What’s Wealth Got To Do With It

 

What’s Wealth Got To Do With It?

Recently we lost Tina Turner, who was not just a music icon but also a shining example of how a survivor of domestic violence can emerge triumphant, that too without playing the victim card. Her most famous song ‘What’s Love Got To Do With It’ sheds light on the truth how lust is often mistaken for love and many souls are led astray with the false notion of love. Luckily she found true love later in life.

When I started to pen my thoughts in continuation of yesterday’s post about the current trends in the practice of medicine, I wondered what title would fit this one. Ms Turner’s song came to mind. Incidentally, just like love, wealth or the concept of wealth is often interpreted and understood in a wrong way.

I was raised by parents who were both doctors. They belonged to the old fashioned variety that I talked about yesterday. For them service was ingrained into their core. Because they were not money minded , their patients hardly ever walked into the clinic or hospital with the anticipated fees. More often than not these fees were noted as “ to be paid later”. Udhar! Balance! A man would bring his wife for the delivery of their second or third child when the bills for birth of the previous babies were still not paid. Yet my mom would welcome them with a smile and keep the new mom and baby for a week with lodging and boarding till the time of discharge.

If and when my parents were in dire need for money and asked for these clients to pay their dues they would be questioned back, how can the dues be so much ???

It would make me angry as a teenager that my parents’ generosity was abused by many. Nevertheless, I feel fortunate that this experience did not influence my young mind to infer that one needs to be extremely shrewd with money. In fact my brain never got wired for money in terms of personal income. Perhaps God knew what wiring HE had installed in my brain so HE guided me into a job where I did not have to worry about money and also did not get into a situation like my parents.

I don’t remember the source, probably some saint literature, but I distinctly remember reading somewhere,  “ A man’s downfall starts on the day he begins to pursue money”. 

As a teenager I took these words quite seriously. 

 My focus remained on the duties in my hands. With God’s Grace I never had to beg, borrow, steal from anyone to feed my family, put my kids through medical school or even fulfill my desire to travel around the world. More importantly, I never had to work unethically to support my lifestyle.

 Many of you may not believe it that to this day I don’t know what is my paycheck. I am not saying that is a good practice. I do believe women should be in charge and knowledgeable about their finances. I want my daughter to be educated about finances. But I remained blissfully ignorant about my own earned money. Ever since I’ve been married, my husband notes down if my paycheck is deposited into my account, and he is the one who bothers about our savings and paying bills etc for the most part; though slowly as age is catching up with both of us he tries to keep me informed about these matters.

It was my destiny that right out of my residency I joined an organization that stands on a strong foundation of ethical and evidence based medicine. 

We need to understand these two concepts.

What is ethical medicine?

A practice of medicine where there is a culture of service, not business. There is goal of benefiting the patients( beneficence) and also not doing them harm( non maleficience). There are also principles of justice and autonomy. 

Justice means doing what is the right thing to do. Treating each patient with dignity and kindness irrespective of their race, gender, religion, ethnicity and what not.

 Autonomy is respecting the patient’s right to choose or refuse treatment. Also maintaining their confidentiality. 

An ethical doctor is an advocate for the patient, not an adversary. 

At the same time he does not compromise the values or principles under pressure from his patients or anyone else.

What is evidence based medicine( EBM)?

While ethical medicine stands on the premise of social justice and righteousness, EBM is supported on the pillars of science. Findings from extensive scientific studies and research form the basis of guidelines regarding diagnosis, stratification and treatments of various disorders.

A simple example is what degree of anemia should one consider giving transfusion to a person? If every person is sent for a blood transfusion for mild anemia it would be problematic. If every woman having excess uterine bleeding is recommended to get a hysterectomy( remove the uterus) that would be insane. Thus the treating professional must adhere to certain guidelines based on scientific evidence when offering diagnostic tests and treatments. 

It is important that the medical community should practice both ethical medicine and evidence based medicine. 

My organization has withstood the test of time and remained in business for the last seventy five years while adhering to both ethical medicine and EBM. So it is a living example that successful business can be done without resorting to unscrupulous practices. And I consider myself fortunate to be associated with this group. 

 You have to make money if you have to remain viable. If you are in the negative for too long you will have to close shop sooner or later. So how does the company stay afloat without resorting to ruthless tactics? 

By using the money and all resources wisely. Avoiding wastage. 

Avoiding unnecessary expenses. 

Avoiding excesses. 

Increasing efficiency.

There is a finite pot of income and predictable amount of expenses. Just like a family income, one must plan to use it wisely where it is most needed while also planning on saving for the future or a rainy day and avoiding wasteful spending. 

If a patient truly needs a test to arrive at a diagnosis or a particular medication to recover from illness, then go ahead, do it. Even if these may be expensive, because that’s the right thing to do if resources are available for you.

But if a patient is asking for a particular medication or test when the guidelines don’t justify it, then refuse it.  Catering to unreasonable whims and fancies to please the patient and retain their business is not good medicine. Also ordering unnecessary tests or favoring unnecessary expensive treatments is not good medicine. Referring to select labs or radiology centers or select specialists for financial incentives is not good medicine.

In all above scenarios, the choice is in the mind regarding how to acquire wealth and how to put it to use. 

It’s your thinking and actions that have everything to do with it. 

What’s wealth got to do with it ? 

The problems you see around the world when ethics and evidence based medicine are ignored , all these problems invariably arise out of greed. Individual as well as corporate greed. Here the eyes are set on unreasonable profits. All principles underlying ethics ( beneficence, non maleficience, autonomy and justice) are forgotten. Scientific evidence is thrown out of the window. 

Money replaces Service as the goal. 

Like Love, Money is precious. But when it is earned after sacrificing values and principles, it becomes the equivalent of lust. 

When I stand at the fag end of my career today I get a sense of satisfaction that I did not compromise the noble values that were passed down by my parents and my teachers. I did not attach too much importance to money. Even in my youth when there was immense pressure from demanding patients for narcotics or other harmful drugs or unnecessary tests and treatments I stood my ground and refused to give into these demands , one because some things were harmful for them even if they didn’t understand that, second because what money is saved from refusing unnecessary tests or medications is used to pay for essential tests and treatments for someone. Even if it meant getting complaints from patients or bad reviews I remained assertive about things I believed in. To my good fortune, my bosses supported me when they saw I did it with good intentions and good understanding. 

I have taken a pay cut to lend my time and expertise in India. And I am not being paid by the institution in India for this work either. Yet the joy and fulfillment that I am already experiencing in this work cannot be measured in terms of money. On the contrary, I have never before felt so untethered while working as I do now, knowing that I am not working for personal rewards. 

Money buys a lot of things but money can’t buy this satisfaction or freedom. The night I laid my father’s lifeless body on the pyre I realized, as poignantly as never before, that it doesn’t matter if you have a billion dollars in your bank account or zero at that moment. You can’t carry a penny with you. 

Then why does the human mind stoop to any level to make money? That’s the mystery.

 Why do people miss out on the satisfaction of righteous living when money can’t be smuggled into the next world ? 

My father used to say, money and happiness/ comforts in life are pre-destined. No matter how hard you try you cannot control their coming or going. But you can choose to be content at heart.

To those who are already caught up in a web of corruption and a life of unscrupulous practices, could a miracle awaken them and give them courage to mend their ways? 

 I dont have the answers. But I do nurture hope. I don’t like to give up on anyone. 

I can tell with confidence that a comfortable life is very much possible even while staying true to good values. And the benefits of such a life last much longer than a life of compromise. 

In the scheme of both finite and infinite life, what’s wealth got to do with it ? 

Saree to work today was a cotton Ajrakh by my friend Irfan Khatri. His trademark scalloped design sits on the pallu. 

As I sat in the first floor office at DMH today I noticed the calendar was displaying month of April. One of Chafekar brothers picture was on that page. I flipped over to open the July page and here there was a photo of Sarojini Devi Naidu, the nightingale of India. I was having bit of fun sitting there alone trying to recreate her pose in the selfie😊