The inescapable greed grid of the health sector
I walked out of the doctor's chamber with my mother when someone took the prescription from me. I thought he was working for the hospital as he was standing right next to the attendant who was maintaining the serial and receiving payments. He took a snap of the prescription with his tab. Only then did it occur to me that a medical representative had just taken note of a document that was supposed to be private. The man was assigned either to monitor the prescription pattern of the doctor or to make sure his company's medicines were being suggested by the doctor concerned. This was wrong on several counts—a medical representative should not intrude into the privacy of a patient; it was unethical and unprofessional for the diagnostic centres or hospitals to allow an outsider to stay so near to the chamber of a doctor; and, there is possibly a direct correspondence between the perks these representatives offer to the doctors and the treatments that follow.
I guess I was so happy thinking I could see the doctor protecting the appointment serial from being bypassed or hijacked, by the late-comers who would tip the attendant, that I did not let the trivial intrusion issue bother me at that time. I just asked him, "So did she prescribe your company's medicine or what?" The guy was mum.
You hear about all sorts of unholy alliances between a doctor and a pharmaceutical company's agent. Many of these doctors receive various gifts ranging from as little as prescription pads and pens to home appliances or even fully-paid foreign trips for conferences or holiday packages for their entire family. Then there are the pathological tests that you do not need but are prescribed nonetheless as the by-products of these alliances. I once took a relative with complaints of heart burns to a gastrointestinal doctor, and the first thing the moody doctor did was to ask us to consult the front desk for an endoscopy. "Don't come to me without doing this test first," she said.
The most common complaint that you hear is: many doctors do not study proper case history before seeing a patient; they just prescribe a series of tests from which they can deduce the problem. News on the grapevine is that some doctors receive hefty commissions from these prescribed tests. Hence, they don't have time to listen; they act like automatons. I will not be surprised if some of these doctors only see a thousand taka note in place of the patient's face, just like in The Gold Rush a hungry miner saw a chicken in Charlie Chaplin and tried to eat him up. The life of the doctors is so mechanical that you cannot but feel pity for them. Some of the surgeons I have come across start their day right after the Fajr prayer. They will operate 4-5 patients in a private clinic before heading for their government/regular job and then, in the evening, they will split their time between various chambers to see another 40-50 patients in 4-5 hours. They are so overworked and overpriced because there is a serious dearth of good doctors in the country.
Some of these good doctors are being picked up by the corporate system. While working for a luxury hospital, these doctors are under the obligation to earn at least four times (I am guessing) their monthly salary which I hear is more than a million a month. So they keep on subjecting their patients to needless and elaborate treatment procedures: routine check-ups, medical boards, constant change of medicines, excess supply of medicinal paraphernalia, personal items and food, diet consultants, lab tests, surgeries, therapies, referrals and so on. They will do everything within their power to prolong the stay of the patients. There are instances where the news of the death of a patient is delayed to increase the bill for life support in the ICU. Then, of course, there are news of hospital bugs in the concealed ventilation system that send every patient of a hospital to their ICUs with bronchitis. These hospitals are so powerful that even if you die from their negligence or accidental fire, they will dowse the news in ways that will point at the illness not only of the individual but also of the society at large.
These ironies are normal for our health system; and unfortunately, our complacency as consumers adds to the situational irony. The corporatisation of the health service is making profiteering their only business agenda under the guise of service. This is the sector that has the potential to save billions of dollars going abroad in the name of medical tourism. When some of these health franchises opened, we were excited by the thought of having world-class service in the vicinity. But soon the international plaster wears away, the mask of nobility and charity falls down, and cutting-edge technology is cut down. We find ourselves helplessly caught in the ugly grid of greed.
Even when you pay a handsome amount, you are not sure whether you have received the right treatment, whether the test reports are doctored or not. I know of a case where the local diagnostic centres (yes, more than one) gave a PSA score of a patient citing that he has prostate cancer; the same patient goes to India and finds out that results are normal. Somehow you cannot trust the system. You end up asking for second and third opinions—confusing yourself in the process and crowding the system even further. In the absence of a proper health system, you rely on bothering your friends and relatives for an over-the-phone consultation. And if you are not that lucky, you end up buying drugs recommended by the salesman at the pharmacy or looking it up on the net.
I was reading in Friday's Bangladesh Pratidin about the tele-conferencing introduced during the pandemic by some of our local hospitals. Someone registered with an apex hospital paying Tk 500 for such a promised service, and then the patient was charged Tk 1,000 for a subsequent call, and Tk 1,500 for the next. An inpatient was charged for the PPE the doctor was wearing; but the doctor was on a round and he was going to every patient wearing the same PPE. How many times was the same PPE charged? You do the math.
The system milks our vulnerabilities. When we or our closed ones are ill, we do everything in our bid to ease the suffering. Monetary or ethical concerns become secondary. And this is when the professional servicemen take advantage of our emotional vulnerabilities.
I will end on a lighter note. I once took my daughter to see a dermatologist in a reputed diagnostic centre in Gulshan. He was an elderly man, and apparently my daughter reminded him of his own in the UK. He started chatting. Despite repeated knocks at the door by the attendant reminding him of other patients, he went on reminiscing about his days in London where my daughter also grew up. He went on and on before writing a skin ointment for my daughter's acne, and hurling a parting request: "do you mind paying for two patients? I need to tell them I saw you too to justify the time!"
Shamsad Mortuza is the Pro-Vice-Chancellor of ULAB.
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