On Doctor’s Day: Before business destroys a great profession

As we celebrate Doctor’s Day in India on 1st July, that is the birthday of Dr. B.C. Roy, a doctor who rode two horses – one of a politician and the other of a physician, I am tempted to talk about another set of horses, i.e. profession and business that Indian doctors are trying to ride.

Historically, there was a clear distinction between a businessman and a professional.

A businessman can sell cancer-causing tobacco to a customer (as long as law of the land permits) with the sole intent to make profit, as he is not expected to have social responsibilities. But a professional such as a doctor can’t prescribe a medicine that earns him greater profit with an intent to make more money for himself.

A doctor will have to prescribe what cures the patient without any consideration for his personal gain. A doctor, as a professional has a social responsibility that must supersede the profiteering objective that a businessman enjoys.

It is a fine distinction that grants honour and social standing to those qualified as professionals. While lawyers, CAs and architects are also recognised as professionals under Indian law, doctors were the most respected professionals due to their life-saving role that society recognised, at least in not too distant past.

Today, Indian doctors enjoy another distinction as professionals. They face more violence in the line of duty than any other professionals. If we go by available statistics, it is likely that at least 70 % of all doctors practicing in India have faced physical threats from their disgruntled patients.

The main reason why doctors have started facing public ire is suspicion of profiteering. Most people have started feeling that doctors are no longer functioning with professional objective to cure people; and, instead are trying to maximise their profit like businessmen.

This problem has compounded due to a newer development. i.e. hospitals. While doctor and hospital have become interwoven ideas, both have a completely different role to play. Doctor is a professional with social responsibility while a hospital is a business establishment serving the cause of profit. So, it is an uncomfortable union, more so because Indian policy makers have not really thought it through.

Medical practice in India faces a complicated question that needs practical and enforceable answer.

Can a professional run a business? Can a professional serve a business?

While the legal answer is NO; in practical world it has become a norm and not an exception to see a doctor running a hospital or serving one through some by-passing mechanism.

If we look at the economics of professional practice in an ideal world, a doctor is charging for his/her knowledge and expertise, and hence there is little capital cost. So, he is not expected to be governed by forces of commerce that drive businesses.

But, in real world, starting from (often crores of) rupees invested in education to purchase of office and medical instruments, practicing as a doctor has its own capital requirements. So, a doctor has a financial and thus business equation to serve while practicing.

It is easy to grasp that doctors, as they function today, will find it hard to play the role of a true professional, as they also have to accommodate for financial liabilities. A doctor who needs to pay an instalment on his clinic or on his X-ray machine can’t be expected to keep a steady eye on the social goal.

With the existing model failing in keeping a doctor a professional, we head for a dangerous situation, as with a doctor turned into a rogue businessman, there will be not just economic, but human suffering.

The only way this problem can be tackled is through systemic removal of commercial forces that operate in medical practice.

The first to go should be massive financial costs involved in medical post-graduation. It is absurd to think that those who have spent two-three crores in getting their specialisation will not try and recover the cost.

The second front that needs attention is cost of practice infrastructure.

While we have enterprising doctors who braved economic uncertainties and built hospitals in many cases, it was not really their job as a professional. In ideal world, a professional must be discouraged to borrow, and if he must, he should be made to surrender his professional title and become a businessman.

Hospital making and operating should be a completely commercial activity that doctors must be kept away from. It is a job of businessmen and must be left to them.

The last but the most critical need is to clearly and legally define the relationship between a doctor and a hospital and regulate it to ensure that there is a separation of commercial as well as medico-legal liabilities between the doctor, who is a not an financier but a curer and the hospital that is a business establishment working as an investor and an operator.

Let me admit that I have almost reinvented the wheel here, but I would like to do so, especially for the last point.

We need deep thinking in setting up a clear policy mechanism for doctor-hospital relationships if we really want medical practice to remain a profession. It needs legal and contractual clarity that aims at keeping profit-making away from diluting decision-making of doctors.

It is a tough task, but must be attempted, as we can’t allow curing humanity to turn into a business. Human body is sacrosanct aspect of our existence. We can’t allow it to succumb to forces of commerce.

I am happy to admit that I have managed surviving till now with minimum effort as all my intellect has be used to avoid doing anything meaningful. As I needed to while all the free time I generated in course of being lazy, science has been my favorite muse that I have enjoyed company of. As an effort to kill time (in a way, to get even with it) one fine day I decided to write a science column, more for my personal amusement than to attract readers. After getting educated about the attention span of modern readers from my editor, it became more like a challenge to tackle esoteric subjects in 600 words that I have managed to remain interested in for more than a year now. I do not want to add my worldly profile here as these are ideas that need to be considered only on the merits they carry and not as an opinion of a certain human being.

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