An important prerequisite for a society to start resolving a problem is ample discussion, and for the discussion to be meaningful it is necessary that multiple different perspectives are voiced and heard. While unethical medical practice as a topic of discussion has been around in Indian society and media for some years now, the dominant perspectives we hear are of victimized patients and defensive, parochial doctors (generally through their ‘associations’). In this background, the new book ‘The Ethical Doctor’ fills a significant vacuum by giving voice to important though reticent groups in India’s medical system: victimized (aka honestly practising) doctors and progressive practitioners.
It is still not widely realized in our medical system that after patients, the biggest victims of medical corruption are honest doctors and young medical graduates who involuntarily get sucked into the unhealthy system. The fact that the author Dr Kamal Mahawar chooses to open his book with the quote ‘The only thing necessary for the triumph of evil is for good men to do nothing’ speaks volumes about what he intends to achieve. It also places him in the company of the ‘good men and women’ of Indian medicine who actually did not do nothing: those few doctors who have consistently and fervently made public, at great private ridicule from peers, their displeasure with several aspects of our medical system — like Dr Arun Gadre and Dr Abhay Shukla who wrote the recent book ‘Dissenting Diagnosis’.
‘The Ethical Doctor’ attempts to explain why the ‘ethical doctor’ remains enormously elusive in India, and how that has a lot to do with our socio-political and legal systems instead of just with unprofessional doctors. Dr Mahawar aptly begins by explaining the obsoleteness of the ‘code of medical ethics’ that Indian doctors are expected to follow. As medical students and practitioners, we are aware that much of the code is an amusing piece of impractical idealism and a dangerous piece of archaic legalese, and with this book one hopes the media and the general public acknowledge the absurdity of what our government terms medical practice regulation.
It is commendable how Dr Mahawar has attempted to touch upon almost every important socio-political and cultural root of unethical medical practice in our country. He even devotes a separate chapter each to quacks and touts. While the reasons for corruption being so rampant in the Indian medical community are multifactorial, it is still only from within it that sustainable solutions can be framed and implemented. This book is thus a step in the right direction. While all doctors might not agree with all that is said, it would serve the medical community well to acknowledge the positive contributions this book and other similar endeavours are making, especially by reminding the society that there do exist members of our profession who wholeheartedly accept its deficiencies and are willing to help reform it.
There are also things in the book that doctors will find themselves almost unanimously agreeing to: like the absolute mess that the former Medical Council of India has put us in, the inefficiency and often exploitative attitude of governmental regulators, the urgent needs for nursing and pharmacy education reform along with medical education reform, and the difficulties Indian doctors face in gaining international recognition due to the academic publishing world’s bias against Indian research. Another interesting point the author raises is the phenomenal need for a body in India on the lines of the UK’s NICE (National Institute for Health and Care Excellence), to especially work on looking at all available national and international evidence to suggest India-specific clinical guidelines for Indian doctors and patients.
The first step towards solving any problem is acknowledging its existence. For decades the Indian medical community has shied away from publicly acknowledging its messy affairs and simply acted more and more defensively when confronted with them. One of the most harmful effects of this attitude has been the gradual and often subconscious acceptance of the system’s abnormalities as ‘normal’ by medical students and fresh graduates. That sets into motion a pernicious circle which can be effectively halted only when more and more individuals entering the profession understand the moral inappropriateness of and realize the adverse social effects of unethical medical practice. It is in fact these individuals who will benefit most from reading this book, a benefit which will slowly but surely be transferred to the entire society.
It wouldn’t be going too far to suggest that this book be made mandatory reading for medical students, especially as part of their education on ethics and social medicine. Dr Mahawar uses interesting hypothetical scenarios of the lives of poor and exploited patients in this book to emphasize the profound impact that doctors’ actions can have on the people around them. While more experienced doctors might be jaded to such scenarios, these will be very helpful for medical students and fresh graduates, and help them realize the inescapable moral necessity of being honest and humane in their dealings with patients.
India direly needs a new more honest and more patient-committed generation of doctors who are not forced to simply, silently accept that several aspects of their profession are by default and by necessity morally unpleasant, and for that the ‘old guard’ needs to give a serious thought to the kind of legacy they are leaving behind. The profession is going through perhaps its roughest phase ever, and one now looks up to established and experienced doctors to use their influence and power to place it on the path to reform, especially by supporting their peers who are trying to take the Indian doctor and patient on a better, more progressive path. Dr Kamal Mahawar must certainly be congratulated for doing his bit through this book.
The Ethical Doctor
Author: Dr Kamal Kumar Mahawar
Paperback: 272 pages (Rs 245)
Publisher: Harper Collins India (Aug 2016)
by Dr Kiran Kumbhar