This is regarding the article, Doctors, let us care for the patient, not look at their purse by Dr.

Araveeti Ramayogaiah published in the Open Page (The Hindu July 3, 2011). I am a doctor, my whole families are doctors! We are into private practice in our native place, which happens to be a small town. We have been practicing for the past 10 years, but I was fortunate enough to start only two years ago, immediately after I completed my MD. I run my own hospital, so I can understand what Dr. Ramayogaiah is saying. I would like to clarify some misconceptions among the general population about doctors. It is high time someone defended doctors who have become a punching bag for the media, political parties and even the common man. From being god and reduced to the status of a dog, we have come a long way silently bearing all the insults. If a doctor starts practice in a small town, he has to pay 25 per cent of the fees to the local RMPs (Registered Medical Practitioners) to get patients from the surrounding villages. If a doctor refuses to oblige he won't get a single case from that place, though he is ethical, worthy, skilled and very good in his profession. As a doctor, if I refer a patient to some hospital, I do so because I understand his illness and the further management he needs and where he can get it best. When he gets well and comes back to me about his recovery, it gives me more satisfaction than the kickback from the hospital. This is what all the consultancy offices do. If spending money on your health is exorbitant, well then let's talk about alcoholism, dowry or marriages. Whose money is the government spending on interim elections, scams and the committees to deal with them? The leaders calling for bandhs for their own vested interest, the loss that occurs on a single day, whose money is it? Think about all the daily wage earners who starve that day. Think about all the revenue lost. Why can't the government provide even minimum basic medicines in primary health care centres? What are the doctors supposed to do in such places?

Evidence-based medicine
If a doctor does not know the importance of evidence-based medicine, it is a shame. How does a doctor confirm his diagnosis that was reached after extensive clinical examination and how is he going to explain to the patient the prognosis? Obviously, we are just human beings and not some robots with X-rays and ultrasound fixed into our eyes and our brains with no errors. If we tell a patient about his persistent fever, that it is just a viral fever and it will stay for seven days, no matter what medicines you give, will he listen to us? If we don't prove it to him, or change his prescription, he will definitely change the doctor. There is an increase in the incidence of fatal cardiac arrest in adults in their late twenties preceded by only mild epigastric tenderness. If an ECG, though may not be necessary in a young adult with epigastric pain, saves his life, then I would not waste my time thinking about Rs. 250.

Defensive medicine

If a patient comes to a doctor with head injury and after a good clinical examination, if he is not advised a CT scan, and if he lands in some epidural hematoma after 10 days, the patient will file a malpractice suit against the doctor. In the end, the doctor may win the case but imagine his years of stress and anxiety. As malpractice suits increase, so will defensive medicine by doctors, because we are also vulnerable and need to protect ourselves.

Advertising
If some hospitals are advertising their facilities, what's wrong? Someone who is sick and really wants some serious investigations done can avail himself of the offer. Is it a crime? So many hospitals exist in cities. There is cut-throat competition among corporate hospitals and people are confused about the choice of hospital. If a hospital does not advertise itself, it does not exist. We are doctors and not some criminals whose names should not be made public. Doctors are not to be blamed for the marketing strategies adopted by pharmacological companies. Half of them are not registered and it is the duty of the drug registrar to seal such companies. There are so many reputed pharmaceutical companies which do nothing for doctors, but their price tag is 10-20% higher than others. So why can't they sell at lower costs? Even patients believe that only costly medicines work. It is the government's duty to rein in the pharmacy companies. Well, if a person can keep a man alive, cure his illness and give him a second life which is almost divine, then what are you whining about? A few gifts he is getting? Even god gets offerings!

Skewed sex ratio

As a pediatrician, I attend to several deliveries and every time a second girl is born, it is like someone has died, it is like all hope is lost. Ours is a patriarchal system where women have little say in every aspect of their life. Who decides to keep a baby, it is the husband and the in-laws. Female feticide is a social evil, whose roots are deeply embedded into our culture and history. It needs a revolution to change that. About the role of doctors, most of the prenatal scans are done by technicians who work in the scan rooms. The cost of a single sex determination scan has gone up from Rs. 500 to Rs. 25,000 after the introduction of the law. Just imagine how far people go to end the lives of their own unborn daughters. Dr. Ramayogaiah, like an outsider, blames doctors for female feticide. What about the sex ratio in the 1-6 age group? Thank god, nobody blames a pediatrician for killing young girls. Doctors have no right to strike even if someone tries to kill them. An elected representative threatens a woman postgraduate that he will rape her in front of everyone over a death in a tertiary hospital. If a death occurs, it is always the fault of the doctor and he is beaten up. The doctor's version never gets highlighted in the media. At the end of the day, we also wish to go home, spend quality time with our families, and mould our kids' future. We didn't sign up for sainthood. So, please don't make us scapegoats. I can put

my hand on my heart and say as a doctor none of us ever intends to do any harm to any patient. We don't look at their purses; we are just trying to save ours. (The writer is MD in Paediatrics, practising in Karimnagar district, Andhra Pradesh. Her email id is: manugadde@yahoo.com) Keywords: doctor-patient relationship