Are Our Doctors Losing Their Soul?

On August 22^nd of this year, in the Lakhimpur Kheri district of Uttar Pradesh, a moral failure in the medical profession was witnessed when a man came to the Collector’s office carrying his dead newborn in a bag, alleging that a private hospital had been raising the fee and delaying the delivery. While that private hospital was immediately sealed for inspection, this disturbing instance of moral failure raises an important question – are doctors in India losing their soul?

Eroding Medical Ethics

The INDIAN MEDICAL COUNCIL (Professional Conduct, Etiquette and Ethics) Regulations, 2002, state that “The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. Who- so-ever chooses his profession, assumes the obligation to conduct himself in accordance with its ideals.” While the medical ethics code clearly puts financial gain subordinate to service to humanity, unfortunately, many doctors see it the other way around. But this problem of the reversal of value priorities, keeping financial gain at the forefront, cannot be solved unless this issue is understood across different levels – from medical education to actual practice.

Education is the first place where ethics can be imbibed into the hearts of future doctors. But unfortunately, now-a-days, education is also where the ethical failure begins. Many private medical colleges demand high capitation fees (illegal donations) for admission. This financial entry barrier creates in students a sense of “I must earn it back” kind of mindset, thus imbibing financial obligations instead of service values.

In the medical education, although the National Medical Commission (NMC) has included ethics modules in the syllabus, the dearth of ethical role models has become a major reason for the poor internalization of these ethics in students. Unfortunately, these role models, mostly the senior faculty, consistently reinforce in students a “sense of entitlement,” i.e. a prevalent mindset among some students who believe they deserve special privilege simply because they are in medical profession, rather than earning them through competence, discipline, and ethical practice. Sense of entitlement makes them view the medical field as a prestigious, high-paid job rather than as a genuine opportunity to serve patients. This also makes them focus on their personal welfare, as opposed to patients’ needs, hampering empathy.

Another, less emphasised issue with medical education is desensitisation. While desensitisation is helpful in the professional handling of surgical procedures, it often fails in the context of a doctor-patient relationship. One example of this is the cadaver lab (a cadaver is a dead human body). While the cadaver is a great educational tool for learning human anatomy and surgical procedures, there is often less discussion about the cadaver as once a “living person.” Consequently, students may start to look at the patient as a mere “subject” rather than a “wholesome person,” and thus, become desensitised to their pain and agony.

To increase sensitisation along with hands-on experience, the NMC has mandated the Family Adoption Program (FAP) for MBBS students. MBBS students are mandated to adopt families, typically from rural or underserved slum areas, to conduct regular visits and understand the health challenges of the underprivileged. While this program is aimed at fostering student-patient connections, it often suffers from implementation challenges due to students’ lack of interest, language barriers, logistical issues, and staff shortages.

These shortcomings of medical education often produce doctors who prescribe mechanically rather than engaging empathetically with patients. The consequences of such value erosion become manifold when the profit motive of corporates is added, leading to “Corporatization of the medical profession.” Many corporate hospitals make doctors chase unethical revenue-per-patient targets, increasing the work pressure and mental stress, thus furthering their compassion fatigue toward patients.

Another important issue is the loss of autonomy of doctors in corporate hospitals to independently decide on medications. Every decision they make is influenced by the management’s guidelines, tie-ups with pharmaceutical companies, and insurance companies. This puts a serious dent in doctors’ consciences if these tie-ups and partnerships are solely profit-driven and disregard quality and fairness in healthcare.

As these structural problems are becoming more concerning, proper reforms at each level become necessary.

Internalise Medical Ethics

Firstly, besides digitising the payment records and independent external audits, there must be a dedicated educational tribunal to address education-related grievances, including capitation fee issues.

Secondly, through awareness programs, medical colleges must de-heroize unethical role models who idolize entitlement behaviour. Thirdly, while the NMC has introduced a “cadaveric oath” reminding students of the altruism behind body donations, a voluntary “body donation pledge” for educational/medical purposes can further empathize students. Fourth, with respect to effective implementation of FAP, students must undergo sensitivity training before such village visits. Robust supervision of student-patient interactions by faculty, coupled with proper feedback, can bring back the seriousness of FAP among students. And language barriers can be resolved with AI voice translators. Further, logistical and faculty issues must be resolved with proper pre-planning.

Fifth, Independent ethics committees to act as doctors’ grievance units must be set up within hospitals. Sixth, doctors should prescribe medicines with their generic names and leave the selection of brands to the patients’ convenience. For its effectiveness, proper maintenance of drug-quality standards across brands is crucial. Finally, there should be patients’ feedback on treatment, their expectations, and suggestions. While positive responses might improve the morale of doctors, negative responses can increase the scope for improvements.

The ethical meltdown of doctors is a major obstacle for India in becoming the health capital of the world. India must act now, as further delay might lead to the vanishing of the remaining humanness of doctors in this fast-growing corporate world!

The views are personal and never intended to hurt anyone's feelings. Just a constructive criticism from a victim point of view. Kindly contribute by letting me and the world know your views. Do comment below!