“I have brought my father who is suffering from cancer of the lung for the past three months. My brother has also come with us. For the last six days, we are waiting to be called inside for the first consultation. Please pray for us, sahib. I think we will go in tomorrow.”

When I asked why she had come all the way from Akola, she explained that she had brought her maternal uncle to the same hospital in 2002. She had waited in a similar way, she said, for almost a week. When she did get in, she had had the most satisfying experience. After her uncle was seen by a doctor, he was admitted immediately in the general ward. His chemotherapy — drugs given to shrink the tumour — was begun in three days and four cycles were administered over a month. After that, he was discharged and called for other modalities of therapy such as radiation.

“Ultimately, we returned to Akola after four months,” Janvi said. On being asked how much they had spent on Manek’s medical treatment, she smiled and said, “I don’t remember the exact amount. But it was about Rs 50,000. In addition, I spent another 10,000 to sustain in Mumbai.”

The amount was peanuts compared to the cost of carrying out the same treatment in a private hospital — a figure that can easily run into lakhs of rupees.

In my last article, I had discussed one or two factors that lead to the abnormally high cost of medicare in private setups in urban conglomerates (see http://merinews.com/catFull.jsp?articleID=124655). In this piece, I will discuss the others. The next most important factor is what is called defensive medicine. In simple terms, it means to cover all ground while sending the patient for investigations and while starting treatment. Some years back, when medicine was considered a noble profession, and the level of awareness among patients and their families was virtually non-existent, the commonman saw the doctor as god. They trusted the doctor unconditionally and literally put their own lives — or the lives of their wards — in the doctor’s hands. The arrival of Consumer Protection Act (CPA) and the increasing use of the computer and the internet to learn about diseases and their treatment changed all that. Gone was the feeling of trust and loyalty to a doctor. Medicine’s nobility had been discarded and patients began to be pursued by unscrupulous lawyers and “social workers” who showed them how to fleece the doctors or to corner them so that they would forego their charges (if nothing else).

While CPA did help to clean the system, many doctors who were either not so savvy or not too well-read fell victim to its merciless onslaught. Even today, the spectre of being pursued by the patient looms large over the minds of the doctors. So what remedy did they choose? They decided to “over-investigate” the patient and to administer medicines from highly reputed large Indian companies or multinational companies — both much, much costlier than those available from reputed but smaller Indian companies. At the same time, there was an increased tendency to hospitalize even those patients who could have been managed without it. Lastly, defensive medicine meant “referrals” to other specialists rather than the patient being treated by just one doctor.

To illustrate this point, let me give you an example: Say, a patient is admitted with hyperacidity, fever and a rash on his skin. Under the older system, the physician who looked after the fever would also give antacids and some skin ointments to help the patient (thereby saving costs for the patient). Under the new system, the primary physician would be committing hara-kiri if he gave treatment on his own. Rather, he will call in an infectious diseases specialist, a gastroenterologist and a dermatologist to look after the patient (and share the vicarious responsibility of wrong treatment if any problem should arise!). Naturally, this means higher costs for the patient, who has to pay professional charges to four doctors instead of one.