Ratan Jalan: He who earns the referral fee...

Why did the Satyamev Jayate episode on medical malpractices prompt so much anger among physicians?

We all know how deeply disturbed the medical fraternity has been with that particular episode of Aamir Khan’s television show Satyamev Jayate that highlighted the widespread lack of ethics and corruption in the medical profession. I have personally witnessed the anger from senior physicians I have met about how untrue and unfair the entire episode was. It is worth noting that at no stage did the episode question the competence of the physician community and its ability to treat the sick.

To examine it more objectively, let me start with the issues raised in a couple of the show’s other episodes. In one of them, he highlighted sexual abuse that children face. He also mentioned that in a vast majority of the cases, the perpetrators were either the children’s relatives or family friends. In another episode, he spoke of the physical violence and abuse to which married women are subjected by their husbands and in-laws, highlighting that these are common incidents in Indian society.

Most of us are friends and relatives of children in our extended families. We also happen to be husbands or in-laws. How is it we didn’t create an uproar about these episodes in the same way that the physicians’ community has done over the one on the medical profession? Although we may have been deeply disturbed by the heinous domestic crimes and their prevalence, we didn’t feel personally guilty, since it spoke about “others”. That’s because despite the relatively common occurrence of such incidents, the perpetrators of such crimes are still a small minority.

Coincidentally, there was another episode that reflected on the lack of ethics among physicians, but only a particular subset among them. It spoke of the prevalence and implications of female foeticide in India and the role gynaecologists play in perpetuating this crime. In fact, it showed a sting operation carried out by a couple, which exposed hundreds of gynaecologists across the country. How is it that the vast number of gynaecologists around us didn’t feel upset? I believe this is owing to the fact that most of them in the country do not encourage such practices, which is why they don’t feel “personally guilty”.

But when it comes to accepting money for referring patients for a diagnostic test, surgery or even doing certain unnecessary tests or procedures purely for financial gains, we may not be talking about a minority. Anyone in the profession will vouch for how deep-rooted and common such incidents are. And how, in some rare cases, such incentives lead to unnecessary surgeries. You simply need to talk with someone you know well in the industry — be it the owner of a hospital or distributor of medical consumables. The CEO of one of the leading lab diagnostics company in the country told me that the biggest cost component in lab diagnostics was the referral fee — not the cost of reagent, machines or salaries!

I have often faced situations, where some well-meaning promoters of new hospitals have asked: will a hospital following ethical practices of not giving such money ever survive? And it’s not getting any better. A large trust hospital in Mumbai went ahead and gave large sums of referral fees to physicians “in advance”. I personally know scores of general physicians, whose main source of income is referral fees rather than consultation fees.

To me, the fact that almost the entire medical fraternity raised such a huge uproar is proof that many were involved, feel personally indicted and therefore “exposed”. Ironically, the only silver lining is that, unlike our politicians who are hardened to this kind of exposure, physicians were visibly upset by these revelations.

Now, let me address three of the frequent “protests” made by these doctors.

They say, “We cure millions of sick people everyday, save lives and do so much good to society. We respond to emergencies. And ours is a 24x7 job”. This is, indeed, a reality. In fact, at government and trust hospitals, physicians perform miracles almost every day, given the constraints and incredibly large volume of patients. But this observation simply means that most physicians are extremely competent at what they do and are committed to doing a good job for each of their patients. It doesn’t, however, prove that competence and commitment should also be taken as evidence of financial integrity! It is a fact that the competent are not immune from taking kickbacks. Which is why the vicious circle continues.

They add, “He should have shown a balanced view. Not everyone does it”. If Aamir Khan has to highlight some issues and talk about aberrations in society, does he need to show how millions of us love and respect our wives and daughters-in-law to create a balanced view and soothe hurt egos? Or, in the episode where he spoke about the problems of alcoholism in the country, does he need to show how millions of Indian don’t even drink? I think the need to ask for a balanced view is more to “take the spotlight off me” and “give me the benefit of the doubt”.

Lastly, they get personal. Do we know that he takes Rs 3 crore for each episode? Imagine him talking about such things. The point is, his accepting large sums of money is no secret. That’s his professional fee and the producers find it a fair fee to pay. He pays income tax on it and other earnings — in 2012, he paid income tax of Rs 3.25 crore. Let me take another example, we all know that travel agents get commissions from what they sell. And there is nothing unethical about that, simply because they don’t hide it from their customers. If there is something you do that you would rather keep as a secret, it is unlikely to be ethical!

Satyamev Jayate means, truth alone wins. I have my doubts if in today’s times, it does win. It is evident, however, that it certainly hurts!

 

The writer is former CEO of Apollo Hospitals’ Group Company and Founder & Principal Consultant, Medium Healthcare Consulting