Where to seek Relief?

1. Hippocratic Oath
B. Bhattacharya
“Physicians are required to do everything that they believe may benefit each patient without regard to costs or other societal considerations. In caring for an individual patient, the doctor must act solely as that patient's advocate, against the apparent interests of society as a whole, if necessary.”
Norman Levinsky
That day I went to consult an Orthopedic Surgeon who frequents Tripura at almost regular intervals. He is attached to a reputed hospital and has virtually made Tripura his fiefdom. After the preliminary examination was over, I requested the doctor whether I could get in touch with him over e- mail or mobile on aggravation of my problem. I was appalled hearing him say that the relationship between him and me would cease to exist as soon as I left his chamber. I was struck dumb! I tried to remind him that the holy relationship between the doctor and the patient as propounded by the medical ethics but all of my carefully crafted words had no effect on him and he was in great hurry to attend to another patient. Having missed the warmth and trust generally found with a caring doctor, I found myself a bit helpless!
When I narrated the incidents to my other friends they also came out with more horrifying stories. One of my friends told me the doctor could not recognize him when he went to his chamber for some clarification within a

2. span of 30 minutes of the consultation. While a doctor cannot be allowed to reduce his profession to a money spinning machine, it is perhaps time to reexamine the doctor/patient relationship in its true perspective.
The doctor-patient relationship is one of the most unique and privileged relation very much in the line of mother- child or teacher- student relationship. Therefore it is imperative that a personal bonding is made between the doctor and the patient. Having said that it must also be kept in the back of our mind that each and every doctor is not expected to have an elephantine memory to remember the tiniest details of each and every patient that they are attending. But at the same time he should not have the audacity to proclaim like a God that the relationship between him and the patient terminates immediately after the consultation is over. Therefore, a midway has to be devised. This may be achieved if it is made compulsive that a doctor should not be allowed to attend more than fifteen patients a day. The idea is not sacrosanct, rather a simplistic one, and some other may come with more innovative ideas! It is always best if the doctor himself decides how best he may attend to the problem of the patients. But for patients having acute problems and the long disease that have virtually made them immobile, it may be made binding on the doctors to visit the house of those patients and provide him clinical and emotional support. This is more so if the patient is above 80. The legendary physician Sir William Osler wanted the doctor to employ his sense of humor for making a rejuvenating effect on the patients even if the scenario is hopelessly bad. His famous quote, “Not to take the hope away from the patient under any circumstances …eternal hope which comes to us all”, has not lost relevance even today. So goes for the patients who are above 80.
In our child hood we used to see doctor going to the houses of the critically ill patient and spending sleepless nights by the side of the critically ill patients. The people of Agartala still fondly remember Dr. Jyotish

3. Chakravorty, Dr. Nandalal Chakravorty and Dr, Binode Saha, etc. To them, the relationship between patients and doctors in the clinical realm was historically framed in terms of benevolent paternalism. Their most revered principles were that a physician should be exclusively devoted to the best interests of their patients and in doing so sacrificing their night’s sleep in compelling circumstances was not so much of importance to them. I believe, these breed of doctors have not been completely wiped away. But they are rarest of rare and their number is decreasing alarmingly!
Further, the nexus between some doctors and the drug companies is well known to anyone who has some knowledge in this arena. Some doctors have sold their souls to the drug companies in exchange of lucrative freebies including foreign tour, gift of costly gadgets, etc. In 1998 I used to know one doctor who prescribed nothing other than the medicines of a particular brand. Since I had good rapport with him, he candidly confessed that he was well taken care of by that company. In 2010, I asked the same doctor whether he was still prescribing the medicine of that particular drug company. He told that his loyalty has been changed to some other company and that company had promised him a foreign tour. This doctor is not the sole exception. There are so many doctors who have become slave to the drug companies. Pharmaceutical companies have mastered the art of marketing to doctors, and spending a lot of time and money on making sure that doctors on their payroll (not all doctors of course) remember their particular brand name while prescribing medicine . This nexus could have been broken if the Government compelled the doctors to prescribe generic medicines. Generic medicine is drugs which have the same chemical composition as branded drugs are and sold under their chemical name. The generic medicines are very cheap compared to branded drugs. The following table

4. (all prices are taken from the 2010 comparative price list) may vindicate my point further. Used as Generic drug Price Branded Drug Price Painkiller Paracetamol Rs 2.45 Crocin Rs 11
Calpol
Rs 10.70 Paracetamol syrup Rs 9.00 Crocin (syrup) Rs 15
Febrex
Rs 20.50 Diclofenac sodium + paracetamol Rs 4.4 Diclogesic Rs 19.40 Antibiotic
Amoxycilin
Rs 13.2
LMX
Rs 40 Remox Rs 38.7
Azithromycin
Rs 41.8
Azee
Rs 107 Azithral Rs 128.55 Anti-TB
Ethambutol
Rs 14.8
Myambutol
Rs 15.3 Vitamins Folic acid Rs 2.8 Folivite Rs 11.8
B-complex
Rs 1.8
Becosul
Rs 11.0 Cardiovascular (Blood Pressure) drug Atenolol Rs 7.0 Aten Rs 23.8 I was reading in the Times of India that Govt. of Rajasthan has already made Rajasthan government doctors stop prescribing branded medicines . The Government of Rajasthan has developed its own infrastructure to distribute generic medicines free. It constituted Rajasthan Medical Services Corporation (RMSC), headed by an IAS officer, for the project. Now, generic medicines are available at 14,964 Drugs Distribution Centers (DDCs) at all Government hospitals, Community health centers, Primary health centers and sub-centers in the State of Rajasthan.

5. I tried to bring this laudable effort of the Government of Rajasthan in to the knowledge of Govt. of Tripura by various possible means. But since idea of use of Generic medicine was vigorously pursued by Dr. Anbumani Ramadoss, the then Union Minister of Health, I could not make much headway. Since the healthcare facilities are in the State list, it is the prerogative of the State Government to decide the best policy suitable for the state considering its socio economic condition. It is Dr. Anbumani Ramadoss who established the National Rural Health Mission (NRHM) and the Government of Tripura is using 90 % of this NRHM kitty to dispense health care facilities.
An inquisitive reader may log on to Log on to www.medguideindia.com , Click on 'Drugs', then click on Brand and type the brand name. (e. g. Metocard XL (50 mg). The site will also help you with drop down menu) & Click on 'Search' and then click on ‘Generics’ (it will display the ingredients of the tablet). If thereafter if we click 'matched brands', we may be seeing that Metocard XL 50 is for Rs. 62.00 & same drug by Cipla (Mepol) is available only @ Rs. 7.00. The cost difference is mind boggling.
Since the percentage of Below Poverty Line (BPL) population is alarmingly high in Tripura despite undertaking of much vaunted anti poverty programmes and other development programmes, it is the bounden duty of Government of Tripura to see that the people languishing under abject poverty get proper medicines at justifiable rates. It should not reduce itself to an ostrich burying its head in sand and not following the efforts of other Governments in providing much sought after relief to the ailing community mainly because they are Congress Governments. It may be anything but surely not pragmatism.
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