The 78-year-old father of a friend of mine recently went to see a doctor in Mumbai about a hernia problem he had developed. He was otherwise healthy and active. The doctor advised surgery. During the routine tests before surgery, doctors said they discovered he had a couple of heart blockages that would have to be fixed before they could tackle the hernia. They also found, so they told him, that he had had a heart attack the week before, one that he was unaware of. After much discussion, the family decided there was no option but to go in for the bypass surgery.

A week after the surgery, the poor man is still in hospital, mentally disoriented, unable to lift his right arm (doctors first blamed it on a stroke, then arthritis and have now veered round to the view that physiotherapy will set it right) and asking to go back home. The hernia surgery, which would have cost him no more than Rs 50,000 has been forgotten and the family is poorer by Rs 300,000 as a result of the bypass. Their faith in doctors has been shaken even though the doctors may not be to blame. Perhaps the doctors did not communicate adequately with them about the risks involved.

I was reminded of this when I heard Richard Edelman present the 2009 Edelman Trust Barometer. He quoted President Barack Obama as saying, “...our problem is not just a deficit of dollars. It’s a deficit of accountability...a deficit of trust." The 10th Trust Barometer findings just out say business has lost the trust of nearly two-thirds of informed publics, with 62% saying they trust corporations less today than they did a year ago.

Even in emerging economies where people credit business, rather than government, with improved standards of living, opinion leaders say they have growing concerns about business, as trust in CEOs begins to slide, says Edelman.

Talk to the family I referred to above and they will tell you they expected doctors to guide and advise them correctly, perhaps about palliative treatment for the hernia rather than surgery. “We realize that we should have taken a second and third opinion and talked to other people before going in for such major surgery,” they keep repeating.

Last week, three other incidents made me mull over this. The first was a protest by ophthalmologists in India who want a Doctors Protection Act following a spate of assaults on members of the medical fraternity by angry relatives, when treatment goes wrong or fails to deliver the expected results. In the most recent case of its kind, a doctor was pulled out of his clinic, his face blackened and he was brutally assaulted after he refused to pay an amount of Rs 1.1 million to the family of one of his patients.

The second was a closed door meeting that I attended of doctors and a pharma company over issues agitating doctors. Interestingly, one of the doctors took up rather forcefully for patients. He said he was opposed to violence of any kind on doctors, “but what do we do when one of our fraternity is in the wrong? How do we redress the grievance? Shouldn’t we think about how we ought to do this?” he asked. As I understood him, he was asking: how do we rebuild trust in doctors? Shouldn’t we ring fence those who let non-medical considerations dictate a line of treatment, so that the whole fraternity is not tarnished?

The third was an article in an Indian business paper headlined “It’s time Pharma Inc stopped bribing doctors to prescribe their drugs.” The article written under a pseudonym, “Pillman,” talked of how what started as a “token of appreciation” to specialists from drug companies, has now extended to meeting the college expenses of doctors’ children!

I have heard of some pharma companies meeting the wedding expenses of doctors’ children (weddings are ostentatious affairs in India), renovating their homes and even replacing consumer durables every two years! Some years ago, I heard my own dentist tell his friend in my presence how a pharma company wanted to show him its “appreciation” for prescribing its drugs – it asked him to open an account with the local gasoline station so that they could take care of his fuel bills!

Is it any wonder then that word about “cut practice” and “commissions” have spread and relatives take the law into their own hands and beat up doctors when treatment fails? I am not for a moment justifying violence against doctors, nor do I believe that most doctor accept payoffs from pharma companies. But there is a certain miasma of distrust and some doctors have certainly contributed to it.

In the last few weeks, a steady stream of financial scandals have hit companies around the world and shaken the faith of big and small investors alike in the ability of the regulators to protect them from crooks. The US has its Enron, Worldcom and Madoff, India has its Ramalinga Raju, the IT czar who confessed on January 7, 2009 to having cooked the books for several years. He said he had been “riding a tiger, not knowing how to get off without being eaten.”

Marketplace realities have compelled some healthcare companies to risk riding tigers, in the hope that they will be able to dismount some day! Shouldn’t they be taking a cue from what has happened to the Enrons, Worldcoms and Satyams of this world and take a public stand by committing themselves to a code of promotion for their products and to more transparency and openness?

Codes exist, but few patients hear of them. If pharma companies joined hand with doctor associations to reiterate them more often, perhaps patients’ faith in doctors would gradually be restored and there would be less violence at clinics and hospitals in India. Wisdom decrees that the entire medical industry, doctors and drug companies included, ought to look at what’s happened to the devastation of trust in the financial sector and put their house in order.