Healthcare Today: Is this what Hippocratic Oath Enjoined!

The news of post-graduate seats in radiology going at an astronomical price in medical colleges in India was news not long ago. Lesser disciplines (with lesser revenue-raising potential) charge less; the pecking order of rates charged, offered and administered seemingly in sync with present-day market demand or the perceived future (foreseeable, not distant) demand as it likely would pan out, with genomics and proteomics and other latest frontier discoveries duly factored in.

Today, US – the high-priest of capitalism – is in veritable quandary, wrung out, and ruing its healthcare model that threatens to blow up societal equilibrium. Activists and policymakers are in a funk in finding solution to high medical costs. A piece titled Cost Conundrum published in The New Yorker in 2009, which caught the attention of Obama and his Administration, observes: “In the war over the culture of medicine—the war over whether our country’s anchor model will be Mayo or McAllen—the Mayo model is losing. In the sharpest economic downturn that our health system has faced in half a century, many people in medicine don’t see why they should do the hard work of organizing themselves in ways that reduce waste and improve quality if it means sacrificing revenue.”

The McAllen model refers to one of the most expensive health-care markets in the country. The primary cause of this billowing cost is the across-the-board overuse of medicine and doctor-care when less would do; yet more is preferred because it helps revenue-swell. In contrast, the Mayo model that believes in accountable-care followed in the famous Mayo Clinic is one where the “needs of the patient come first – not the convenience of the doctors, not their revenues.”

Change tack to India and see how in our honeymoon capitalism we have monkeyed what US today is struggling to rid. Throw in our endemic and much-vaunted DNA to cheat and con, and see what a deadly cocktail we concoct. This piece seeks to put in public domain my recent experience in a cancer hospital in Bangalore. I am a patient of carcinoid cancer and underwent two surgeries to remove the offending tumour in the colon, a large part of which was excised. Ever since then I have been under the close observations of my doctors.

About a month ago, I experienced pain in the anastomotic site. The CT scan done shortly after showed up cysts in the liver, apart from inflammation and ulceration in my colon. The most effective treatment for carcinoid is the complete, surgical removal of the tumour(s), which in my case had been performed four years ago. But microscopic cells could even show up after years and it’s the tumour diasporic proclivity that prompted my doctors advise me a nuclear scan called Gallium-68 PET CT DOTANOC to zero in on the problem.

            For the uninitiated, this PET CT is a nuclear scan and radioactive isotope is injected before the procedure. After the scan got over, I requested the nurse if I could speak with the doctor and get a preliminary idea of the scan before the detailed results came out a day later. She said, “No doctor’s around. The technician did it.”

I puzzled, finding it hard to believe what I’d heard. “You mean to say that this nuclear scan was done without the supervision of a doctor, a consultant nuclear medicine?” She looked at me, speechless. I walked over to the edge of the console room and asked the technician if he could do the scan without the supervision of the specialist nuclear medicine. In my money receipt the specialist’s name was mentioned. I was livid. I demanded an answer.

The technician panicked and spoke with the specialist seated in Tower 1. My scan was done in Tower 4, about 200 meters away from where the doctors – consultant, nuclear medicine and the radiologists – sat.

Within minutes the technician materialized. “You can speak to Dr Kallur” and handed me over the cordless phone.

“Doctor,” I asked, my voice quizzical, “how is it that no doctor was around when my scan was done?”

His reply was pat. “I can’t be present in all the 60-70 scans done everyday. You can take your money back!”

For all my ailments and my sundry visits to doctors across hospitals/cities wherever I’ve lived, I had never heard anything remotely resembling this. “That’s okay but what happens to the radioactive isotope injected that’s gone into my body? And is this the medical protocol your hospital follows?”

He had no answer to my riposte. After a deafening silence that refused to die down, I heard a disembodied voice say, “If you want to meet Dr Kallur, you can.”

“But am I not speaking to him?”

“No, this is Pravin speaking.”

I asked him to come meet me.

He came half hour later – after two reminders. I demanded to meet the Chairman. “The Chairman’s in a meeting,” Pravin promptly conveyed.

“That he must be,” I said, my voiced dipped in sarcasm, “but know that that ploy won’t work. Please set up my meeting with him. Quickly.”

He shuffled from one foot to another. Then moved away.

I sought him out again, as my wife and I sat in the patient’s room in the high radiation hazard zone. It was getting to six in the evening.

Finally, Pravin after his string of meetings and phone-calls materialized to take us. But no, it wasn’t the Chairman of HCG, Dr Ajaikumar. It was Elizabeth, the Chief Administrative Officer. I told him I had nothing to do with her. After confabulation with Pravin, Elizabeth came over to us, now seated in the reception of Tower 2. She was nice. But I told her I wanted to see the Chairman and there was no point repeating things time and time again. She hadn’t been purveyed the full story. When she heard me her face mirrored her shock. I told her Dr Kallur wasn’t rude, his behaviour was downright obnoxious.

I was fasting since morning. More than two hours after my scan got over, we’re being escorted to the Chairman. I was asked for my visiting card. “I’m a patient. You know my name, below it write PATIENT”, I replied.

Dr Ajaikumar quickly apologized on Dr Kallur’s behalf. “I’ve already told him,” he said, “and I’m going to tell him again”. I asked if his hospital followed the medical protocol prescribed for nuclear scans. He was politeness personified but his answers were neither here nor here waffling with US examples. I knew they were faux excuses.

“How can a doctor ever mutter such words you can take back your money to a patient?” “Stress”, he tried to reason. “He’s a busy doctor!”

“Who isn’t? Certainly you don’t do 60-70 DOTANOC scans everyday! Your hospital says about 3-4!”

Little later, he said Kallur is “compassionate” and “an icon!”

“Compassion” to a cancer patient I’d freshly experienced. So I told him to disabuse culting his icon. “In my 56 summers spent on Mother Earth I’ve met many busy icons but they’re invariably polite and professional,” I said. “My personal ethics prompted me to meet tell you before I hammer out the next course of action for the criminal neglect in medical care in your hospital. This isn’t Hippocratic Oath that you doctors are sworn to, this is Hypocrites’ Oath! I speak here not for me but for the voiceless – the illiterate, uneducated masses – who know nothing what doctors, whom they trust blindly, do!” In my throat I added, “As you go seeking Mammon relentlessly throwing all medical ethics out the window!”

The morning next I saw a half-page advertisement in the front page of a national daily enticing cancer patients to this hospital. I gulped at the patent conning, my experience fresh in mind. In the evening when I got my report, my apprehension was further vindicated. I found the radiologist’s signature; three names (without signature) of consultants in nuclear medicine printed alongside, including Kallur’s – conveying the nuclear scan was seen only by the radiologist, not the nuclear medicine specialist who was to oversee the scan. Now I need to see another specialist in nuclear medicine to give me expert advice on my nuclear scan – to make my doctors wiser before they plan my imminent surgery. This after paying Rs 17,000 and with the radio-isotope in my system!  

Remember, my experience isn’t a one-off, an outlier. Exceptions apart, it is symbolic of the general malaise that afflicts, if it already hasn’t, hospital practice across the nation – to maximize revenue.

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