Published on: July 1, 2025

‘Integrity is choosing thoughts and actions based on values rather than personal gains’ -Chris Karcher

Dr Savita Butola writes:

The years in which I grew up, I saw medicine as a mission, not as a profession. Amidst a family that served either in the armed forces or in the medical profession, work ethics meant honesty, ‘service before self’ and ‘people before profit’. Money was to be ‘kept in the pocket and not in the heart’.  Fifty years later, it is a different world. In 1996, it was shocking enough to hear that healthcare had been included by the Supreme Court in the Consumer Protection Act, putting medicine in the same bracket as other consumer goods and services. Most of us feared that doctors would start practising defensive medicine rather than using clinical judgement, translating into higher costs for patients. It is almost thirty years now since that change and I still feel myself cringe every time I hear or read the word ‘client’ or ‘consumer’ instead of ‘patient’. The social and technological changes with radical consumerism and commercialization have changed medical practice beyond recognition.

The best interest of the patient, which had been the guiding star since ages, was quietly buried and along with it, the patient-doctor relationship died a quiet death. Unsung and forgotten. The interests which have now taken over are varied and powerful – organizational profit and growth, the pharmaceutical industry, the laboratories and investigation centres, professional services guided by precise investigations and diagnostic procedures; with impersonal, technology driven algorithms and invasive processes taking over the reflective decision-making process.  The implicit trust the doctors enjoyed has been replaced by visible mistrust and even hostility as patients turn to Google and Whatsapp for information.

While the business model of medicine replaces the inherent caring and service with cold efficiency, the patients too come to a hospital as if to a five-star hotel, reacting to human errors as if a room in a resort has not been cleaned well, threatening legal action at the drop of a hat – to extort the value for money that is their due. 

It is not therefore surprising today, to hear young doctors, who have spent crores on medical education, bluntly declare that they are not in this profession for charity. They have their valid questions about why only doctors are singled out for practising ethical service or service bonds in rural areas at the cost of their own and their family’s comfort for an increasingly ungrateful society.

Practising medicine with integrity in India today is like walking on a sharp-edged sword. One has to be tough to walk against the current, to stay out of the rat race, to know how to balance success with the never-ending quest for ‘more’. To be able to tell patients that they do not need more investigations or expensive medicines. To spend two hours walking reluctant patients and hostile relatives through the evidence, the cost-benefit ratio without any compensation for the extra time spent, instead of spending three minutes in writing the prescription they want; only to have them get it from another colleague; then brushing it off and doing the same thing with another patient because it is what one believes to be ‘in the best interest of the patient’. It may mean refusing an antibiotic injection or intravenous fluids to a parent who thinks it will cure her/his child’s diarrhoea faster than the probiotic and ORS that has been advised. It may mean refusing invitations to speak at sponsored events or refusing to buy products of companies whose ethics are doubtful.

It may mean refusing job offers from hospitals where one gets higher remuneration but loses the freedom to practise ethically. It may mean teaching our children that our worth isn’t measured by the brand of our phone we use or the car we drive. It may also mean teaching them that a holiday abroad is not possible every year but it is a trade-off through choices one has to make every day.

It takes a lot of grit, energy and even obstinacy. It is often exhausting and usually a lonely place to be in. Every time I hear or read about doctors or hospital staff being manhandled, it makes me wonder why we bother to teach ethics to our students, when neither patients nor communities nor the nation seems to be bothered. This is a question I have often grappled with after the violence faced by healthcare workers during the Covid pandemic.

Knowing the way society has changed, how does one pass on these values to the younger generation? Are they outdated? Does the survival of the fittest demand that young healthcare workers be more practical than idealistic? There are no easy answers. Each medical professional has to find his or her own point of balance because ultimately it is to our own self that each and every one of us is answerable to.

No doubt, the straight path is always the most difficult but a clear conscience always makes the softest and best pillow for a sound sleep, not only at the end of each day but also at the end of the winding and wearing road that is life. 

Dr Savita Butola is currently the Commandant at the Border Security Force Hospital, STC Udhampur. She is a Senior Tutor with Cardiff University, UK, past Secretary of the Indian Association of Palliative Care. Dr Butola has served for 30 years in the armed forces with 16 years experience in palliative care.