A doctor explains how his profession became a business

What is the status of our healthcare industry? Well, before I attempt to answer that, I find it a little distasteful that it is even deemed an ‘industry’. I have always believed that when a doctor’s clinic becomes an office his or her practice becomes a business. An interesting article by the National Centre for Biotechnology Information notes that the US has stimulated more interest and alarm in a new form of entrepreneurism — investor-owned and for-profit organisations that provide healthcare services as a business in recent times. The revenue of this industry is today estimated to be close to 25% of the national expenditure. at over $70 billion. Honestly, I am surprised at this scale. But that’s what happens when you mix business and medicine, it makes for an unhealthy cocktail. Many medical practitioners, including this writer, feel that using medicine for profit is also antithetical to the traditional values and ideals of our profession. I am surprised by patients who leave my clinic with a list of tests and come back with the result of 10 extra tests. When I ask them why they say they got a deal, similar to the 4-for-2 type deals offered in shopping malls. Is this extra testing harmful? Will it uncover a disease that your doctor previously did not suspect? medium nocaption89771777Unlikely, unless you’re dealing with a doctor with poor clinical skills. Writer Atul Gawande says that millions of Americans get tests, drugs and operations done every day, which will not make them any better or may cause harm, and yet cost them an arm and leg. Many procedures like putting a stent in your coronary arteries, even if you have no symptoms or stable cardiac disease, reveal that the likelihood of heart attack or death is unaffected if it’s been placed for over five years. Taking an MRI scan for lower back pain, without any neurological symptoms and signs, also does not benefit the patient. In a single year, researchers reported that 25% to 42% of Medicare patients received at least one of 26 useless tests and treatments. The other problem is inappropriate treatment. For example, a 50-year-old man with giddiness had an angiogram of the neck and heart arteries and found that both were diseased. He was then advised a triple bypass followed by a neck surgery. In such a situation, it is likely that the neck vessel disease is responsible for symptoms rather than the heart. Unfortunately, the man underwent a triple bypass surgery and got a stroke. This despite the fact that a neck surgery reduces the risk of stroke by 1% a year and it would take 15 years to cover the risk of 15%, which was the predicted risk of surgery. medium nocaption89771788A lot of today's problems lie with hospitals that put unnecessary pressure on talented doctors to suggest more tests, more admissions and more surgeries. These days ending up in an emergency care situation for non-serious symptoms almost ensures that you will be admitted. The other problem of pressurising young doctors to increase their revenue is the issue of malpractice. The young doctor, in a bid to outpace colleagues, loses his or her ethics. It is also relevant to understand how the Indian public responds to all this. In Covid times, many people were so desperate that they had to sell their assets to admit their loved ones in a hospital. Some people were so upset that they went on a rampage and damaged hospitals. Though this behaviour cannot be condoned, one must understand how the stress of healthcare affects people. Not to mention the exorbitant medical bills. No wonder hospitals are so trauma inducing. It reminds me of this an old saying: beware of vaid, vaishya and vakil (doctor, sex worker and lawyer) as they can lead you down a path of destruction. I think it still holds true. So, here’s my advice: Choose your doctor well. One who does not lead you down the path of unnecessary expenses, testing or hospitalisation. Also, please insure yourselves, because it is impossible to predict when disease can strike.Dr Altaf Patel writes on good medicine and age-old common sense(Disclaimer: The views expressed here are the author's own)From the same author:- Why eating for your age is crucial for good health- Why some people are afraid of using public toilets- The health benefits of honey need more study- Why mosquitoes are the worst form of predators