In "The Steel Windpipe", by Mikhail Bulgakov, a young doctor is faced with the choice of an emergency operation he had never done before or letting a child die. He dares and the child survives. Such and much more complex situations occur across the medical world daily where doctors decide to skate on thin ice to reach a destination than not proceed at all. In an atmosphere of mutual trust and compassion, society accepted this as a fact of life.
That trust is now perceived by the laity to have been breached, giving rise to suspicions of 'crimes' such as incompetence and negligent treatment. The State has stepped in to protect the public by introducing a new bill with a few modifications, some aspects of which need to be debated from economic and medical points of view.
The new bill re-emphasizes that private hospitals cannot demand upfront payment for emergency treatment and should recover their costs later, even though it does not define the legal route for such recovery or promise any government funding. It is difficult to find a parallel for such an act in modern economies. Most developed countries have a universal healthcare system covering more than 90 per cent of the population. The private sector only caters to the super rich, that too for simple procedures and cosmetic surgeries. In India, 80 per cent of healthcare is given through the private sector. Public spending on health is only 1.4 per cent of the GDP. The government would need to do more than just adopting a regulatory role from the economic point of view.
From a medical point of view, it needs to be pointed out that with an ageing population hospital emergencies are now burdened with complicated, difficult to treat, end-stage chronic diseases. The number of such admissions is directly proportional to the standard of healthcare available in the state for which the government has some responsibility. The bill forbids denial of treatment to the victims of accidents, rape and acid attacks. But what moral authority would a councillor, who fails to keep his ward clean, have to judge the local hospital stretched to tackle an outbreak of dengue or malaria? Without a competent first-response service, moribund patients brought in on bicycle vans can only improve hospital occupancy rates.
The government will henceforth regulate charges in the private sector and impose fines for contraventions. Private healthcare has been unregulated. Medical malpractice and the devious fleecing of patients are inexcusable. But the concern in the medical community is that the bill would severely affect smaller set-ups in the periphery catering to modest and lower income groups. Corporate hospitals would shift their focus to newer, costlier procedures and to less risky patient groups. They will recover unpaid dues with their efficient back office. These regulations, unless executed expertly and humanely, would stymie medical care, particularly emergency care, outside Calcutta. Government institutions have been kept out of the purview of the regulations. But it is not clear how the bill will view government employees getting treated in private hospitals through various schemes.
What is more worrisome is the 'guilty unless proven innocent' principle being applied to doctors and the consequent violent retributions. A physician gains nothing by wrong treatment. Neither are the authorities ready to pay heed to the court directives that medicine cannot guarantee immortality and a treatment cannot be labelled negligent because the end result is unsatisfactory.
If it is noblesse oblige for the physician, society, too, must understand the inherent limitations of medical science and the conditions under which doctors work. Trust and compassion between the doctor and his patients cannot be replaced by any number of laws.
The author is a surgical oncology consultant at Apollo Gleneagles Hospital, Kolkata