In India, where 70% of healthcare is corporate-run, doctors must balance two forces: ethics & profit. The industry's challenges are not for the faint of heart; only a higher calling can prevail. Who gets up at 3 AM to deliver a baby for a paycheck? Yet, any sustainable endeavor needs a healthy cash flow. 

The conflict between values and profits can be observed on multiple levels: doctors weigh whether to serve in government Primary Health Centers (PHCs) or corporate hospitals, clinic owners balance the patient experience with maximum turnover, and pharma reps fine-tune salesmanship with health impact. Let's simplify and note these challenges, as reported by senior doctors.

Ethical Challenges in Modern Indian Healthcare

Medicine is a social science, making every medical professional a social worker. Yet most of India’s healthcare is provided by massive corporations like Fortis, Max Hospitals, Aster, and Apollo Hospitals, which are answerable to shareholders.

This conflict of interest, the company’s need to profit vs. the hospital's role in social service, leads to serious systemic issues. Despite the “Planet>People>Profit” idiom that supposedly guides boardroom decisions, the ground reality in most corporate hospitals involves:

#1. Over-Investment

Overzealous and naive hospital management tends to overinvest in world-class facilities. The idea is that the latest technology will improve footfall by attracting patients. While that may be true to some extent, potential ROI can only be calculated in hindsight, while the actual capital demands a break-even point. This way, overinvestment leads to immense pressure for rapid growth.

#2. Referral Fees

Faced with the pressure of rapid growth, hospitals then offer independent practitioners referral fees to grow their patient base quickly. This practice is widely criticized as deplorable, as it veers dangerously into the marketing & sales domain. What's more, the cost of referral fees ultimately falls on patients, as the hospitals factor it into the bill. This makes healthcare costlier.

#3. Unnecessary Procedures

There are two primary reasons why doctors and hospital management are motivated to undertake unnecessary investigative procedures like diagnostic tests (x-ray, bloodwork, etc.):

1. “Fee For Service” Model

This is not about whether the patient pays cash, has a cashless private insurance, or opts for credit; It's about how the bill amount is calculated. They do it based on the individual services administered throughout the treatment process. When patients are charged separately for each service, hospitals are monetarily incentivized to perform more procedures.

2. Defensive Medical Practices

While no systematic data proves the full extent, medico-legal cases have been rising at an alarming rate. Whether the causes behind it are healthcare's commercialisation, rising patient/consumer awareness, hostility toward healthcare professionals, or something else is uncertain. Regardless, the looming threat of malpractice lawsuits prompts procedures to be done “for the record” and “just in case.”

Yet, the fact remains:

• More tests do not always mean better treatment.

• CT scans & over-diagnosis add risks beyond cost.

#4. Brain Drain

To be clear, we are not calling this (very public) economic issue an ethical conundrum to place the onus on doctors and condemn them for prioritising career growth. We believe this issue belongs on this list because it warrants discussion, particularly among Indian medical students. 

When private institutes overtake public ones, it encourages a brain drain & concentration of talents. The result? 80% of Indian doctors are in cities where only 28% of the population resides. Most doctors struggle with this decision at some point in their career: go where they think they are needed or where they might get paid the best?

Generally, we believe that the best solution is to practice as best as you can wherever you may be. Moving tends to carry greater and less predictable financial repercussions than trying to do better wherever you are. Of course, for more helpful advice, you should give us a call and talk to our advisors who specialise in doctors' finances.

#5. Medical Tourism in India

India holds great potential for medical tourism. Foreigners worldwide often seek out “first-world treatments at third-world prices” here. This is mainly seen as a net positive for both hospitals and patients, and doctors need all the "win-win" situations they can get. 

Without diminishing the positives, there are some ethical implications to be aware of. Many hospitals end up having separate facilities (areas, floors, or even buildings) for the rich and the poor. Separate hospital facilities for affluent patients both symbolize and perpetuate health exclusion.

#6. Polypharmacy

Our pharmaceutical industry is also a worldwide giant, with India being one of the biggest exporters of affordable generic meds. Yet, for being the birthplace of Ayurveda, there is another troubling trend shaping within our borders: Overprescription of medicines to patients.

This might partly be fueled by defensive medical practices (as explained in point #3.2 above), but patients themselves are often unwilling to stop taking medicines. Big Pharma's aggressive promotions can also produce drugs of questionable value. Furthermore, it’s dangerous when pharma companies sponsor medical conferences to push their products. 

Conferences are rare opportunities for busy doctors to stay updated, and this commercialisation of healthcare products (where new, bigger, better drugs are emphasised) also contributes to polypharmacy.

Potential Solutions: Ethical Guidelines

The reason we discuss these issues is that in high-stakes industries like medicine, finance, and law, trust matters most. As the public loses confidence in hospitals, they also lose faith in the doctors, nurses, and staff's ability to help them heal. 

The point is not to play the blame game. It’s to understand why tensions are rising between doctors and patients, and how HCPs can better succeed. Once we acknowledge & accept these difficulties, we can start building sustainable solutions. These rules of thumb, partly inspired by official NMB guidelines, might help:

• Informed consent (clearly explaining procedures, risks, and alternatives to patients).

• Lean Healthcare (invest & expand slowly as income & patients grow organically).

• Transparency in billing and referrals (avoiding kickbacks, unnecessary tests).
  

• Patient confidentiality (protecting medical records and privacy).
  

• Duty of care (prioritizing patient safety and best interest over profit motives).
  

• Competence & accountability (practicing only within one’s expertise, avoiding negligence).

These standards are widely known and practiced by most doctors, but a little revision never hurt. In the first guideline shared above, informing the patient should also include the cost and effectiveness of other centers. When patients are educated & offered second opinions, the clinics providing such excellent service profit in the long term.

Shrouded in Darkness, A Glimmer of Hope

It’s natural to get jaded and lose faith. High-stress situations can make even the most resilient among us feel naive for believing in ideals. Here is a little inspiration:Dr. Govindappa Venkataswamy of Tamil Nadu. Dr. Venkataswamy (affectionately known as Dr. V) had a dream to eradicate blindness from the world.

He founded the Aravind Eye Care System in 1976, which annually treated up to a million people, with 60% of them receiving free treatment. The doctors who participated performed an average of 80 daily surgeries and became renowned for their incredible gentleness. 

A key component of the system was its differential pricing model, which featured tiered charges for individuals in various economic groups. Dr. V said it best:

“If you can’t pay them, you don’t have to. If you can’t come to them, they’ll come to you.”

Business executives might flinch at this philosophy as a business model. But that might reveal a fundamental misunderstanding of profiting in healthcare, more than anything else. As a Harvard Business Review study should prove, Dr. V’s lifelong efforts led to a very successful & financially viable institute that continues to thrive.

Conclusion

This is the mantra of Business in Ethics: the good of the many leads to the good of the few. As doctors, the more good you do in the world, the more likely you are to succeed in the long run- financially, personally, and holistically. I’ll end by quoting Dr. V:

“We identify ourselves with all that is in the world, 

so there is no exploitation.

It is ourselves we are helping.

It is ourselves, we are healing.”

- Dr. Govindappa Venkataswamy