The American idea of medical practice is that "it is a business first, and if service is done, it is only a byproduct of the business". We have been aping the Americans in a big way in modern medicine and most of us practise that kind of medicine in our country, despite our having had a hoary culture of medical practice which is basically a human service and money was a byproduct of the latter. The three key areas where the Americans have failed; resulting in spate of malpractice suits against hospitals and doctors, are the following.

1) Playing God:
The lay man was made to believe that medical establishment has a cure for all ills of mankind and death has been brought down in society because of the present hi-tech methods of interventions. Despite clear cut evidence contrary to this view the public was kept in the dark. To cite just one example, the fall in death rate due to coronary heart disease, was found to be due to change of mode of living in America to the extent of 54.6%, while the hi-tech stuff like bypass conduits and angioplasties were responsible, if ever, for only 3.4%. If this fact was widely publicised in society, I think lot of malpractice suits in the USA would have come down. We never let the patients know the truth in the first place. Even in the field of another killer disease, cancer, the facts are that the death rate has not shown a tendency to come down even in 1995, and it is still going up; although the survivors live longer now than in the past. But the media advertisements keep feeding the public that the newer hi-tech stuff have made cancer curable. All our medical interventions are made out to be the panacea for all ills. In fact most of the interventional methods have not had the rigorous scientific scrutiny at all. One of the meanings of the word intervene is to go in between with malice.

Man lives or dies inspite of doctors and hospitals. It does not mean that doctors and hospitals are not necessary. They are very important " to cure rarely, comfort mostly, but to console always."Doctors are not Gods to pull a dying man out of the jaws of death. They are needed to give assistance to the patient’s inner doctor to be aroused and put to work to get the patient back on his feet. If the public know these facts there will be a precipitous fall in malpractice suits. Man, on this planet, has two great attractors, a dynamic attractor called health, and a static attractor called death. When man falls out of this dynamic attractor called health, he has a natural tendency to fall back into the health attractor again. Occasionally he is thrown too far away from the health attractor due to infections, degenerations, cancers, alcohol and tobacco etc., that he may not return to the health attractor and might meet with his maker. In this last act doctors and hosiptals help a lot but they can not decide who should die and who should come back from the jaws of death. A dying patient needs the doctors and hospitals more than any one else. Death has to be peaceful and dignified. To that end the medical fraternity has a great responsibility. The new concept of hospice in the west means the same hospitality from which the word hospital is derived.

2) Predicting the Unpredictable:-
Another area of discontent leading to malpractice suits is the area of screening healthy population for evidence of early disease. People are told that " small is early ’’ ,and early detection means total cure and so on. While the specificity and sensitivity of the future predictions from screening tests is less than 50%, we keep goading people to have these tests every day. Audit of all the screening procedures has shown that their capacity to predict the future is very poor and the cost and the damage done to the person in terms of mental trauma and anxiety is immense. We never let the public into confidence in this area, resulting in a lot of malpractice suits. If one follows the present American screening protocol he will have little time left for any other pursuits in life. He will have his hands full with appointments for one or other of these procedures daily. The only two areas where early detection might be helpful are diabetes and high blood pressure. Even there opinions differ.

We should stop frightening our patients by advertising daily that the public are in threshold of onr or the other epidemic. We talk about the recent epidemic of vascular diseases ( scientifically not proven) and cancer and all the rest. While there are a few million people who may be ill at a given time, there are billions who are well and healthy, in this world and no one will be able to predict why and how they are well or ill. We should encourage the population that they have a very good prospect of a healthy and full life on this planet. This will make their immune system robust to resist diseases.

3) Paternalism in medicine:-
The third area of discontent between patients and doctors is the area of paternalism. We in the medical profession want to have the total decision making in our hands and do not let the patient take an active part in our decisions, both diagnostic and therapeutic. Our main thrust must be to educate the public about all these aspects of their existence on this planet. Let them have an equal measure of responsibility in all the decisions. If they are not in a position to do so, at least let their near and dear ones should have a say in the matter to lessen the misunderstanding prevalent now.

We should spend our time and energy to revitalise our medical set up in our country on the above lines based on our age old wisdom of living in harmony with Nature. We should win the confidence of the masses to have the respect and adoration in society which our forefathers enjoyed. Let us not play God and take the poor people for a ride with our jargon, but try to take them as our partners in the health care delivery set up. Change is a must and is a part of life. This new law of consumerism can at least give us the impetus to go back to our roots, as far as the ethics of medicine are concerned, to " cure rarely, comfort mostly, but console always". Doctor is an example to society and we must live up to the expectations of our people following Dharma the order, prescribed for all of us, of doing most good to most people most of the time. Long live doctor - patient relationship based on faith, confidence and friendship. We will be able to live happily ever after, the consumer act notwithstanding.

The surest way to health, say what they will, Is never to suppose we shall be ill.