This is by Dr B M Hegde, MD, FRCP, FRCPE, FRCPG, FRCPI, FACC, FAMS - Padma Bhushan Awardee 2010 (for more on him, click here), which has been doing the Yahoo/ Google - group rounds of recent:
Most of these observations are either completely or partially true. Corruption has many names, and one of civil society isn't innocent either. Professionals and businessmen of various sorts indulge in unscrupulous practices. I recently had a chat with some doctors, surgeons and owners of nursing homes about the tricks of their trade. Here is what they said
1) 40-60% kickbacks for lab tests. When a doctor (whether family doctor / general physician, consultant or surgeon) prescribes tests - pathology, radiology, X-rays, MRIs etc. - the laboratory conducting those tests gives commissions. In South and Central Mumbai -- 40%. In the suburbs north of Bandra -- a whopping 60 per cent! He probably earns a lot more in this way than the consulting fees that you pay.
2) 30-40% for referring to consultants, specialists & surgeons. When your friendly GP refers you to a specialist or surgeon, he gets 30-40%.
3) 30-40% of total hospital charges. If the GP or consultant recommends hospitalization, he will receive kickback from the private nursing home as a percentage of all charges including ICU, bed, nursing care, surgery.
4) Sink tests. Some tests prescribed by doctors are not needed. They are there to inflate bills and commissions. The pathology lab understands what is unnecessary. These are called "sink tests"; blood, urine, stool samples collected will be thrown.
5) Admitting the patient to "keep him under observation". People go to cardiologists feeling unwell and anxious. Most of them aren't really having a heart attack, and cardiologists and family doctors are well aware of this. They admit such safe patients, put them on a saline drip with mild sedation, and send them home after 3-4 days after charging them a fat amount for ICU, bed charges, visiting doctors fees.
6) ICU minus intensive care. Nursing homes all over the suburbs are run by doctor couples or as one-man-shows. In such places, nurses and ward boys are 10th class drop-outs in ill-fitting uniforms and bare feet. These "nurses" sit at the reception counter, give injections and saline drips, perform ECGs, apply dressings and change bandages, and assist in the operation theatre. At night, they even sit outside the Intensive Care Units; there is no resident doctor. In case of a crisis, the doctor -- who usually lives in the same building -- will turn up after 20 minutes, after this nurse calls him. Such ICUs admit safe patients to fill up beds. Genuine patients who require emergency care are sent elsewhere to hospitals having a Resident Medical Officer (RMO) round-the-clock.
7) Unnecessary caesarean surgeries and hysterectomies. Many surgical procedures are done to keep the cash register ringing. Caesarean deliveries and hysterectomy (removal of uterus) are high on the list. While the woman with labour -pains is screaming and panicking, the obstetrician who gently suggests that caesarean is best seems like an angel sent by God! Menopausal women experience bodily changes that make them nervous and gullible. They can be frightened by words like " and "fibroids" that are in almost every normal woman's radiology reports. When a gynaecologist gently suggests womb removal "as a precaution", most women and their husbands agree without a second's thought.
8) Cosmetic surgery advertized through newspapers. Liposuction and plastic surgery are not minor procedures. Some are life-threateningly major. But advertisements make them appear as easy as facials and waxing. The Indian medical council has strict rules against such misrepresentation. But nobody is interested in taking action.
9) Indirect kickbacks from doctors to prestigious hospitals. To be on the panel of a prestigious hospital, there is give-and-take involved. The hospital expects the doctor to refer many patients for hospital admission. If he fails to send a certain number of patients, he is quietly dumped. And so he likes to admit patients even when there is no need.
10) "Emergency surgery" on dead body. If a surgeon hurriedly wheels your patient from the Intensive Care Unit to the operation theater, refuses to let you go inside and see him, and wants your signature on the consent form for "an emergency operation to save his life", it is likely that your patient is already dead. The "emergency operation" is for inflating the bill; if you agree for it, the surgeon will come out 15 minutes later and report that your patient died on the operation table. And then, when you take delivery of the dead body, you will pay OT charges, anesthesiologist's charges, blah-blah-
Wonder how widespread this is. Or, is it a matter of a few black sheep giving a bad name to the entire fraternity? Doctors are humans too. You can't trust them blindly. Please understand the difference.
Young surgeons and old ones. The young ones who are setting up nursing home etc. have heavy loans to settle. To pay back the loan, they have to perform as many operations as possible. Also, to build a reputation, they have to perform a large number of operations and develop their skills. So, at first, every case seems fit for cutting. But with age, experience and prosperity, many surgeons lose their taste for cutting, and stop recommending operations.
Physicians and surgeons. To a man with a hammer, every problem looks like a nail. Surgeons like to solve medical problems by cutting, just as physicians first seek solutions with drugs. So, if you take your medical problem to a surgeon first, the chances are that you will unnecessarily end up on the operation table. Instead, please go to an ordinary GP first.
Simultaneously, another mail, detailing a certain Srijan Sharma's unpleasant experience with FORTIS, Noida, has also been doing the rounds, and the matter supposedly came up for discussion on TV too.
On the one hand, you have the dismal state of the government hospitals (check this, and this), and on the other, there are these kinds of mercenary pursuits of some of the Corporate hospitals. There is no reason why we can't have a proper and equitable regulatory mechanism in place, except of course the political will. When money is to be made, I guess, the politicos don't discriminate between sectors, even if it's healthcare.
Given all that, a symposium on Ethics in HealthCare organised by a city hospital recently, where eminent personalities like Justice M N Venkatachaliah, former Chief Justice of India (check the report in the New Indian Express here) should be considered a welcome step. More open discussion on the subject, I expect, is the best way to finding lasting solutions.
Muralidhar Rao
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Doctors often ask for needless tests’
"On many occasions, doctors ask for tests that are unnecessary. Similarly, there are drugs that have become outdated or whose efficacy isn't proven. But doctors keep prescribing them. Unless there are standard guidelines on treatment of certain illnesses, such misuse will keep happening," said Dr Kameshwar Prasad, head of the clinical epidemiology unit at AIIMS.
With the number of cases involving unwarranted prescriptions of surgical procedures, diagnostic tests and medication increasing, Dr Prasad said patients must ask their doctor about the pros and cons of the treatment offered before making a decision.
To create awareness on the issue, AIIMS will hold an international meet — the first of its kind in the world — where experts will discuss how standard guidelines can be evolved for treating diseases.
Dr Prasad said unnecessary diagnostic tests and surgical procedures not just put additional financial burden but also affect the patient's recovery. "We are also proposing that evidence-based treatment methodologies should be emphasized in medical schools," he said.
To access the full text of the article published in the Bharat Pensioner's Samaj site, click here.
I expect many have gone through this experience. I certainly have. The cure (pun intended) may lie in openly talking about it.
unfortunate
Murali,
What you have stated is very true and sad. Gone are those days of simplistic medical treatment. When i was growing up we used to go to the doctor down the street and he used to charge a simple fees. The doctor used to do diagnosis based on simple clinical judgement based on his experience. There were no unnecessary tests. These days due to increasing commercialization and middlemen this has changed. we are sadlly following the western system here more specifically the US system here, needlessly complicating the medical care system. Combine that with lax enforcement of rules and regulations (which is common in india) we have a recipe for disaster and what you have stated does not surprise me at all.
There is attempt show
There is attempt show healthcare as lucrative. Then only students will study MBBS courses and the colleges make money. So this industry is not regulated.
IN the US, any bill exceeding 20% of yearly salary is seen as catastrophic. Here the people go bankrupt paying the bills. Again, universal healthcare insuranve coverage with fixed cost of 5 to 10% income is necessary, but govt is ignoring this.
Bane of Corporatisation, and perhaps the way out
Dr Samiran Nundy, chairman of the department of surgical gastroenterology and organ transplantation at Sir Ganga Ram Hospital and editor-in-chief of the journal, Current Medicine Research and Practice, stirred a hornet's nest with his recent editorial on corruption in healthcare in India in the British Medical Journal. The editorial exposed the widespread practice of doctors taking cuts for referrals and prescribing unnecessary investigations and procedures for profit. Dr Nundy talks to Rema Nagarajan about the urgent need to fight this corruption to deliver trustworthy and quality healthcare to the people.
The full text of the interview, that was published in the ToI, may be acfcessed here. It is a must read for everyone concerened.
Simultaneously as I read this interview, I happened to witness a debate, on NDTV, moderated by Ms Nidhi Razdan, between Dr Nundy, Dr Devi Shetty (Narayana Hrudayalaya), Dr Trehan (Medanta, New Delhi), and Dr Jawali (Fortis, Bangalore), perhaps the most eminent panel of doctors compared to any from across the country.
Dr Nundy started off with the comment as to how sad it was that it required an article by an Australian doctor to set off the debate amongst the medical fraternity in the country, on a matter that the entire lot was well aware of, and a lot many fairly concerened too.
Dr Trehan and Dr Shetty tried to say that the 15% or so 'rotten apples' were tarnishing the image of the entire lot. Dr Nundy responded saying that by his understanding, it was not 15%, but 99%, essentially implying that the rest of the panelists themselves were part of the problem (The way even Narayana Hrudayalaya is beginning to advertise now, we know). When Dr Jawali tried to wriggle out by talking about quacks, Ms Razdan pointed out that the talk was about regular, 'reputed' doctors, and not quacks. As to Ms Razdan's repeated questioning on why the MCI (Medical Council of India), of which Dr Jawali was a governing council member, had taken back Dr Ketan Desai, after he was forced to resign from the Chairmanship, because of proven misdeeds, all that the eminent cardio-surgeon had to say was that that was all a matter of the past, and things had changed now. Really???
The question that arises here is shouldn't the Union Health Minister, Dr Harsh Vardhan, be more bothered about setting right the wrongs with the MCI, than going about banning sex education in the country? For instance, why is he not nominating Dr Nundy into the membership of the governing council of the MCI?
Whatever, more open talk can perhaps lead to the right answers, and towards that let's, Prajagalu, contribte.
Killings from medical devices
Sources in the healthcare sector told TOI that in several hospitals, the margins on devices — ranging from stents, implants and pacemakers to artificial joints, titanium plates for fractures, and valves — could add up to as much as 30% of their profits. Hundreds of such devices are used in a hospital every day. Of course, it is the patient who pays for these handsome margins.
- - - "If the Telecom Regulatory Authority of India (TRAI) can regulate and prescribe ceiling rates for call charges or roaming charges, why is there no government regulation on what hospitals can charge for medical procedures and devices? Just as there is a National Pharmaceutical Pricing Authority (NPPA) for medicines, there ought to be an authority that regulates the price of devices. Why is the government allowing hospitals to loot patients like this?" asked the lawyer whose father had three stents implanted.
For the full text of the report in the ToI, click here.
Last week, while travelling in a taxi, the radio happened to be tuned to a local Kannada channel, which, for some 15 minutes, was non-stop extolling the virtues of a Bangalore based hospital group head and his family members, equating them all to gods. Now, at least one of the family members is a politician, and better known for all the wrong reasons, than right ones, if there are any. I asked the taxi driver if he believed all of what is being said. "Ella kalru, sir", he responded with a wry smile.
The question therefore arises again as to why the Dr Devi Shetty's and Dr Trehan's, of this world, who have certain reputations at stake, haven't bothered so far to check the systemic rot that has set in, which now apparently has engulfed them too. Would they at least now wake up and do something to restore their credibility? One awaits to see.
Simultaneously, the question arises also as to whether the good Dr Harshvardan, Union Minister for Health, is going to be bothering with such issues that badly need his attention, rather than some inconsequent trivialities.
Way out !
Simply a lawyer has to open an office just next to each hospital. If docs can do such practises points 1) to 10), then I would encourage a lawyer to simply sue doctors/hospitals on behalf of patients. An advertisement in lawyer's offce should read like this :
"For filing cases on nearby hospitals, 25% rebate" :)
Thus to bring a natural ecosystem of preying professionals..
- wgwwd : (w)e (g)et (w)hat (w)e (d)eserve...so look at yourself first
On the other hand - -
Whistle-blower doctors, and a shameless IMA
There is a strong lobby of the corporate health sector and the Indian Medical Association, the biggest lobby of doctors in India, that are trying to completely eliminate any kind of regulation. It is total jungle raj now. This is the larger policy environment in which we are releasing the report," said Dr Shukla. - - - The report based on interviews titled, "Voices of Conscience from the Medical Profession: Revealing testimonies by rational doctors about the reality of private medical practice in India" has been put together by Dr Arun Gadre, a doctor and writer with 20 years' experience of working as a gynaecologist in rural Maharashtra, and Dr Abhay Shukla, convenor of SATHI who did his MBBS and MD from AIIMS.
For the full text of the report in the ToI, click here.
One had hoped that Dr Harshvardhan, being the good doctor that he is known to be, would have worked to set right the rot, sooner than later. Not too sure what to expect from the present incumbent (Union Health Minister), Sri J P Nadda. Whatever, the Civil Society needs to demand a clean up, and at the earliest.
@murali
Regarding your comment "Apparently, we in India are far better off." based on abstract of an essay by Dr Sowmya R. Rao; certainly. One of my relatives happened to have a valve replacement surgery at Narayana Hrudalaya, Bangalore. That is a world class facility with world class doctors from what i hear. One of the senior cardiologists working there happens to be my relative too. There are other world class hospitals like Kokilaben Ambani hostpital, Mumbai. Escorts hospital, Delhi etc.But one has to remember that at the same time there are hospitals like Royapettah Hospital, Chennai or GH (opposite the chennai railway station) Chennai or KIMS, Bangalore that are not upto the mark where healthcare service delivery is not up to the mark and has to be revamped. These are the hospitals where the poor ignorant patients are taken for a ride and looted by not getting proper care and the tax payor's money being wasted.
much needed initiative
No more doctors treating Sunanda Pushkar?
"...to ensure that doctors and hospitals practice ethics in treating patients" - But aren't medical degrees given only to those will quietly prescribe suicide when necessary?
Public and charitable institions
Healthcare is expensive and if need for excessive profit is also added it becomes unaffordable. There is a big component missing in providing healthcare, charity and nonprofit institutions. Historically, charitable institutions are guided by religions, but now nonreligion based NGOs are also there. Also charitable services are provided by government, but somehow it does not work well here. The social service is duty of religion. All religions should strive to develop health care facilities to provide for all their needs. Religon just meaning a group of peoplele, like members of praja develop healthcare facilities for all their needs. If the services are done well by a group, they can expand it because charity is service. Main problem in India is Hindu religiondoes not have enough hospitals.
When the people stop patronizing corporate healthcare, doctors also will have to leave those hospitals. All over the developed countries, healthcare costs are affordable only because of charity. Even in US, public health care has important role like NIH, State hospitals, Children's hospitals etc. Doctor's associations themselves have indicated the need for increasing the capacity of public institutions, doubling the percentage from curent level. If at all the doctors want to run private practice, they have to be managed by doctors themselves not corporate managers.
Reform medical insurance
Another point need to be considered is why private medical insurance is not reducing healthcare costs. The medical insurance need to cover all the disease condition of a human being, even heart transplant or brain surgery, not an amount. IRDA is allowing insurance companies to provide insurance like Rs. 5k will provide 3 lac cover that is not really medical insurance but something else, shoud not be called medical insurance.