Satyamev Jayate: Doctors Need Not React

Nipon Haque

Today being admission day, I din’t go through the headlines. Wasn’t aware of the theme of Aamir Khan’s talk show Satyamev Jayate this week till a friend (Dr. Basu) told me at dinner that Aamir Khan has criticised corrupt doctors and even suggested that doctors should see patients for free as a social service. We ridiculed the idea. But both of us were pretty nonchalant about it and we discussed other things.

Then *headdesk* moment for me when a Sir called me urging me to write a strong mail to Aamir Khan! I tried explaining that Aamir Khan has done his job but why should I bother – I don’t have to justify myself to anybody or everybody! I am too busy to even think about it, forget about retorting! Those who are saying how much study and efforts they put in to become doctors and how little is the pay and more such boring details are only wasting their time. We have much better things to do, really. The fact that we save many lives and give relief to many people every day is a far greater truth than the talk show named Satyamev Jayate.

The same sentiment was voiced by Dr. Parijat Sen on Facebook. The most important point in his post that each doctor is an individual says it all. Making and ignoring criticism both are fundamental rights, he stresses. He is unhappy about the venomous knee jerk reactions though, which some doctors have come up with – that is silly and totally uncalled for.

Surprised at the huge uproar in the medical fraternity in response to Aamir’s show!!! Well firstly the corruption in healthcare is undeniable. But at the same time it just represents a smaller picture. Now why Amir sensationalised it?

  1. Class sentiment against doctors fetch great TRPs.
  2. He has an entire season to run so there is a dearth of issues.

But all said why should the doctors react and project as we’re really trying to defend whatever corruption exists. YOU CAN NOT LABEL A CLASS. Each doctor’s an indvidual and is responsible for his/her actions. So just stay clear to your conscience and after that Aamir khan theke pasher barir Jhuntu boudi ki bollo ki eshe jay??!!! Just chill Docs, you are not obliged to be answerable to anyone and everyone. Dont waste your energy trying to do that :) :)

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"Satyamev Jayate: Doctors Need Not React" by @bongbuzz

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  1. It is unfortunately necessary to react. The reason is that media has a huge reach and as Goebbels showed long ago, if you perpetuate a lie ( in this Case” All Doctors are corrupt”) , it becomes fact in the eyes of the public.
    This has led to actual physical danger to doctors who have been beaten and even killed because of these perceptions.
    However the way to react is by facts and figures and perhaps by turnng the searchlight on ourselves. It can never be an excuse that lawyers or politicians are getting away with worse!

    1. Sir, you are right that the way to react is by facts and figures. Dr. R Sreedhara, the nephrologist who treated the case of organ transplant, did just that. His version of the story, which is backed by documents and not just someone’s verbal complaint, speaks volumes about the lack of research done by Satyamev Jayate. It now becomes that the organ transplant story aired on Satyamev Jayate is nothing but a gross lie.

      http://ibnlive.in.com/news/satyamev-jayate-doctor-hits-out-at-aamir-khan/264652-44-124.html

      It is also worth reading the letter Dr Sreedhara wrote to Aamir Khan.

      Respected Aamir Khan Ji

      I watched with shock and despair the Satyamev Jayate program of May 27, 2012. I am responding since you referred to me although you do not know me. I am the Nephrologist that you referred to while conversing with Mr. Rai. Mr. Rai has been making false and fabricated allegations for the past 2 years. While talking to you, in addition to providing you with false information, he also withheld crucial facts.Over the past 2 years, Mr. Rai has been harassing the Transplant surgeon and myself (Nephrologist) and the Hospital by filing multiple and concurrent complaints at various fora whether or not they have any role on his complaints. With his manipulations, he has succeeded to a great extent in bringing to a standstill transplant surgeries at the the Hospital which has caused a great deal of hardship to several patients. In addition, he has also caused immense damage to the noble field of cadaver transplantation in Karnataka State.Once you are aware of the actual facts, I have no doubt that you will express regret for having given platform to a sophisticated lier with immense theatrical and manipulative skills.Here are some facts that shed light on the truth.

      1. Mr. Rai never informed you that Mrs. Seema Rai underwent cadaver donor transplantation and was registered for a cadaver transplantation more than one year prior to surgery. The phone call on the night of admission was made because a suitable cadaver donor had been identified by ZCCK (Government body that allocates cadaver organs) and not by the doctors or the Hospital. Cadaver transplantation has to be done emergently, otherwise the organ(s) will decay within hours and become useless. That is why the patient was admitted on Saturday night (1 May 2010). The patient and her family were all informed about risks and benefits of transplantation for more than 2 years (since June 2008). In fact, whenever the patient consulted me she was eager to get kidney transplant so that she could stop the misery of undergoing dialysis. You can ask any dialysis patient, they will inform that they do not want dialysis but prefer transplantation.

      2. Mr. Rai, Mrs. Rai and Abha Rai all were again counseled for more than 1 hour on the night of admission about kidney and pancreas transplantation. Subsequently they also discussed with their relative in New York. Then on the night of 1 May itself Mr. Rai personally informed me and other doctors to proceed with kidney + pancreas transplantation. The Informed Consent form was signed on the night of 1 May itself and handed over the ward doctor. These facts have been documented by the nurse as well as the ward resident doctor. The State Medical Council as well as the National Law School of India have investigated the Informed Consent issue and clearly stated that Informed Consent was indeed taken prior to surgery. In fact, if the Informed Consent was not given on the night of 1 May, the cadaver organ would have been allocated to the next patient on the waiting list for cadaver transplantation who was also admitted to another Hospital on the same night for possible transplant surgery. (Whenever a cadaver donor is available, several patients on the waiting list such as Seema Rai are called and advised to get admitted so that the cadaver organ does not get wasted in case one or more patients are found to be unfit or do not want surgery.) If Mrs. Rai and her family had not consented for the surgery on the night of 1 May, then a surgeon from another Hospital would have proceeded to retrieve the cadaver organ on the night of 1 May. The surgeon from our hospital would have gone home. The very fact that our surgeon traveled on the midnight hours of Saturday to the donor Hospital and brought back the cadaver organs by about 5.30 AM on a Sunday morning suggests that the patient and family indeed had agreed for the surgery.

      3. Mr. Rai also concealed from you the fact that he had telephoned the Nephrologist several times on the night of 1 May to seek help to arrange for a special medicine (Simulect) that was to be given to the patient in the Operating Theater before the transplant procedure. The Nephrologist had personally called the Pharmaceutical company on Saturday night to help Mr. Rai to procure the medicine. The Nephrologist had given personal surety to the Company since Mr. Rai told him that he did not have cash to purchase the medicine in the middle of the night. In fact, Mr. Rai procured the medicine at about 7.30 AM on 2 May (Sunday) and handed the same to the Operating theater staff. If the patient and Mr. Rai had not consented for the surgery, why would he purchase the medicine and hand it over to the Hospital staff?

      3. Mr. Rai never asked the doctors or any other Hospital staff not to proceed with the surgery at any time. He was plainly lying when he made a statement to that effect to you. If in fact, the patient and her family had not consented for the surgery, that would have been Mr. Rai’s first and major complaint when he filed an FIR with the police on 30 May 2010 accusing the doctors of murder. In his initial complaint to the police as well as to the State Medical Council, Mr. Rai never complained that he or the patient had not consented for the surgery. This fabricated allegation is clearly an afterthought on Mr. Rai’s part.
      4. The patient did not receive 119 units of blood, i.e., 60 liters of blood. She received 33 units of blood over 4 days which is about 13 liters of blood since she had developed a massive bleeding condition called Disseminated Intravascular Coagulation (DIC). She also received platelets, FFP and other blood products to correct DIC. The doctors never told Mr. Rai and his family that 390 cc of blood would be required. No doctor can predict the exact amount of blood loss in a given patient who undergoes surgery. Besides, the large requirement of blood in this patient was due to the fact she developed a medical complication called DIC which can happen after any major surgery or major trauma. Normally in transplant surgeries, we do not transfuse any blood at all.

      5. The transplant surgeon is highly qualified to conduct pancreatic transplantation as well as kidney transplantation. He is trained at well known Hospitals in the United States where he had conducted numerous multi-organ transplantation surgeries. All relevant documents were reviewed by the Health Department before the Hospital was granted registration for multi-organ transplant surgeries in March 2010.

      6. Mr. Rai was again lying when he stated that the doctors had switched off their phone on 6 May after the patient’s death. In fact, Mr. Rai spoke to the doctors several times after the patient’s death. This can be easily verified by looking at Mr. Rai’s phone records.

      7. The Hospital was registered for multi-organ transplantation. There was a clerical error in the Certificate which was acknowledged by the Health Department. The Health Department have clearly stated in their report that registration for liver includes pancreas as well (since the skill required for transplantation of both these organs is one and the same).

      8. Mr. Rai also withheld from you that the Karnataka Medical Council has thoroughly investigated the case and found no evidence of any negligence on the part of the doctors.

      9. Mr. Rai also withheld the fact the Hospital bill was not for the surgery alone. Most of the cost was due the use of blood and blood products and other medicines which was necessitated by the development of DIC and infection. If the patient had not developed DIC, the bill for a transplant surgery would have been about Rs. 3.5 lakhs. In fact, there was no additional charge for pancreas at all. Whether the patient received cadaver kidney or cadaver kidney + pancreas, the bill would have been the same. There was absolutely no financial motive in recommending the combined surgery. The surgeon recommended combined surgery because diabetic kidney failure patients do much better with combined cadaver kidney + pancreas surgery than cadaver kidney transplant alone. This has been well established in the medical literature. The surgeon made the recommendation with the best interest of the patient in mind. Even todate Mr. Rai has not produced any scientific evidence or professional opinion to contradict the recommendation of the transplant surgeon. All transplant specialists who have reviewed the case (from AIIMS-New Delhi, PGI-Chandigarh, Chennai, Bangalore, and USA) have unanimously opined that the patient received the best possible treatment and that her death, although very unfortunate, was not due to any negligence on the part of the doctors or the Hospital.

      10. Mr. Rai also did not inform you on the Air that he has filed a complaint with the Consumer Forum seeking compensation of Rs. 84,55,933/-. I am sure Mr. Rai has used his theatrical skills to convince you and your team about his false allegations. I am also confident that you will realize the lapse your research team has done once all the facts become apparent. I am enclosing a detailed Medical History as well and other documents that shed light on true facts.After my medical college, I studied and then worked in the United States for nearly 16 years. I came back with a dream to serve my countrymen. However, now after going through the mental trauma caused by a reckless individual who is inadvertently abetted by a corrupt officialdom and a thoughtless media, I am beginning to wonder if I made a mistake in returning to India. Perhaps, I should also go back to the United States like the doctor that you showed in the opening sequence of your program who returned to the UK because of the corrupt system in India.

      I invite you and your team to visit the Hospital, meet other patients who have undergone/undergoing dialysis, patients who have had transplant surgery, and meet the Transplant surgeon so that you can clarify all the facts for yourself.Please do not hesitate to contact me if you need any clarifications.

      Dr. R. Sreedhara

  2. I will confess that I have been reluctant to write about this. For one, it often starts a flame war and I have been flamed much too often in the past, on forums, on my erstwhile short-lived social networking life, at the bar, and even over the phone! And my good friends will know that.

    Well for starters, for those who watched the program, either on the telly or over YouTube and the like, I remember the part where Aamir says that “it is not about mistakes, anybody can make mistakes. Doctors are humans and can make mistakes, but today we are not here to speak about mistakes. We will speak about intent. When doctors will scare a patient, just in order to extract money from them……”

    I think that is the crux of the issue that Aamir was wanting to highlight. It is not that all doctors are bad or the entire medical profession is corrupt. But there are enough and more professionals amidst us who take money and gifts each day from businesses, in exchange for which they will prescribe certain brands of medicines in preference to others and direct patients to certain labs in a particular preference. My friend, Nipon, did point out that certain brands of medicines work better than others. It is true. And it would be difficult for the Aamirs of the world to understand this, but practicing doctors know that for the same medicine (say paracetamol), brand ABC always seem to give better results than brand XYZ and so on and so forth, so I say go ahead, prescribe ABC. The problem comes up when another existing brand, DEF, is giving commissions and gifts (want a new iPhone sir? An iPad perhaps) for prescribing it in preference to ABC (your trusted brand). Now, you are not quite sure if DEF is better than ABC or good at all. It is packaged well, costs a bit more (so should be good, right?), but when a brand has sponsored your beer party last Saturday night, the mind does become foggy, doesn’t it?

    I remember my short stint in Rajasthan. This was 1999 or whereabouts. Fresh out of medical school, the desert did not feel so dry. Or the sun too hot! I remember the first week at the government hospital where I worked and sent out a few patients to the town to get some lab tests done, the routine stuff, ultrasound of the abdomen and the like. These were patients who wanted me to send them for tests to the private system instead of referring them to HQ, so I just did that. I just wrote the investigations on an empty piece of paper. Now on the weekend, I was more than surprised when a few nondescript-looking characters come to my house with envelopes bulging with currency notes and a thank you note from different labs in town! I call up the labs immediately from the phone numbers on the note. I ask them what is this! I am going to return the money! Sir, they say, “Yeh aap ka fees hai. Aap ka yeh banta hai” (Sir, it is your fees; it is rightfully yours!). Some of the doctors owning these diagnostic centres would befriend me as well, in due time. WTF!

    In due time, my referrals to the private system dwindled and so did my popularity among the “medical professionals of town.” The friendly visits stopped. I could not push a poor employee for tests that he could often do without. I did not want him to be paying the money that would pay for my 30% commission! I used to think that this problem had particularly afflicted North India, but now it is here as well!

    And I have been there. Done that. I have been guilty as many others are. And it sure is wrong. Someone told me nothing wrong in earning. Yes, it is true, but certainly not in this way! You can have a good roaring practice and make good money as well. Surely not by living off money of poor patients!

    It is almost impossible to cover all the good and the bad there is in every system. There are professionals who will give money from their own pockets to the patient. Or give plently of samples to the poor patient who cannot afford to buy them. When I was an intern, there was a dada, a housestaff, who in the evenings could be often seen reading out the newspapers to some old patient in some ward. All is not bad. Definitely not. But not all is good either.

  3. Thanks for sharing your views. I have no problem in Amir Khan finding faults with corrupt doctors. Problem is his sensationalising the whole thing. The overall tone of his show is high on the popular class sentiment against doctors. I don’t agree with you and would share my views on the issues you have raised.

    You and I know very well that doctors are in no way involved in the manufacturing process of drugs. They don’t frame the drug policies of the government. It is upto the drug control authorities to ensure strict quality control and regulate pricing. The central drug control authority, correct me if I am wrong, doesn’t have a single medical person on board. I am at a loss why blame the doctors if some brands are costlier. Technically I am licensed to prescribe any brand available in the market I like. Don’t you think? If one is really worried about drug prices then he should push for strict standardization and quality control like it is in the US instead of bickering about doctor prescriptions.

    There is so much patient load in my medical college hospital that it takes a few days to get investigation reports. Some patients would not wait for that and like to get tests done from outside. Or sometimes some tests we advise are not available in the hospital. Patients ask me where to get the tests done. I always tell them to avoid the local diagnostic centres that have mushroomed around the college campus and go to one of the few test centres in town proper whose reports are reliable. I am not wrong. Similarly, in your case you did no wrong in advising routine investigations to patients. Wrong were the owners of the diagnostic centres who came with pay packets to you. You will know that these centres are owned by non-medical persons in most cases. I am glad you saw through their trickery.

    The problem with people is that they tend to equate the healthcare system with doctors. Healthcare is a big system comprising of pharma companies, private hospitals, diagnostic centres and so on. Doctors don’t run diagnostic centres. Neither do they own big chains of private hospitals. The entire system is hardly in their control!

  4. During infamous Sanjay’s emergency rule all kinds of sterilization operations and foeticides became a rule. Even unmarried boys and girls were not spared and were sterilized to meet the targets. After emergency willful selective female foeticide pracice have continued with vengeance. It is a social evil on which doctors have little control. It will die its natural death the day when the bride’s parents start demanding dowry. Amir should have had focus his attention on that greater evil. As regards the commission/gift by the medical firms to the doctors you name any firm, any mall any individual who is not doing this. Even with noblest intention a doctor is liable to attract some praise and commission.

  5. It is totally wrong to say that the diagnostic centres or pathology people are wrong or they are responsible for this menace. If the doctors don’t accept commision, why will they pay it? I have many experiences where the clinicians claim the reports wrong if he is not paid the commision. It is difficult for a pathologist/diagnostic centre to survive without paying comission.

  6. I am wondering why doctors are creating such a panic about “Satyamev Jayate”. We all (including Doctors) say that politicians are corrupt, are there no honest politicians? There are, and similarly, there are honest and sincere doctors as well. There is need for doctor’s community to rise upto the occassion and go by the intent rather than content of the show. And from intent perspective, all doctors will agree to the prevailing corruption in the profession while percentages might vary. Rather than knee-jerk reactions even from honest doctors, public will expect their cooperation in eliminating corruption from the profession!!