I paid for my patient's surgery. With my own money.

I've paid for my own patients' treatment multiple times.

Think about that sentence. I funded the hospital bill for my own professional service. I did the surgery, provided the post-operative care, took the liability risk, and then opened my wallet to cover the costs the patient couldn't afford.

Can you name another profession where this happens? Because I can't. A chartered accountant doesn't pay his client's fees. A lawyer doesn't fund her client's bills. They may do pro bono work. But they don't reach into their own pockets to pay for the professional service they're providing.

That's what's truly noble about a doctor's life. And that's exactly what makes us exploitable.

You've done this too. Maybe not directly paying a hospital bill, but accepting half your fee. Waiving consultation charges for a patient who drove up in a Mercedes. Staying three hours past your shift because "someone has to." You've felt the weight of it. The expectation that because you can heal, you should sacrifice.

And when you want to charge fairly, you feel guilty.

That guilt isn't natural. It was installed.

The ₹10.5 Lakh Question

Early in my career at a Chennai hospital, I saw a patient's total bill. ₹12 lakhs. I looked at the surgeon's professional fee line: ₹1.5 lakhs.

12.5% of the total bill.

I remember thinking: where does the rest go? Not to the nurses (they're paid fixed salaries). Not to the ICU staff (same story). The infrastructure costs were already covered by previous patients. So who captured the other ₹10.5 lakhs?

The hospital. For "overhead." For "administration." For profit margins that would make tech companies jealous.

Indian private hospitals maintain 22-23% operating profit margins. Premium chains like Manipal Hospitals achieve 29.8% EBITDA margins. Max Healthcare commands ₹77,100 average revenue per occupied bed at 75% occupancy.

But when a surgeon wants ₹3 lakhs instead of ₹1.5 lakhs from that same ₹12 lakh bill, the surgeon gets called greedy.

Before you call the surgeon greedy, follow the other ₹10.5 lakhs.

I wish I could tell you I figured this out quickly. I didn't. For years, I accepted the narrative. I was privileged to be a doctor. I should be grateful. Charging fairly meant I was "money-minded." Wanting sustainable compensation meant I didn't care about patients.

I believed it so deeply that I perpetuated it. When a junior resident asked why his stipend was ₹32,000 per month for 80-hour weeks, I told him the same story I'd been told: "You're building your future. The money comes later."

But here's where it gets worse.

The money doesn't come later. Not automatically. Not for most surgeons. The system that benefits from undervaluing you has zero incentive to stop.

And the guilt conditioning is so effective that doctors inflict it on other doctors.

A doctor couple's daughter, without a licence, accidentally drove their car and rammed into two bystanders. One suffered a fractured tibia. Grievous injury. I admitted the patient, did the surgery, charged my standard fees. Not inflated. Just standard.

The doctor from the main hospital showed up at my doorstep. The costs were too high, he said. The charges were excessive.

A cardiologist, their friend and mine, came to my clinic. "Why are the fees so high?"

I looked at him. "That's my standard fee. It's not high."

These were medical professionals. They knew what complex orthopaedic surgery costs. They knew the liability, the expertise, the years of training required. They knew because they'd billed for procedures themselves.

But they couldn't see it. They were blinded by the moment they had to pay instead of collect.

Here's what I was thinking but didn't say: If my daughter without a licence crashed into someone and caused a fracture, I'd be apologetic to both the victim and the treating doctor. I'd take responsibility for giving car keys to a minor. But instead, they blamed the doctor for providing professional services at standard rates.

The guilt conditioning is so deep that we inflict it on each other while demanding standards we'd never apply to lawyers, accountants, or consultants.

People who can afford to pay make the loudest noise about greedy doctors. Poor people who cannot pay don't dare say anything. They don't have the confidence. They don't have the leverage. They accept whatever care is provided and remain quietly grateful.

The "greedy doctor" narrative serves the wealthy who don't want to pay, not the poor who cannot.

The Hippocratic Bait-and-Switch

The Hippocratic Oath was written between the 5th and 3rd centuries BCE. You know why it was created? To distinguish trained physicians from con artists.

During that time, untrained charlatans swindled patients by claiming illnesses had supernatural causes. Trained physicians needed a way to establish medicine as a profession ordinary people could trust. The Oath was designed to protect patients from scammers.

Fast forward 2,500 years.

Now the Oath is weaponized to scam the doctors.

Professional norms introduced altruism toward patients to solve the physician-patient agency problem. It created trust. But that trust is now exploited by third parties who benefit when doctors feel guilty about charging fairly. Hospital chains built 22-30% EBITDA margin businesses on guilt arbitrage. Pay surgeons 12.5% of patient bills. Capture 87.5% for "overhead" that includes executive salaries.

By 1973, the US Supreme Court rejected the Hippocratic Oath as a guide to medical ethics, stating it was "incapable of covering the latest developments." Patient autonomy and justice, now cornerstones of bioethics, were never discussed in the original Oath.

But in hospital boardrooms, the Oath is alive and well. Not as ethics. As leverage.

When you want fair compensation, they remind you of your duty to serve. When they want 87.5% of the patient bill, they remind you of profit margins and shareholder obligations.

Noble service prescribed by those who profit from it is exploitation wearing a morality costume.

Let me tell you about my starting salary. When I began post-graduation 30 years ago, the Government of Karnataka paid me ₹6,000 per month as a stipend.