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How Indian Doctors Loot Patients
Written By murali772 - 27 September, 2011
Bangalore Corruption Transparency Media Reports Living public health Healthcare
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
COMMENTS
Doctors often ask for needless tests’
murali772 - 7 October, 2012 - 12:49
"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.
blrpraj - 8 October, 2012 - 02:03
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.
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..
murali772 - 24 September, 2014 - 13:33
abidpqa - 8 October, 2012 - 16:52
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.
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