I am a honest and experienced doctor and I know what I am doing. There is always a huge difference in costs in achieving a 90% success rate, a 99% success rate, a 99.9% success rate and a 99.99% success rate. The incremental increase in that 9% extra success over the existing 90% needs is about 5 times more expensive (more manpower, more machinery, more stress to be endured by physicians, more time spent etc). The additional 0.9% success rate over 99% too is achieved with only similar incremental costs.

So long as patients are happy with only a 90% success rate (that is 10% chance of death or complications) healthcare can be accomplished at dirt cheap rates. Anything beyond that will need exponential increase in costs. But the problem with Indian public is that they want 99.9% success rates but they are willing to pay only the costs incurred on the 90% success model.

Just like lawyers make a living out of divorce cases, lawyers make a living out of healthcare litigations too. These lawyers instigate patients into during doctors for negligence, even in cases where there is none. They even try to pass off the ” complications” of a procedure as mentioned in textbooks as “negligence”. That is if a procedure has a risk of 0.1% complication, there is a realistic chance that 1 in 1000 patients will end up having it, despite the doctor not being negligence. The compensation claimed in such cases is several hundred times his professional fees so that the doctor ends up losing his entire lives’ savings and more if he/she ends up losing such a case, despite no fault of his. Hence more more doctors are resorting to practicing defensive medicine, trying to minimise their chance of landing up with a complication as much as they can. The result? Healthcate costs shoot up.

Unless patients and their families start having realistic expectations, the healthcare costs are only going to increase

Completely agree with Kalyan. Defensive medicine is a result of Consumer Protection Act applicability on Health care. When this got applied, the health care became a business. Nobody understood that healthcare should not be treated like a business. The patient should not expect perfect results and perfect delivery as expected in other businesses. The Hospital managers – MBAs should also understand this. It is the poor doctor who gets sandwiched between the hospital management and patient.
A case of fever could be due to many causes- Dengue, Viral fever, Chikungunya, Malaria, Common cold/Flu, are few to name. Some of them are self-limiting, and just require reassurance so that it cures naturally with just supportive therapy. But some require investigations further so that deadly complications can be prevented.
A doctor is now faced with a dilemma – if he orders investigations and it turns out to be negative for deadlier disease s/he is called a crooked doctor who prescribes investigations unnecessarily. If he does not investigate and it lands up to be a deadly disease- he may be sued for negligence.
What does the doctor do?
Getting a bad name is preferable to getting sued. Result – the doctor take the first route. Investigated further so as to prevent getting sued. Healthcare costs go up.
For the own kith and kin, the doctor may take a slower route, because there is no chance of legal problems, but it is not possible to apply the same to general public. Patient is not a consumer. And doctor is not a shopkeeper. Their relation is not a business relation. But Alas, this is not understood by many.

Completely agree with Dr Kishan and Dr Kalyan. Without a cap on the amount of compensation for alleged medical negligence, defensive medicine and cost of healthcare will keep spiralling up. Even if we accept Subra’s suggestion of working only 4 days a week, in order to attain the same level of income, the fees would have to be raised by 50% (assuming one day off in a week now).

With the (Medical Indemnity) Insurance industry and the legal system making so much money off these cases, it is unfathomable how Medical Care can be taken off the CPA list by any government. A possible way out might be like the Air Insurance of yesteryears — a fixed (capped) amount would be given to the next-of-kin in the event of any mishap, and if the patients want more, they’ll have to purchase addiional insurance themselves.

@Amit Gupta: Point taken. Yes, Doctors will compensate in crores for a death due to their negligence provided:

1) the same rule is applicable universaly in all professions. For eg: if a bus driver causes an accident which results in death of 40 peopel, he should compensate all the victims family by paying them Rs 1 Crore each.

2) If the cost of losing a life is Rs 1 Crore, the cost of saving it too should be the same. Hence if a doctor saves a life, the patient should pay him Rs 1 Crore. Fair deal, isnt it?

Lastly, We doctors are scientific people who have been trained to scientifically understand a disease and provide the best solution for it. We are not interested in playing God. We are perfectly fine if you don’t equate us with God. In fact we hate to be compared to God, as after all, it was the “God” who gave you the disease in the first place….

If you are unhappy with the Doctor’s treatment, you can always approach God to revoke the disease.

By the same logic, if God wants the patient to suffer, he will naturally make the Doctor negligent too, won’t He?

@Subra sir: my previous comment was rhetorical, not to be understood and replied verbatim. Yes, I know that ppl cant pay Rs 1 crore as fee for saving a life. But my point was how can they be miserly when giving and be greedy while receiving. If somebody wants to have a right to sue a doctor in consumer court, the doctor should have a right of charging him either his annual income or 10% of his net worth, whichever is higher. If the patient cant afford that, the doctor can treat him for a nominal fee (as charged today) but the patient will have to forego his right to go to consumer court. Fair deal, isn’t it?

@Amit: Completely agree with you. I don’t at all oppose the idea that a negligent professional should be punished to the maximum so that other professionals are cautious. There is no doubt – what you say is completely correct

The question arises – What is “ negligence”. In medicine – All diseases and the treatments come with complications. The doctor generally does whatever is best known to him. But all doctors are not equal. Neither does the same disease have similar symptoms in every patient. For eg Dengue in all patients does not lead to same amount of platelet depletion. But if the doctor does not investigate thoroughly, a deadly complication may be missed. Therefore it is prudent that the doctor investigates thoroughly. Another example- when an abnormality is seen in a Chest X Ray of a patient we the doctors in India have to keep Tuberculosis as a possibility. But the same Chest X Ray if shown to a doctor of USA, Tuberculosis will not be thought of at all. What I want to imply here is that medicine is not 2+2= 4 at all. It can be anything. And sometimes the diseases present in such a pattern that not even the greatest doctor will be able to diagnose or treat the disease correctly and perfectly. Human disease and it’s treatment has never been, and it will never be predictable. There is a lot of “gut feeling”, “individual experience” “local disease pattern” involved.

Also- There are many restrictions for a doctor. Finances of patient, infrastructural problems and many more. And it is humanly impossible to ascertain whether a particular complication will occur in a particular person or not. If a particular disease is studied and it’s treatment is reviewed you will find innumerable complications and side effects. Now if law / media does not take this into consideration and labels a known complication of a procedure as a negligent behaviour then there is a problem. Here the doctor is not responsible. A known complication cannot and should not be labelled as Negligence.
You must have known a recent issue where a journalist of a renowned channel barged into the ICU of a govt hospital and started accusing the doctor of negligent behaviour- that is a problem. Treating a patient on a stretcher can be called negligent behaviour. Keeping two patients on a single bed can be called a negligent behaviour. On the other side of that doctor had refused admission since he did not have enough beds, even then he would have been called negligent. What should one do? Accusing a doctor for things beyond his control just to earn some TRP is one of the worst behaviours I simply pray to god that I never face such a situation.

But regarding other professions – they are more predictable- a bus driver, if follows a set of traffic rules, will not cause an accident in majority of times. Recently a driver dozed off while driving and about 30 lives were lost in that accident. Why did the driver do overtime and risk so many lives. Will he be punished( if alive), or will the bus company be punished for over working the driver?
A law person if follows some set of instructions and system should arrive at a correct and predictable judgement. But still they don’t. A lower court judgement can be completely opposite of a higher court judgement. Why?? There are so many cases where a person is given punishment by a judge without his mistake and later on it is known that original judgment was incorrect. In this case will the original judge be punished for the undue punishment? When the process is predictable and even then there is a mistake the professional should be punished. But it does not happen in these cases. And when the process is unpredictable in medicine the professional is asked to compensate.
Is that logical??
Just recently a doctor in UK was suspended for few months. Do you know why? He did duty for 12 hours continuously rather than the allotted 6 hours to him. The authorities concluded that he risked life of patients by working more than required. It was negligent behaviour according to the authorities.
I tell you we all doctors in India would be behind jails and all the hospitals would be shut down for ever it such rules come to India. Working 12 hours at a stretch is nothing for a doctor in India. I have worked for 48 hours continuously without sleep during my PG. This is not just me. Almost all doctors go through such work schedules. It was not for money nor fame. Money and fame does not matter when you don’t enough sleep. I did it because the patient load is like that. That is why an avg Indian doctor’s life’s expectancy is about 5 years less than general population. The emergency of any avg hospital in India is always full. Patients wait years for the disease to get critical before attending hospitals but want immediate perfect treatment when they reach the emergency. In the west, if people get attended to in 5-6 hours after reaching emergency room, they feel blessed.
Go to any pharmacy shop and spend some 15 min there. You will see so many Schedule H drugs being sold there over the counter. People don’t want to go to doctors for diagnosis. They just explain the symptoms to the pharmacist there and take treatment.
The west is altogether different. Their rules, work conditions, patient ethics, everything is different. We better not compare ourselves with the west. If all the rules of the west were applied in India and to the Indian patient load, the average patient will have to wait weeks before he could be seen by a doctor.
I see around 25 OPD patients every day. In the west they see 8-10 per day and don’t do any procedure on their OPD days. After OPD, I do one cardiac surgery per day (avg) and do night duties for 5-6 times per month. When a night duty is there, I am in hospital for 36 hours continuously. And mind you I do not – DO NOT get any extra benefit for night duties. It is the need of the patients. This is at an age of 43 after being in the field for about 16 years. In the west the avg surgeon does not do more than 10 surgeries per month. And they are paid about 5-7 times per case as compared to Indian surgeons. The surgeon does not any night duties because overworking is negligent behaviour according to their rules. Here if I don’t attend to a patient after doing surgery I am called negligent.
By western standards I am extremely negligent. But can’t help it. If I don’t do in such a way, the patients have risk of dying without surgery. In that way I will be negligent by Indian standards.

Try to enter the shoes of an average Indian doctor in a neutral manner. I bet you will thank god and your luck that you are not a doctor