Grey

I am a regular reader of The National Medical Journal of India (NMJI), and I read the journal from the back to front. There are a few reasons why I do this. The front-page articles and papers are often full of statistics and other details which my old (grey) brain refuses to understand. In these, I end up reading the introduction and conclusion. Whereas in the back pages, I find material that is more interesting and easier to understand and thus hold my undivided attention. These pages also cover a wider range of topics.

Professor Mani's Letter from Chennai is one such, and those of us who worry about healthcare delivery and related issues can easily understand and share his concerns. He dwelt on a public discussion on the subject of healthcare corruption in India that took place at Chennai. ^[1] The panelists were all distinguished persons of proven integrity. Dr Mani writes that the hall which caters for 230 was overflowing! This in itself is quite remarkable. Whether it is the reputation of the panelists or the topic that drew such an overflowing audience is difficult to guess. My own impression is that it is the former. Why am I surprised? When an issue of civic importance such as solving a traffic problem or keeping the area clean is to be discussed, I have found it difficult to fill even a small hall catering to 50 persons. In contrast, the appearance of a star cricketer or film star would attract a crowd.

So, should I say the distinguished panelists have achieved this status in the eyes of Chennai public? Whatever may be the reason, it was a pleasure to know of such audience participation.

The word grey appeared several times in the discussion. The word grey when used as a noun denotes a colour, an in-between shade of white and black, I believe a very unpopular one at that. When used as an adjective it has a different meaning. My hair turned grey when I was in my mid-thirties. Suddenly, I found young women not much younger than I, addressing me as ‘uncle’. This did some damage to my ego, though to some extent compensated by others calling me ‘sir’.

Coming back to the adjective grey when used as the panelists did, means an area between what is wrong and what is right (black and white). Depending on how one interprets the matter that falls in this grey area can be right, or wrong. Some years back, one of my friends had argued, ‘there is nothing wrong in a sponsored trip to a continuing medical education (CME) event, after all, the pharmaceutical companies depend entirely on our support for their survival and success’. According to his reasoning, it is nearer the white end of the band, and to mine, it was nearer the black end. To give another example, a 75-yearold underwent a stress test as his resting electrocardiography had shown minor ST-T changes. The stress test was positive at high exercise levels. He was advised an angiogram. Despite my telling him that it is not necessary to do the procedure as it is likely to show blocks (as it would be in most of us as we grow old), he got his angiogram done, which showed double vessel disease. Despite being asymptomatic, he went through the procedure and got stents placed. He became a lifelong patient.

Thus, this grey area can be used for a patient's disadvantage or to the doctor's and more specifically, to the institution's advantage. There is money in doing procedures. The breed of doctors who say, ‘you don't need surgery or intervention’ is becoming less and less as more and more privatization takes place in the health sector.

Many of the panelists felt the dire need to strengthen the public sector health delivery system as a means of making more doctors to inch closer to the whiter side of the grey zone. Ultimately, whether one works in the private or public sector, it is left for each of us to decide where we want to be in this zone.

I will end this with what an old doctor friend told me many years ago, ‘I am honest because I don’t know how to be dishonest.'

Today it appears, one is not taken amiss if one says, ‘I am dishonest because I don’t know how to be honest.'