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MEHRE ALAM
DOHA
As a professional, how often does your conscience prick hard enough to push you into pain? Or feeling ensconced by forces you find unremitting, making you question those long established premises?
If your answer is 'yes', and you happen to be in the profession of medicine, then, as Dr Kamal Mahawar found out, the dilemma multiplies manifold.
Call it catharsis if you may but Dr Mahawar found a way out, in the shape of a book he's penned, his first, titled The Ethical Doctor.
"I think the profession has to immediately come up with a robust self-regulatory framework. If we don't do it ourselves, the public will impose it on us and that will undermine the doctor-patient relationship forever," said the doctor of Indian origin, who works as Consultant General and Bariatric Surgeon at the Sunderland Royal Hospital, Sunderland, UK.
What was the idea behind writing this book?"I got a free medical education in India and when I was in a position to return something to the society that nurtured me, I moved to the wealthy West to live a comfortable life. The guilt has been playing on my mind for quite some time," explained Dr Mahawar, in email interview with Qatar Tribune.
"The overarching aim of this book is to improve the healthcare provisions for people in India (with possible implications for people elsewhere) but in this context, one recognises that medicine is a profession, not a business and unethical practices have no place in the practice of medicine. At the same time, no one indulges in these practices out of choice. When the survival of your family is at stake, what will a person not do?
"Hence I felt that a superficial analysis that just ends up exhorting doctors to be more ethical wasn't going to be successful. Somebody had to put together the myriad of reasons underlying the behaviour of doctors and we need to debate the whole situation in its totality in our society. For example, do you honestly believe a young cardiologist setting up a new practice at the age of 32, with a wife, two children, and parents, has a choice?"
However, he agrees that trust is crucial to a doctor-patient relationship and patients have to be confident any medical advice being given is solely for their own benefit.
"In this book, I have attempted to examine if it's possible in today's India for doctors to practise ethically and if not, why. The book explores what it means to be an 'ethical doctor' today and if a large number of doctors in any society are failing to reach this benchmark, then who's at fault?"
Enunciating the key challenges of the medical profession in India, he said that the list is long but the failure of the medical profession to come up with robust self-regulatory mechanisms that can inspire patient confidence would be at the very top.
"Lack of a fit-for-purpose, systematic training programme for all fresh doctors; pathetic remuneration for in-training doctors and junior specialists; almost complete concentration of medical facilities in urban areas; lack of evidence-based and India-centric care pathways and guidelines that can improve and standardise care, little incentive and funding for research; and unaccountable, poorly funded public healthcare are some of the others," elaborated Dr Mahawar, who has been writing academic articles in his area of specialisation in addition to his column on IndiaMedicalTimes.
About the state of the public healthcare in today's India, he rues that the poor man, in reality, has nowhere to go."You'll end up selling whatever meagre resources you have if you are unfortunate enough to fall ill. Millions of families are pushed into poverty as a result of illness every year in India. Where is our social fairness? Let's face it - poor in all parts of the world have to be looked after by the state healthcare system. Our public facilities are ill-managed, ill-funded, and unaccountable. This has to change and I can't understand why the government is not making a concerted effort in this direction. The medical profession is not raising its voice either. I don't hear doctors saying people deserve better and we want the government to do these things. I think a beginning has to be made and somebody has to initiate the conversation and that is what, I hope, this book would facilitate," said Dr Mahawar, who grew up in a middle-class family in Kolkata, went on to obtain an MBBS degree from Calcutta Medical College and did MS in General Surgery at Pgimer, Chandigarh, and subsequently, moved to the UK in 2003 where he now lives with his wife and son.
(Dr Kamal Mahawar's book, by Harper Collins India, is available on Amazon)
