Healthcare . . . Quo Vadis

I've been in Kerala for about 10 days. And one of the major thing I've noted is the explicit business that healthcare has become. 

I'm not sure about how much of what I heard is true . . . I would love to hear that all of this is mere gossip. 

One of my friends, who was working in the paramedical wing of a major hospital in the south of Kerala was narrating to me how expensive doctors have become. He was trying to facilitate a Internal Medicine consultant to shift from his previous place of work to the hospital he was presently working. 

The compensation the young doctor was demanding was a whopping 200,000 per month. It seems that he was making about 150,000 per month.

I wondered how the hospital made up this much of a money to pay the doctor. And I've been asking questions to anybody who has anything to do with healthcare whom I meet. The answers are very disturbing. 

It's easy. Every doctor is given a target of the number of blood investigations, ECGs, EEGs and CT Scans they are supposed to give. Obstetricians are given target of the number of Cesarian sections to be done in a month. Interventional cardiologists are given the target of the number of angioplasties for a month . . . The list goes on and on.

I could only feel sorry for all those of our teachers who were quite keen to drill into us the aspect of cost effective medical practice. Leave alone those who try to teach us evidence based medicine. 

The question is about how many of us doctors would take a stand against this sort of healthcare practice. 

Another side of this story is that almost every patient is happy to comply to any investigation or procedure that his/her doctor prescribes without a whimper questioning about the need of the test/procedure. The more complicated and latest the investigation or intervention, the lesser the chance of a patient not complying. 

And the pharmaceutical companies and their ploys to increase their sales make the scenario all the more enticing for unscrupulous business practices. 

Here also, I noticed that the patients also loved to have the latest antibiotic and the latest drug . . . many of which did not even have complete safety profiling. 

Sad . . . but true. No wonder, there is a big lobby against public healthcare all over the country. And with the rapidly increasing upper middle class with massive paying capabilities with a liking for all the latest, the future appears quite bleak.