Once upon time, doctors were their family’s pride, neighbour’s envy and stars of their cities. Now—a days , the mistrust between common people and doctors is abysmmal.Many people believe that doctors have tasted  the forbidden fruit of  “Greed” and patient’s life, safety and health do not matter to them anymore.

Now, what is the truth? To understand this, we need to recognize some unique characteristics which make healthcare services very different from other services.

    Unpredicatability :The people can not predict when they will require healthcare services. It is very difficult to know when and which ailments/disease(s) someone will suffer from? how much time and money will be required to treat the disease? what complications she/he may have? what will be outcome of the disease? Most of time, when healthcare services are needed they are unforseen ,sudden and surprising. Most of the people are not mentaly, emotionally and financially  prepared for the diseases.  

     “Life’ and “Health” cannot be converted in monetary terms. We cannot put a price tag on healthy life. The healthy life is essential for growing professionally, fulfilling responsibilities, enjoying the world, surroundings, environment and commodities. People often underestimate the importance of life and health when they or their loved ones are healthy.  People perceive the cost of healthcare services and various diseases differently depending on their economic, educational, social status and their perception about the seriousness of the disease. It is especially true in our country where a very wide range of disparity exists among people in above terms.  

    Variability: The human body is the one of the most complex entities in the world. The medical science has discovered more than 20,000 human diseases. On the other hand, the body can produce more than 100 different symptoms from head to heel. Each symptom or group of symptoms can be produced by several diseases (10-20 or even 50). For example, the fever can be produced by more the 100 diseases. To add the complexities, many times, a single disease can give different symptoms in different people. 

     Asymmetry of Information: Doctors receive anywhere between eight to twelve yearsof intensive training in medical science before coming to practice.  Doctors generally diagnose, treat, and manage hundreds of patients of large number of diseases with their complications during their training period.  They have better understanding of the various diseases and what needs to be done.  

    Decision making power- When people go to restaurant, movies, shopping, making investments or spending for weddings, they themselves decide where and how they should spend their money. They feel they are “in control” for their own decisions. But, when the people are sick and need healthcare services, these are the doctors who make the decisions for the patients depending on their symptoms, diseases, and possible complications. The doctors get to decide which tests patients should go through, whether patient needs hospitalization or not, if yes, ward or ICU or patient needs surgical intervention.  

Now, in our country where most of the people pay money for their healthcare services from their own pocket directly to the doctor and hospitals.  This type of payment system can be called as “Direct, out of pocket expenditure.” The amount of money is paid is proportional to the number of visits made to the doctor, number of tests and procedures done, the use of medication, the duration of stay in the hospital /ICU and medical facilities used etc. 

In healthcare, the decision-making power lies in the hand of doctors but at the same time there is a very wide gap (8-12 years of training) of knowledge between common people and doctors. When people pay for their healthcare services from their own pocket, there are very high chances of mistrust and doubt towards doctor’s intentions and capabilities. The patient feels/perceives, that he/she is made to pay more than necessary money as the doctors are not losing any money and they are not working in the best interest of the patient.

Most people fail to comprehend the need of various tests, hospitalization/ ICU care or any surgery. They feel that doctors are prescribing unnecessary tests, unnecessary hospitalization and longer period of hospital/ ICU stay to increase the hospital bills. They feel that they are being cheated.  

On the other hand, if any patient develops complications or the outcomes are not good, the very same group of people, who were accusing the doctor for doing “too many unnecessary things for minor ailments” change their stand and accuse the doctor “did not do enough to treat and save the patient” and they say the doctors were being “Negligent.” They can also feel even after paying too much money, they were denied the “health” and “life” of the patient by the doctor and hospital.  

The situation becomes horrible, when a patient comes in emergency department and too many steps to be taken immediately to save patient’s life and /or patient’s body organ. If the patient and their relatives must pay big amount of the money in a very short period of time, many people perceive the doctors as greedy and inhuman. If the outcome is not good or the patient dies, even after prompt and thebest efforts of the doctors. The people see it as even after paying so much money, the doctor did not perform his duty properly.

This direct, out of pocket expenditure in our healthcare system has put both doctors and patients on “Lose-Lose” situation. On one hand, doctors feel frustrated and remain under tremendous pressure, as even after so many years of training, intense hard work and their best possible intention towards patient care, they are seen as greedy. Each step in the patient care is questioned and seen as a money-making tact. When the outcomes are not good, the patient and their relatives feel cheated and consider doctors being incompetent and negligent. On the other hand, common people avoid seeking medical attention when the disease is in initial stage and take unnecessary risk of advancement of the disease, stop medical treatment in the middle, avoid hospitalization even if it is necessary to save their lives.  

In this way both parties are on losing side. In the war against diseases, for better health, productive and longer life, the doctors, and people should work together as a team, not against each other.  

Now, this is the time to come out of this undesirable, pathetic and disastrous cycle.  

As the healthcare problems are sudden and unforeseen in nature, the amount of time and money to get treated cannot be predicted. Not taking proper care of the diseases can lead to loss of a human life which is irreversible and irreplaceable loss forever.  

Now, we should take pro-active step, think seriously, and put healthcare as number one priority. Taking a very good health insurance plan with extensive coverage, cashless and coveringallthe tests  for diagnosis and treatment of diseases can be a very good step towards our healthcare needs.

                                                                             Dr. Meetesh Mahajan

                                                                    M.B.B.S., M.D. (Medicine)

                                                                       ECFMG certified (USA)

                                                                    Master of Public Health (USA)

                                                                    (Healthcare Organization & Policy)


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