Chandrakant Lahariya | Everyone Has a Right to Question Doctor, Hospital

Whenever I have written about over-prescription, unnecessary procedures, inflated hospital bills or the commercialisation of Indian healthcare, the responses have been predictable. Alongside generous appreciation from patients and readers arrive angry emails, hostile messages and occasionally personal abuse. Some come from fellow doctors, others from hospital administrators and corporate healthcare professionals. A few arrive from mysterious correspondents. Recently, even ‘Ranchhod Das Chanchad’, the character played by Aamir Khan in 3 Idiots, apparently found time to send me an angry, threatening email.

Rather than contest the evidence or arguments, the critics behind these emails question my qualifications, competence or motives. One doctor asserted that, as someone trained in preventive medicine, I had no business commenting on interventional cardiology. Another considered questioning specialists by a fellow doctor an act of professional disloyalty. Others accuse me of maligning corporate hospitals while ignoring government failures. A few have demanded to know who finances my writing. For the record, nobody pays me to influence my opinions or determine the subjects I choose to write about.

Such reactions are sometimes amusing, but their implications are serious. They reveal two troubling tendencies: healthcare being increasingly equated with medical intervention, and a professional culture in which clinical decisions are regarded as the exclusive domain of specialists, immune from questioning by colleagues outside their field, let alone patients. Some argue that doctors should refrain from criticising one another, forgetting that professional solidarity cannot mean collective silence.

My credentials are frequently put on trial. Apparently, being a qualified medical doctor, educated at leading Indian medical institutions, and having worked with international health agencies counts for little because much of my career has been devoted to public health, the practice of preventive medicine and health policy. But this argument misunderstands both medical education and the nature of scrutiny.

There is a fundamental distinction between performing a specialised procedure and asking whether it was necessary, supported by evidence, properly explained or reasonably priced. The first demands specific technical competence. The second falls squarely within clinical review, scientific inquiry, ethical debate and public accountability. A patient needs no medical degree to ask why an invasive intervention was recommended, what alternatives existed or whether commercial incentives influenced the decision.

Certainly, an interventional cardiologist understands the technical complexities of coronary procedures better than a general physician. But questions about inappropriate incentives, informed consent, institutional revenue targets and avoidable treatment extend beyond cardiology. Confusing specialised expertise with an exclusive right to judge oneself creates an obvious conflict of interest. This distinction is central to responsible public debate.

Another familiar accusation is that questioning corporate hospitals amounts to attacking doctors. This conflates individuals with institutions. A conscientious physician employed by a corporate hospital may work under expectations surrounding revenue, investigations, admissions or procedures. Concerns about unnecessary interventions and distorted incentives are neither imaginary nor confined to India. Challenging such pressures can protect a doctor's independence rather than undermine it.

Private healthcare has undoubtedly expanded India's medical infrastructure, introduced sophisticated technologies and improved access to specialised services. Government facilities, meanwhile, continue to struggle with overcrowding, inadequate resources and workforce shortages. But public-sector inadequacy cannot excuse private-sector excess; nor can questionable private practices absolve governments of their obligations. Patients deserve accountability from both.

Another defence is that treatment in India costs substantially less than in wealthy countries. Sometimes it does. But affordability cannot be measured against American hospital bills. A procedure that appears inexpensive internationally can still consume an Indian family's savings or push it into debt. India's National Health Accounts estimated that households paid 39.4 per cent of total health expenditure directly in 2021–22. That burden makes appropriateness, transparency and value indispensable considerations.

The pertinent question is not simply whether treatment is cheaper, but whether it was needed at all. Were patients offered reasonable alternatives? Did they understand the likely benefits and possible harms? Was a fourth investigation, another prescription or an additional procedure likely to improve their health? These questions should concern responsible doctors as much as patients.

Some colleagues rightly point out that doctors face harassment, violence and unreasonable public expectations. Assaults on healthcare workers are indefensible and demand strong protection. Yet safeguarding doctors from violence and safeguarding patients from unnecessary interventions are complementary obligations. Both express the same commitment to ethical, safe and trustworthy healthcare.

What troubles me is the romantic insistence that medicine is inherently noble and therefore somehow exempt from criticism. Its ideals are noble; its practitioners are human. Degrees do not confer moral infallibility, just as expensive equipment does not guarantee better outcomes. Institutions become more trustworthy when they acknowledge mistakes, examine incentives and welcome independent oversight.

Scientists accept peer review, judges face appeals, and public officials answer questions from citizens. Medicine, entrusted with human lives and family finances, requires at least comparable openness. Indeed, ordinary people deserve a stronger voice in decisions about the healthcare they receive and the systems they fund.

There is also a wider imbalance in our national conversation. We celebrate specialist hospitals, robotic surgery, expensive diagnostics and the newest drugs while giving inadequate attention to nutrition, physical activity, sleep, prevention, environmental conditions and accessible primary care. Healthier societies cannot be built through escalating prescriptions and expanding hospital towers alone. Preventing avoidable illness deserves the same seriousness as treating advanced disease.

A profession confident in its integrity should never fear reasonable public questions. Ultimately, medicine is neither a private estate of specialists nor a commercial possession of hospitals. It exists to serve society. And every citizen, with or without a medical degree, has the right to ask whether it is fulfilling that purpose.

Chandrakant Lahariya is a practising physician and author of Pill-Free: You Don’t Need Everything You Have Been Prescribed.