Medical profession and the conflict of interest
MATHEW THOMAS
The Hippocrates oath should govern the physicians’ collective conscience. Far from it, it is removed and isolated. A conflict of interest occurs when a doctor/or any family member/or an institution posses a financial interest in the activity of/or responsibility as a doctor in relation to patient care or the professional interest of the doctor.
The medical profession has moved away from voluntary ethical codes governed by the Hippocratic oath to one where the ethics are dumped on unsuspecting patients to include fee splitting between doctors, commissions from private medical laboratories for referrals, recommending unnecessary tests on patients, acceptance of presents from pharmaceutical companies, holidaying on the expense of medical equipment manufacturers and pharmaceutical companies, prolonging patients stay in hospitals on one pretext or the other, open advertisements that such and such doctor is available in the hospital, etc.
Patients’ vulnerability
A sample case study of the natural delivery birth versus Caesarean section would bring about glaring anomalies between them, when often the C section is unnecessarily recommended to the unsuspecting patient giving an impression that the delivery may be difficult and the baby could be still born or with defects. The patient has no way of checking up or a second opinion be taken as it would be too late to make amends if things go wrong.
The patient is put in a quandary and often the medical advice is couched ambiguously by the doctor. The price differential between them would range from Rs 25,000 to 30,000 depending on the hospital. Organ transplant is another common area which is notorious for mal and unethical practices.
Eye operations constitute another instance wherein the Intra Ocular Lens are often a cheap substitute, though the patient is charged for a better lens. Most of these inconsistent practices are tolerated by the profession and most medical councils turn a blind eye to such practices.
Dilution of moral stance
The conviction of a renowned cardiac surgeon in Chandigarh is is an interesting case because of the media attention and the span of unethical practices — charging for material where less was used, forging records, charging exorbitant rates for cheaper quality of valves, procuring fake bills in connivance with the company and splitting the profits between the company and the surgeon.
The court awarded a five year prison term and a fine of Rs1.4 lakh. It will not be surprising if this doctor will be awarded a lesser quantum of punishment or walks free on some technical grounds, on appeal.
The ethical prohibitions are now more subjective instead of an objective assessment and voluntary adoption. The patient is often vulnerable and it is the moral duty of the medical profession to act honestly and in the patient’s best interests. Often, it is breaches of obligation that is in conflict between the patient and the doctor.
The Constitution of India guarantees the Right to Life under Article 21, but it is the common man who bears the brunt of this conflict of interest in the medical profession. Visiting a government hospital today can be a traumatic experience for the poor patient. Often medicines are unavailable because of the nexus between doctors, medical shops and clinical laboratories. An MRI scan is often done in a private laboratory at a heavy cost. The simple reason is that for every referral the doctor is paid anything from 20-25 per cent of the cost.
It would do well to remember the Oath of Maimonides, “The eternal Providence has appointed me to watch over the life and health of our fellow human beings. May the love for the art actuate me at all times; may neither avarice nor miserliness, nor thirst for glory, or for great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of the lofty aim of doing good to my patients.”
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