Dr Harsh Mahajan, Founder and Chairman of Mahajan Imaging and Labs, begins his story by taking us back to a time when healthcare was personal, local, and built on trust. He recalls the days when the neighbourhood physician, often referred to as "doctor-uncle," knew every family intimately. The relationship was not just about health but also about trust, a bond that transcended mere treatment.
"In 1947, life expectancy in India was 32 years. Today, it's 70 for males and 72 for females. In many families, living to 85 or 90 is commonplace," Dr Mahajan notes, highlighting the remarkable progress in healthcare. Yet, with this progress came a shift from personal care to a more transactional relationship.
A Turning Point:
Mahajan explained that the transformation began with the introduction of the Consumer Protection Act in the early 1990s. This act redefined patients as consumers and doctors as service providers. What was once a sacred doctor-patient relationship became a transaction, fundamentally altering the dynamics of healthcare in India.
"Suddenly, the doctor became a seller of services, and the patient a customer," says Dr. Mahajan. This shift, he argues, has had profound implications for both doctors and patients. Doctors became defensive, often opting for a more cautious approach to avoid legal repercussions, a practice known as defensive medicine. This, in turn, led to higher healthcare costs and a breakdown of trust between doctors and patients.
The Cost of Defensive Medicine
Mahajan illustrated the impact of defensive medicine with a common scenario: A patient with a persistent headache might require a CT scan or MRI to rule out serious conditions like a tumour. If the first doctor doesn't order these tests, but a subsequent one does and discovers a serious issue, the first doctor could face severe legal consequences.
"Most of us became doctors because we wanted to treat and heal," Mahajan reflects. However, the fear of litigation has led to a situation where doctors are forced to prioritise legal safety over patient care. This not only increases costs but also erodes the fundamental trust that should exist between a doctor and a patient.
Technology and Corporation:
Mahajan acknowledged that technology and corporatisation have played significant roles in the evolution of healthcare. While these advances have undoubtedly improved the quality of care, they have also contributed to the perception of healthcare as a business.
"Today, 70 per cent of all patients in India are being treated by private healthcare providers," Mahajan noted. The corporatisation of healthcare, driven by the inadequacies of government infrastructure, has led to a system where costs are high and the pressure on doctors is immense.
He also points out the financial burden placed on private healthcare providers, who face commercial rates for land, construction, utilities, and more. This reality is often lost on the general public, leading to a growing trust deficit.
The impact of legal judgements:
In recent times, Mahajan mentioned that the Supreme Court of India has acknowledged the challenges faced by doctors under the Consumer Protection Act. There is a growing recognition that the act's application to the medical profession may need to be revisited.
This is particularly crucial in light of incidents like the tragic case of a Rajasthan gynaecologist, who, facing charges of murder after a patient died of postpartum haemorrhage, took her own life. "Doctors are not gods, and we need to work towards restoring the trust that has been eroded over the years," he added.
Mahajan concluded his address with a call for a relook at the definition of patients as consumers. He urged for a system where both doctors and patients can work together in harmony, with trust as the cornerstone of the relationship. “The goal should be to ensure that healthcare remains patient-centric, even as it evolves in response to technological advancements and societal changes," he concluded.
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