वैद्यकाचा बाजार.... आणि त्यातून सुटकेचा मार्ग

डॉ श्रीराम गीत यांनी लिहिलेले आणि समकालीन प्रकाशनाने प्रकाशित केलेले हे उत्कृष्ट पुस्तक अलिकडेच वाचनात आले.

वैद्यकीय उपचारांच्या अतोनात वाढलेल्या ख्रर्चाबद्दल खूप साधक बाधक चर्चा होत असताना आलेल्या या पुस्तकात; वैद्यकीय व्यवसायातील अर्थकारणाबद्दल खूपच संतुलित विवरण दिलेले आहे. खर्चाचा भोवरा कसा तयार होतो, त्यात रुग्ण कसा सापडतो, आणि त्या भोवर्‍यात सापडू नये म्हणून सामान्य माणसाला काय करता येईल अश्या क्रमाने हे पुस्तक अतिशय सोप्या भाषेत प्रबोधन करते.

बिघडलेल्या वैद्यकीय अर्थकारणाला निरनिराळे घटक कसे हातभार लावतात हे या पुस्तकाच्या पहिल्या भागात सांगून लेखकाने वैद्यकाच्या आर्थिक वास्तवाचे वर्णन केले आहे. डॉक्टर, रुग्णालये, रुग्ण आणि शेवटी बाजारातील शक्ती ह्यापैकी कोणत्याही घटकावर टीका, आरोप न करता लेखकाने अर्थकारणावर हे सर्व घटक कसा परिणाम करतात हे उदाहरणासह दाखवून दिले आहे. "टाळी एका हाताने वाजत नाही" ही म्हण सर्वांनाच माहीत आहे, पण टाळ्या वाजवणारे अनेक हात लेखकाच्या चष्म्यातून आपल्याला दिसतात..!!

साधे आजार, गरजा आणि वास्तव या विभागात डॉ श्रीराम गीत यांनी सर्दी, पित्त, कंबर दुखी, खोकला, लठ्ठपणा अश्या १५ आजार समूहांवर उपचार सुचवलेले नाहीत, पण त्यांचे अर्थकारण कसे बदलत जाते हे वरील चार घटकांच्या अनुषंगाने उलगडून दाखवले आहे. गंभीर आजार, रुग्णांच्या आणि त्यांच्या नातेवाईकांच्या अपेक्षा आणि त्यातून सर्वांची होणारी फरफट निरनिराळी उदाहरणे देऊन पुस्तकाच्या एका भागात विस्तृतपणे मांडलेली आहेत. हृदयविकार, मूत्रपिंडांचे आजार, कॅंन्सर इत्यादी आजारांशी लढा देणारे अनेक रुग्ण, आणि अतिदक्षता विभागात दाखल केलेल्या रुग्णांचे निकटचे नातेवाईक यांची मानसिकता या सर्वांचा अतिशय प्रामाणिक आढावा या भागात घेण्यात आला आहे.

शेवटच्या भागात या सर्व परिस्थितीवर काही उपाय सुचवण्याचा प्रयत्न लेखकाने केला आहे. तसेच इच्छापत्रक तयार करुन आपल्या कुटुंबाला ख्रर्चाच्या भोवर्‍यातून कसे वाचवता येईल याची माहितीसुध्दा या पुस्तकात दिली आहे. डॉक्टरांनी आपल्या रुग्णांना हे पुस्तक वाचायला सुचवावे असे वाटते.

वैद्यकीय व्यावसायिकांच्या मदतनिसांसाठी अभ्यासक्रम वाढवणे आणि डॉ. देवी शेट्टी यांनी चालू केलेली स्वस्त विमा योजना सर्व लोकांसाठी उपलब्ध करणे ह्या गोष्टी सर्वसामान्य वाचकांच्या हातात नाहीत. पण डॉ श्रीराम गीतांनी काढलेल्या "प्रश्नपत्रिकेतील" दहा प्रश्नांची उत्तरे वाचकांनी स्वत:पुरती शोधल्यास, आणि त्या प्रश्नांवरील चर्चेत नमूद केलेल्या मुद्यांवर विचार केल्यास वैद्यकीय खर्चाच्या भोवर्‍यातून सुटका करुन घेण्यास नक्कीच मदत होईल. त्यासाठी हे पुस्तक अवश्य वाचावे..!!





डॉ. श्रीराम गीतांनी काढलेल्या प्रश्नपत्रिकेतील हे प्रश्न खालील प्रमाणे आहेत:
 
१) आजारी कोण पडणार?
 
२) पैसे कोण देणार?
 
३) तपासण्या कोणाच्या करणार?
 
४) आजाराची संपूर्ण माहिती कळण्याचा हक्क कोणाचा?
 
५) उपचारांचे विविध पर्याय समजून कोण घेणार?
 
६) निर्णयामधे सहभागी कोण होणार?
 
७) नीट माहिती न देणारा डॉक्टर कोण बदलणार?
 
८) नीट शुश्रुषा न करणारा कोण बदलणार?
 
९) दोन सारख्याच औषधांची किमत फरक फार असला तरी खरेदी कोण करणार?
 
१०) औषधे नकोत, उपचार नकोत, जगणेही नको, हे कोण ठरवणार?


डॉ. राजीव जोशी.

Cut Practice in Medical Profession

I started my hospital, with 15 laks as bank loan and 5 lacs loan from friends in 1994. A group of general practitioners met me to ask what percentage I was going to give them if they referred the patients to me. I had courage to tell them that I would treat any patient they recommend free of cost, but would not be interested in giving any percentage as cut. They asked me as to how I was going to repay bank loans without their support. I served them a cup of tea with big smile and big thank you.

 

In first week of practice a poor family working as labour on construction site brought their daughter to me with complaints of excessive frequency of micturation. On examination I found that the child had ectopia vasicae which was confirmed by my paediatric surgeon friend. Since the family was obviously non affording I requested the surgeon, anaesthesist to work for free and I offered to waive operation theatre, bed, nursing and medical attendance charges. This brought the possible expenditure from 22000 to 9000 for medicines and disposables. The parents promised to get admitted the next day and left.

 

They visited their general practitioner and informed him about above discussion. He called me and asked how much I was planning to give him. I politely informed him about my views regarding cuts and he congratulated me on this. The parents did not get the child to me next day, week, month, year..!! After one year they came back, now obviously in better financial condition as labourer was promoted to supervisor. He told me that now he does not need any concession, but surgery should be done by qualified doctor. I asked him what did he mean and why he did not come for one full year. He told me that the general practitioner told him that expenditure could be brought down from 22000 to 9000 only if "trainee" doctor was going to operate on the child. By this time child had massive urinary tract infection which had to be treated first, followed by surgery. Total hospital stay was 21 days and he happily paid 25000. I kept on wondering, whether had I agreed to pay that doctor 10% with explanation of concession etc, poor child would have been continent, free of urinary tract infection with obviously better quality of life.

The general practitioner visited the family during the child's hospitalization and met me in my consulting room. He was so thick skinned that he asked his share from the bill. I asked him to leave my cabin, on which he told me that he will show how he can recover his cut from me. I told him that without support from general practitioners from the area I have been able to repay loans in first year of practice and would continue to do so. He left clinic. I persisted on not giving cuts to anyone.

 

Fifteen days later he referred a 13 year old girl with pain in abdomen. I diagnosed twisted ovarian cyst and informed parents regarding need of surgery. They went to the GP again who called me for cut. I refused. The parents refused to sign the concent giving vague reasons and told me that the GP would visit hospital. By one hour the child started looking toxic and I requested the parents to give consent or shift the child to another hospital. They agreed for surgery and we started the surgery in next 15 mins. The ovary showed gangrenous changes and had to be removed. Poor family members had no clue that the ovary could have been saved. They thanked me 100 times for saving their daughter's life, but I kept on wondering. Had I agreed to pay the GP, could I have saved the ovary?

 

The GP called me and asked me what the bill would be. I told him that it would roughly be 15000. He told me that he knew the family for a long time and that they would create issues at the time of payment of bill. He advised me to increase the bill and then offer concession. I prepared a bill for 20000 and handed it to the family members. They went to the GP who wrote a note "Please give Rs. 1000/= concession to the patient". The family members came to me with that note on bill and paid 19000/= saying that doctor had "TOLD" me to take only that much. They thanked me again and again and left hospital happily. Within 10 mins the GP came to me and asked for 4000/= ( to which I was not entitled to any way). I had no option but to give him 4000. He laughed and reminded me about his promise to recover cut from me. I wept the whole night as I had failed to save ovary of the girl by sticking to my principles.

 

Most of my practice now is direct. Most patients referred to me are non affording who get free treatment.I have repaid my initial loans for hospital. I have taken loan for my house and repaid that also.

 

Question I still keep on debating in my mind is, if the patients have so much faith in GPs, if GPs have so much control on the patients, are they entitled to share in income which doctors dependent on referrals get by treating patients referred by GPs?

 

I started hospital with initial investment of 20,00,000 in 1994. Same size hospital would cost not less than 1 crore, and gradually small hospitals like mine will loose business to big hospitals which are recognized by insurance companies. That is reality of life.

 

Would cut practice become official in next few years? Or it is already official?