The Hippocratic Oath taken for ethical conduct by doctors appears to have lost its relevance these days.
The tacit understanding between diagnostic centres and a large pool of physicians for referring patients for a variety of diagnostic tests has become a standard practice in the State capital.
Many conscientious medical practitioners themselves concede that many a time, tests which are not required are also prescribed to improve business of diagnostic centres. And these doctors get hefty commissions from these diagnostic centres.
It is an open secret that diagnostic centres survive on prescription.
Patients, who consult a doctor because they charge low consultation fee, are unaware of the fact that many such doctors make up for the ‘low' consultation fee by advising unnecessary tests.
Depending on the kind of test, most physicians directly receive their cut from the diagnostic centres.
Thanks to the mushrooming of diagnostic centres in the State capital, there is intense competition among them to win over a doctor. Typically, super-speciality doctors command 40 to 50 per cent cut in the overall bill, charged to the patient by the diagnostic centres.
Reputed diagnostic centres, however, have devised a novel system. They simply pay a lumpsum amount to the doctor every month.
“Our offer is Rs.1 lakh every month to super-speciality doctors. If the doctor prefers to go by bill by bill commission, for that we give Rs.1,000 for a CT scan, Rs.1,500 for an MRI. For PET CET Scan, the commission is between Rs.2,500 and Rs.3, 000,” a representative of diagnostic centre confided.
Thanks to the huge commissions, sometimes even up to 50 per cent involved, MRI and CT scans are favourites. Similarly, radiology tests like x-ray, pathological tests like blood tests and bone density tests bring around 25 to 30 per cent to the physicians on each bill.
“Kickbacks from diagnostic centres, medical shops and pharma companies to doctors have become a serious issue in Hyderabad. The greed among the doctors is increasing by the day. Ultimately, it is the patient who suffers by undergoing unnecessary tests and spending their hard-earned money. This practice is highly objectionable,” says vice-chairperson of Andhra Pradesh Medical Council, Dr. K. Ramesh Reddy.
Instances wherein doctors demand advance payment from diagnostic centres. “My limit of payment is Rs. 50,000 in a month. Sometimes, we even host weekend parties to the family of the doctors. Of course, the doctor ensures that we get the patients,” medical representative points out.
Keywords: medical service
Comments:
This is blatant injustice. On the one hand our people are reeling without medical help and paying the price, but here the greed of the doctors is like adding insult to injury. Hope The Hindu makes a case out of this and shows to the world how this unholy nexus is spreading like a disease.
Wish some way out is suggested .To day a beautiful cartoon was there in Patrika (Rajasthan Govt has started free medication in state hospitals ) Previously for minor injuries the the injured were kept in hospital for 4/5 days; are discharged now after some time saying it is minor take rest at home !
While prescribing the diagnostic test/scans, I usually give the patient option to do it at the centre of his choice, if he demands me to send him to my centre of choice, I write down on the paper "to give maximum concession to the patient".
People will pay come-what-may, to watch a movie but when it comes to doctors they always complain. I have seen patients haggling with my mom-in-law, who is a gynaecologist, after she has delivered their baby. Don't forget doctors also need to pay rent!!!
The system has evolved so much, from socialistic practice to corporate set up, where growth,profit are the motto. The article described here is not even the tip of the iceberg. De listing hospitals, pharmaceuticals from stock market is one way to reduce the unethical profit making agenda.
when becoming a doctor has become so difficult with such high fees in private medical colleges and lack of govt seats makes profit making impossible to resist
In USA a system of prescribing medicines is as follows. They just write the name of the medicine, not a brand name and suggest few commonly available brands underneath. Its up to the patient on which one to buy. And from the Govt side, they should open more public medical shops and diagnostic centers, where in any patient with a medicines or diagnostic test prescription can walk into these centers and get the tests done at a minimal price.
Medical practice should be state run, doctors should get a fixed pay. Corporate practice to medicine has already ruined the system along with private medical colleges.
To get admission to med school and to complete the program, graduates pay hunderds of thousands of Rupees. Naturally they want to get maximum return on their investments. Don't blame the doctors. They are as smart as Dalal street sharks.
I don't agree with you Dr.Kavita.A movie ticket does not Cost as much as CT scan or MRI scan.Next I do agree that there are certain set of people who try to bargain with doctors on reducing their fees.But you simply can't deny everything is ethical in the Indian Medical industry set up.There is a huge nexus between corporate hospitals/independent doctors & pharmaceuticals in this country.Greed causes that.I have seen MR's sitting with gifts to meet doctors whether it is Mumbai,Pune,Bangalore,Chennai,Kochi or Trivandrum.What are these for?Are we going like a government contractor culture of pleasing the concerned govt engineer with goodies.This is totally unethical when it comes to doctor-patient relationship.The trust is the one which bonds doctor & patient together. De listing hospitals, pharmaceuticals who participate in the unethical profit making should take prominence at least even we think about cleaning the already corrupt/unethical system.
Education cost is root cause for most corruption in out country. In Medical its much higher. People are treating Education as business. How do You expect a person spending >50Lakhs on Medical to think on humanity. Education must provide knowledge and focus on developing Creativity which benefit humanity. But our current System has created a vacuum out of it. Pushing kids and parents for immediate results. Goals which are towards temporary happiness. This in turn creates a community which is full of stress.
Unless a serious action to fix the root cause for this our tree will
fall pretty soon.
The government in the present situation cannot control this. It has got many problems to deal. Medical Council of India alone cannot do this. It has got too many functions for such a big country. Also MCI itself is mired in corruption scandals.How can it control the corruption in medical practice? The state medical council also do not do anything. How many erring doctors have been disciplined in the last few years? None. That means - there is no error/malpractice happening. Is it true? The medical practice in India is highly unmonitored. So no one trust if they really got the right treatment/investigation(even if they got the right one).There is urgent need for a proper independent regulatory authority. Also there is need for national guidelines, minimum standard equipment and monitoring, enforcement authority etc (like in UK National Health Service). The worst part of this ugly practice is doctors who do not participate in this malpractice are also got suspected
It is not only in Hyderabad but in all parts of the country. Especially in Chennai also. All doctors get commssion form these centres. whether it is reqired or not they will suggest for diognosis and finally say no problem. Same way the MRP mrp is a bogus price and the shop is getting very good commisssion from the companies which they are sharing with doctors. Many doctors are prescribing the costliest medicines so that they can receive more commisdsion and they will fix one pharmacy (through letter head supplied by them). and the medicines will be available at that shop only. This tactics is also many doctors adopting. Whether the patiest is getting cured or not the doctors are getting good commissions from the parmacies and scanning centres. Jovially my fried use to tell that if you approach a doctor for pain in the little finger the doctors suggests to scan for MRI and heart so that they will get commission. Unless the system is scraped the peole will have to suffer.
My appeal to Doctors, Engineers and Civil servants is that the world is so big and vast like our mind that all of us can comfortably live on this earth by upholding best values learnt and bringinging dignity to profession. Satkarmas alone shall lead to best life!
I am a doctor who came into the system with a lot of idealism but currently am cynical of the current situation.Young doctors who are not fully confident about their skills are not ready to work hard and improve their skills. Rather they would "refer" their cases to a senior who in turn would suitably "reward" them.Corporate hospitals routinely advertise their doctors though it is unethical.As pointed out by one of the readers hospitals routinely offer free check up only to bill the patient indirectly at a later date.Patients also prefer going to hospitals which heavily advertise not realising that the cost of advertising will eventually be recovered from them. Moreover hospitals with richly decorated waiting halls with LCD televisions and those offering free Tea or coffee to the waiting patients are given preference by the general public. These are centres which give consultants a cut in every diagnostic test and every medicine prescribed.
The entire medical system in India has become corrupted. It has become subservient to vested interests. Instead of curing the malady doctors aare prolonging the illness. People should be taught to rely on their natural immunity and not take any medicines as far as possible. Medical treatement should me made cheap and inexpensive. People should be encoraged to adequate exercise like walking , running etc. They should be taught to stop relying on medicines and depen on their natural vitality.
Please do not generalize based on this article. The entire Doctor fraternity has not lost its values. There are so many super speciality doctors out there who are doing a lot of social service for free. We should appreciate such efforts as well. As rightly pointed out in one of the above comments, people do not hesitate to spend any amount of money for eating, drinking and shopping. When it comes to paying for their own health, they think twice! Wake up, if you take care of your health, well and good, otherwise be prepared to spend for the expertise of these Doctors.
Doctors in other cities are no exception to this practice of commission. If our politicians and ministers give a damn to their oath, then why blame doctors. The corruption has got so deep rooted in our blood that no law whatsoever can remove it. Someone had said, " we are importing everything from abroad except honesty". I feel blood transformation from the honest people may do some good.
The report and learned Readers comments in which some Doctors too participated made the whole issue interesting. It would be quite appropriate for 'THE HINDU' to forward a copy of this special report and comments to Medical Council of India / PMO to initiate some measures of improvement. Let's hope a bright & healthy future.
There is no justification for doctor community and the hospital to cheat and fleece the patients. Period.
In India, especially in TN, the state of Government hospitals is appalling. System is drenched in corruption. Person with average cleanliness quotient will never want to enter a Government hospital mainly due to poor sanitation. Healthcare in India needs to be modernized. Modernization doesn't always mean deregulation and letting in the capitalist to make profits and amass wealth. Contribution of private sector in India's health care cannot be undermined, but Government should bring in adequate controls so that the common man is not extorted by the greedy who prey on vulnerable. India should take a cue from countries like UK where healthcare is completely free & everyone gets required level care.Government should look into social issues like these instead of spending vast amount of energy to find holes every project that was completed by previous Government. Our media will be much better off highlighting social issues like this than reporting who was evicted from BIG BOSS & so on
Here in the U.S, there are STARK laws, it is illegal to get ANY kick back in ANY form from ANY source, using the patients. The pharmacies are mandated to give Generic medications so that the pharmacist or the doctors are not promoting a particular stock .
While some Doctors do excellent service be it helping poor patients or providing treatment which cures their diseases perfectly, there are some whom I should refer as Psychos instead Doctors. They don't give a damn about life/health of a patient especially in case of Cancer/AIDS or any such dangerous diseases. I would like to tell to those Docs who commented on this article saying you pay for shopping.,etc.,etc. Docs, for gods sake think about poor people who can't pay much. I don't mind charging little bit extra or earning for you and your family sake. But, don't suck blood out of them. On one end, Private hospitals charge like hell and get everything out of patients in the name of fake/unwanted tests. On other hand, there are these Govt hospitals, where Docs work part time while their full time is at some own clininc/private hospital mostly. Don't blame on high educcaiton costs, Govt is spending 15lks per person on their behalf and half if not most of these Docs becoming insane.!!!!
This is very well recognised and a serious issue that needs to be addressed by reforming and implementing appropriate law and policy following open debates by doctors, private hospital and diagnostic centre owners/corporate hospitals, lawyers, insurers, activists, patient groups, Medical Council of India/Indian Medical Association and policy makers from health ministry/DGHS. This seems to be stemming from an imbalance between desire to earn fee while ignoring professional ethics by practising clinicians and continuing illegal business practise by diagnostic centres/hospitals. Having said that there are many unsung heroes from medical fraternity who are honest and do not receive cuts and similarly there are exemplary centres who follow good and honest business practice. Finally mushrooming of diagnostic centres and small hospitals and their regulation are an important aspect of wider solution to this problem.
Please Email the Editor