Is it time for Us Doctors to set aside the burden of Morality ?!

Virtue is precisely what you don't advertise 

The recent comments of Prime Minister Narendra Modi about the mutually beneficial relationship between Doctors and the pharmaceutical companies has upset a lot of doctors.  There are messages doing rounds on social media (supposedly by doctors) pointing out existing malpractices in every other field which are not regarded or objected to as corrupt, with the insinuation that doctors being the most ethical are being wrongly singled out. The Indian Medical Association promptly wrote a letter to the PM telling him how his words have hurt the medical fraternity and how it's entirely up to the government to decide the actual pricing of the medicines and consumables. The statement may be  in principle correct but it is also correct that doctors are co-beneficiaries in this price game. It is also correct that though most doctors are the minor beneficiaries they are not untouched by this ugly side of commercialism.  Well,  "the onus of these malpractices should squarely be on the pharmaceutical firms who are well known to be the driving force of these corrupt practices". Is it okay for them to be immoral or it is only up to the doctors to uphold the morality in this whole medical profession ? Or is it that the majority of the doctors are being blamed when the actual beneficiaries of this doctor-pharma commercial nexus are only a few ? 

The truth of today is that medicine as a field is to a great extent driven commercially. We know how researches are funded by large pharmaceutical companies and results moulded for commercial interests. We know how the pricing strategy of drugs is like the branding and marketing of any other consumable.It is but obvious that the cost of all promotional activities is factored in the ultimate price of the drug and eventually borne by the patients. We doctors voluntarily or unknowingly are intermediary facilitators in this commercial cycle. 

'It is immoral to be in opposition of the market system and not live in a hut isolated from it.
It is even more, much more immoral to claim virtue without fully living with its direct consequences'

Are we ready to live with the direct and total consequences of our projected morality. Not having financial aspirations in today's materialistic world is unrealistic. Upholding morality is even more difficult .
It's tough going for doctors,no doubt. They step out after ten years of grueling training knowing how to treat patients with no idea of how to run a practice. They are faced with an aggressive set of industry representatives who either want to sell him their expensive medical gadgetry or want him to endorse their pharmaceutical brands.
Then there are issues of running a practice which includes any thing other than just plain consultations brings in scores of government clearances, guidelines , departments, accreditation , insurance and so on. They demand considerable financial investments and are issues which are directly not associated with the doctors core are of specialization .
The medical field is associated with a prolonged financial incubation period which may often be stretched painfully longer.They are testing times for upholding morality.  But then each field has it's set of hardships and nuances, financial aspersions and a cozy personal life is desired by all. 

If your private life conflicts with your intellectual opinion, 
it cancels your intellectual ideas, not your private life

Medicine is much more than just a intellectual pursuit, it has an 'altruistic' component to it which ideally should not be measured against a financial scale. But it's understandably hard for all in the medical profession to perhaps do so .. 
Many from the fraternity, as is the general perception, have practically abandoned the idea of morality for faster financial gains. They are the ones who are often labelled as the black sheep by the rest of the fraternity, but it is for the other white fish's to realize that they are never going to be rewarded for being 'white' .
Morality is a reward in itself.
But, here is the dilemma for many, firstly there is no way to distinguish the 'black' from the 'white' and secondly  if the image of the profession in the society has already been tarnished no amount of self proclamation would re-establish it. 

It may be better if doctors let go of this 'holier than thou' image that they have of themselves  and understand the reality of the times. The doctor patient relationship is a two way thing.If the doctors feels that the relationship is still sacrosanct then it certainly deserves being preserved and upheld. 

But if the special relationship no longer exists then the message is loud and clear, --- the profession and its ways have to change, the personal doctor patient relationship has to give way to a professional service. Whatever rules, ethics checks and balances  apply to other services would apply to this profession too, whether it dealing with pharmaceuticals or medical equipment companies . Whether it is the issue of market promotions and advertising or receiving kickbacks.

When doctors themselves don't mind being compared to hotel or hardware industry I don't see any harm in this. It would be in best interest for the quality of the service rendered and also the best deal for the service providers also. The future set of medical professionals should be trained in the financial aspects of medical profession in the medical school itself. 
Maybe its time to replace the Hippocratic oath with a new code of professional ethics. 

Being commercial in no way means being corrupt, it only intends to take away the burden of morality which the doctors seem to be carrying alone, at least in their own view. One can't be virtuous and proclaim it too ! 

--Saurabh Agrawal

Excerpts from -- Skin In the Game (Merchandising of Virtue) by Nassim Nicholas Taleb.