Read the passage and answer the following questions

Medical practice at the start of the 21st century is at a crossroads. On the one hand, due to scientific and technological advances, there is an unprecedented ______ to improve the quality of life for people suffering from various ailments. On the other hand, health inequalities are widening and access to affordable and good quality healthcare is becoming difficult for vast sections of the population. Policymakers and the public look to doctors to provide the necessary leadership to tackle shortcomings, and help design better systems of care so that everyone can benefit from modern medicine. But are doctors up to the task? What should be done to ensure that they rise to the occasion? Are they still true to the Hippocratic tradition and the vocational nature of medicine, or have they become hypocrites, interested only in money? How can we restore doctors’ pride and support them and at the same time gain the confidence of patients and policymakers? 

Whilst the context is important, and not everything from the NHS will be directly applicable in India, there are parallels between the UK situation and what is happening here. I have had the privilege of meeting many dedicated and committed doctors over the years in India. Equally, I hear frequent laments about a lack of professionalism and comments about doctors overcharging, ordering unnecessary interventions, and being interested only in money. 

This last issue of a close relationship between money and medicine is especially pertinent to the Indian health system, as a vast proportion of healthcare is in the fee-for-service sector as the HLEG observed in its report. From paying huge amounts to secure admissions to both under- and postgraduate programmes (I am told that students can expect to pay Rs two crore to get a postgraduate place in specialties like orthopaedics and radiology), to receiving commissions for referring patients for tests/procedures (with referral commissions reportedly representing a substantial proportion of the costs of laboratory tests, for example), to hospital doctors being given ‘quotas’ of admissions or procedures to retain their admitting privileges (leading to unnecessary interventions), there seems to be a malignant financial angle to almost every patient interaction in the private sector. Although in theory there is a comprehensive public health system, it is disorganized, with widespread absenteeism and poor facilities, and does not inspire confidence, with the result that even the poor choose the feefor-service private sector. 

My purpose here is not to make judgments. Regardless of which healthcare system one looks at, there will always be good and bad doctors. This is because they are both victims and perpetrators. They are victims of a less than perfect science, a society that demands zero risks, and the pervading moral and ethical culture. They are also perpetrators of the crimes they are charged with as they fail to address and adapt to the changing societal and healthcare context.