, Prof Ajay Shah of NIFP advocated the separation of powers of professional regulators to ensure that 'poachers cannot be gamekeepers'. He cites the example of stock brokers regulation as a success model here.
http://www.nipfp.org.in/media/medialibrary/2016/07/25072016.pdf

Ever since the Medical Council of India(MCI) which was plagued by corruption was dissolved and a new body asked to be created with 4 verticals of UG education, PG education, Licensing and New College creation/Infra, there has been interest in figuring out models for others.

As regulators like CVC and CAG have put it below, professional regulation is not working enough:
http://indianexpress.com/article/business/business-others/one-in-five-cas-breach-tax-audit-norms-says-cag-report-regulator-steps-in-to-form-panel/
http://cvc.nic.in/codeethics.pdf 

My view is that unless the disciplinary arm and academic arm is divorced from the membership body, we will have issues like lax disciplinary measures, pass rate depending on economic conditions(or so it appears to the outside world) and people joining the councils for reputation/business enhancement(eg coaching class owners who are clearly conflicted) rather than public service motto

Hippocratic oath or Hypocratic oath-where has medical ethics died

Though I'm not a medical professional(that's why I could write this bold title), I've quite a few relatives, friends and others in the medical profession. To them, I say that this is a general article not targeted towards any class, but that what I noticed reflects a non-significant proportion of doctors. The Hippocratic oath(http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html) is not free from controversy, with even doctors questioning some aspects of it. But it is still largely accepted. Below, I reproduce a modern version of the oath in Italics, with my comments in normal print.Given the modern issues of high cost healthcare/medical insurance overcharging/reluctance to admit mistakes/cosy nexus with pharma companies marketing staff/low continuing education etc, it would seem at times that the hippocratic oath is practiced by hypocrites. Civil comments welcome below.


I swear to fulfill, to the best of my ability and judgment, this covenant:

1. I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.  Doctors do teach and avoid plagiarism(atleast not much more than other professionals). So there, they escape censure.But seeing the very small number of multi doctor practices in India(as compared to USA), it is doubtful whether doctors care about sharing knowledge with non relatives. Also, while continuing professional education is implicit in this, it is an open question about how many doctors rely on industry funded seminars/sales representatives to educate them, rather than take the pain to subscribe to and read authoritative journals/attend study circles etc.
2.  I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. Afraid of being sued and mindful of the revenue generation obligation, doctors tend to prescribe unnecessary tests. Also, simple remedies like those of homeopathy are not advised-either the doctor does not know them, or prefer allopathy. While the doctor has the right to his professional judgement to reject alternative medicine, the patient should have an informed choice to that extent. And that is what is often missing today.
3.  I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. In the corporate approach of quick turnaround times, cold clinical approach and preferring standardized jargon/self education, this is easy to forget. And for those not so literate/tech savvy/assertive, the chance of being misdiagnosed/not receiving optimal treatment is there. Not all hospitals are as sensitive like say Sankara Netralaya, which despite being in the South, set up a Bengali speaking reception counter catering to its patients from that region. Doctors IMO prefer jargon to explaining in Plain English to the patient/those accompanying him.
4.  I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. While second opinions and referrals are taken, I doubt whether this is done on a old-friends basis, or purely on the basis of competence. 
5.  I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.  Abroad, the topic of doctor assisted enthusania is still being debated, but undoubtedly it is against the classical version of the oath.
6. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.  This is the closest that the oath gets to advising the holistic approach embedded in Eastern medicine approaches like homeopathy. However, I'm yet to see allopathic doctors follow that approach in practice..
7.  I will prevent disease whenever I can, for prevention is preferable to cure. The family doctors(conversant with their patients and their family history) are likelier to do this. But for corporate hospitals/others, while they do have the data, they are likelier to use it for cross selling insurance/other services like checkup than use it for diagnostic purposes.
8.  I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. This is violated to the greatest extent in my opinion. Hospitals are reluctant to admit accident victims, render probono services etc. While this behaviour is rationally understandable in a supply constrained situation like India, shirking one's obligation of public service, undermines the right to be called a professional. And for practices like not reserving the agreed proportion of hospital beds/services for the poor, there is no excuse.  

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.