Doctors and their choices

I never understood, until recently, why in India people revere doctors so. To "get into Medicine" after 12th std is considered to be a pinnacle of success (on par with "getting into IIT"). Now I wonder if I ought to have tried harder, at 18, to get one of those Medical seats. But the choice between Engineering and Medicine requires some amount of firm decision-making. For chronic ditherers like me, an engineering seat in Biotechnology forms the perfect compromise of getting an education without having to choose a camp. 

Now, since the big return, I'm seeing the benefits of being a doctor. Red carpets are rolled out, people are begging you to take their money and are willing to let you ride roughshod all over them. It's insanely easy, if you're a doctor, to make choices that are very beneficial to you personally, but may not be in the best interests of anybody else. When a whole culture of medicine is like that, with doctors willing to cut corners or make decisions that benefit them financially, the trust between patients and doctors erodes. This is true even in a big city like Bangalore, with a hospital at the corner of every block, and presumably, that many doctors. Patients go from one doctor to another, hoping to find two opinions that are the same or similar, to reassure themselves that they are not being taken complete advantage of (the wording here is deliberate: I think nearly all patients are aware they are being taken advantage of, but they are willing to fight for how much).

Doctors almost never write notes on their patient encounters, keeping other doctors (even other doctors who may be involved in the care of the same patient, within the same hospital system) in the dark about their thinking. Is this some kind of self protection? Or just plain laziness? Can this same doctor recall why they made certain decisions with regards to a particular patient a few months down the line? How can they, with the numbers of patients they see? In which case, where is there any opportunity for longitudinal, continuity of care? The onus of keeping track of prescriptions, of what the doctor said during the visit lies wholly with the patient and heaven help him if he gets muddled or forgets something that the doctor said! 

On the shoulders of the doctors and the choices they make is a whole industry of middle-men, agents whose sole purpose is to help a doctor make "cuts", from the referral fees that a hospital pays doctors to refer their patients for additional treatment,  from prescribing certain branded, non-generic drugs, or from ordering additional tests or drugs to be procured only in certain establishments.  

This is an ecosystem without any kind of oversight or accountability. 

In the US, health insurance companies are considered to be the "bad guys" who limit payments, who force doctors to choose one treatment over another, who push for outdated practices and who are easily influenced by rich lobbies. But I am appreciating the other, more crucial role they play- that of keeping a doctor accountable for his or her choices and actions. 

The insurance options in India are fairly limited, especially if you happen to be middle class or poorer (which encompasses, what, about 95% of the population?). The government has multiple schemes for the truly poor (and it makes these truly poor people jump through hoops to prove that they are truly poor) and there are other schemes for inpatient admissions. Nothing exists for continuous, out-patient treatment for chronic diseases.