A confession to make: I was corrupt

I joined my residency programme in dermatology, a most-sought after specialty among medical graduates in the prestigious Seth GS Medical College & KEM Hospital, Mumbai in May 2008. I was awed by the glamour and richness of the city. To be frank, I hailed from a family whose head was a single working mother with limited income. As a result, my wishes of wearing expensive clothes and donning a techno-craft wrist watch remained unfilled. Within few days of joining residency programme, I saw how medical representatives from numerous pharmaceutical companies made a bee-line to outshine each other and coaxing my colleagues to prescribe their worthy brand of creams, ointments and lotions. We were assured various kick-backs in form of cash and kind. I received gifts of various kinds ranging from a Parker® pen to costly textbooks in dermatology. Registrations for various conferences were done on my behalf by couple of ‘friendly’ medical representatives. I was invited to enjoy sumptuous dinner meals at exclusive restaurant and eating joints whose bills sometimes ran into few thousands were footed by our friendly medical representatives. I enjoyed screening of many films in various PVR’s^® and Big Cinema^® across the city. My hostel room was overpopulated with various household items, crockery and clothing.

  It is a common scene outside major medical colleges to see touts of various private pathology and radiology centers luring patients and assuring them delivery of reports within few hours. I too was offered a handsome kick-back of Rs.1500/- per month for referring my patients to one particular pathology center for various blood tests. I did not realize that the source of kick-back was ultimately from patient’s pocket. Today, I hold myself responsible for burning holes in my patient’s pockets.

 Today, I ponder over my attitude and behavior which made me become corrupt by accepting free gifts and holidays. A recent communication by Bawaskar H with editor of Indian Journal of Medical ethics reveals the practice of bribing doctors under the garb of ‘professional fee’ as an incentive to increase the business of private players.[1]  Bawaskar H acted honestly and returned the cheque of value Rs. 1200/- back to the radiology center and requested them to return the same amount of money to the patient. After reading the communication, I too hopelessly wished for the same courage in my residency days to refuse the various gifts and commissions I received back then. Sheth described the practice of ‘referral commission’ commonly called as ‘cuts’ as trade and patient’s illness a commodity which was shuffled from doctor (trader) to doctor (trader) on a commission basis. I represent the ‘corrupt blood’ as aptly described by Sheth in another paper- White coated corruption.[2]

  There may be few acquaintances from my residency period who might criticize me for boasting of honesty after indulging in corruption. There is a well-known saying in Hindi- After eating 100 rats; the cat now goes for a pilgrimage. But one must also remember the story of ‘Daku Angulimal’ from era of Lord Buddha where he gets transformed from a notorious killer to a great Buddhist monk. This transformation shows universal human potential for spiritual progress and becoming honest and clean, regardless of one's background.

I end this communication with a fervent hope that all the “Angulimal” from medical profession should choose the path of transformation.

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[1] Bawaskar HS. The medical trade. Indian J Med Ethics. 2013;10:278.

[2] Sheth A. White coated corruption. Indian J Med Ethics. 2011;8:63.

From a physician to an anxious parent to a humbled person

It was 1:00 am in the night, when my wife woke me up saying that our tiny tot (who is six month old) is shivering and having a high fever. We immediately packed him in all his beddings and rushed to pediatric ward of my hospital. Surprisingly, on that night, there was less hassle and chaos in the ward. I requested one of the senior post-graduate students to assess my baby. Wasting no time, she immediately started assessing all the parameters and told us that the baby was having 102⁰ F of temperature. Meanwhile, the baby again started shivering with rigors and had two bouts of vomiting. Keeping in mind the whole clinical scenario, the pediatrician advised to get the baby admitted under intensive care.

 We obliged and I rushed to the admission counter to get all the admission formalities done, while my wife stayed back. The baby was put on antipyretic drugs and injectable antibiotics (which I thought was unnecessary). Few blood samples were drawn to know the cause of fever (which ultimately was non-contributory except raised leucocytic count). Around 3 a.m.  in the morning, both mother and child went for a peaceful sleep. Somewhat relaxed and less anxious, I started taking stock of other patients admitted under ICU care. Ours being a rural medical college, most of the patients hailed from villages of central India. The situation was disturbing, the usual laughter and infectious smile of babies which enlightens the atmosphere was totally missing. It was replaced by shrill cries, few moans and groans which were intermittently breaking the silence of relatively peaceful ICU. Laughter, smiles and babbling, the usual signs of a healthy baby was over powered by intermittent beeps and alarms of various monitoring systems kept in the ICU. One of the child had various tubes and catheters placed in all the possible orifices of the body and he seemed to be in lot of pain. At other end of the ICU, few under-weight babies were admitted for supportive care; one of the babies was grossly underweight at 1.34 kg and looked listless. Amidst all these happenings, the post-graduate students were regularly monitoring the vital parameters of the critical patients. Somehow, I started comparing the plight of myself as a parent and the parents of other critically ill babies. At one end, I being a doctor (knowing all the science behind illness and diseases) was well placed financially and socially with a good family support. On the other extreme were clueless parents caring for their admitted babies with all the worries haunting them (financial crunch, rain-washed crops, loss of wages, kids back home, and flooded homes). Every day, I see hoards of patients thronging the hospital wards and OPD section accompanied by their kin. Seldom, we doctors are concerned about the anxiety or worries of the patients which are subconsciously occupying their debt burden minds except giving few heavy sighs on reading some article (farmer suicide, rain washed crops, poor rain, dry and wet drought) in the print media. We doctors in government or semi-government setup readily gets miffed at the patients when there is a delay in follow-up or the patients has missed few pills in total disregard to his economic backing. It is a fact that the financial and societal strata of the patient are predominant decisive factor either in treatment adherence or regular clinic visits. It seems the white apron donned by physicians makes him impermeable to all the agonies of the patients and their kin.

Keeping in mind the high rate of hospital acquired infections, we both considered it wise to obtain discharge on request during morning rounds. I left the ICU with a healthy baby and quite relieved. This culminated my short journey from a physician via anxious parent ending with a humbled heart.

My first encounter with poverty

Those were the days of  May 2007 in Nagpur when i had completed my MBBS and was preparing for my post-graduate entrance examination. The sun was scorching out as it happens usually in Vidharbha. I was studying in the college library (IGGMC) and it was around 3 in the noon. My friend Amit asked me to accompany him for a cutting chai. I happily nodded and we both went ahead seeking the shadows of walls and trees along the way and reached 24 hour ( a small canteen frequented by doctors and patients). It was the only place in the campus where doctors could smoke without being noticed by their seniors. We ordered "Do cutting chai" and were gossiping about the frustration of doctors seeking a PG seat in a good college. Amidst our talk, a middle aged man about in his late thirties entered the 24-hour canteen who was looking frail and was having a IV line in one of his hand. His clothes were soiled rather they were not washed for days together. We continued our talk on cutting chai. But somehow i was aware of that man and his activities. Soon he ordered a plate of rice!!! I assumed that some curry or dal will soon arrive for him. But to my sheer surprise he poured half a glass of water in the rice and started eating it. I got a lump in my throat. I could not digest what he was eating- rice with water. We both left the canteen to resume our studies with some food for thought. Few weeks passed by. I was invited by a friend to a restaurant called "Xing' on Presidency road in Nagpur. I was not aware of the reason for this unexpected treat. We all ate heartily and i was happy to have a sumptuous food at one of the good Chinese restaurant of Nagpur. The friend paid the cheque of around 2000 bucks. While returning back to home i recalled both the event- "rice with water" and water after a heavy meal. I witnessed two extremes of living. Here was a man who didn't have enough money to meet his ends and there was a friend who had spent 2000 bucks on lavish eating. Anyone to be blamed?