Bangalore, 27 September 2011
This is an article by Dr B M Hegde, MD, FRCP, FRCPE, FRCPG, FRCPI, FACC, FAMS - Padma Bhushan Awardee 2010.
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.
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The "Tagore" telugu movie of the year 2003, is not a fiction but an exaggeration and dramatization of actual happenings in corporate hospitals.
My View:
You and your family should have a family physician with whom you should develop good relationship. Overtime he will be well conversant with your family health issues. Use his referral contacts in case any specialist requirements. Take his help at every stage including second opinion etc. Being a family friend he would be equally concerned about your well being and what you can afford and what you can't. He may not be a saint at least he knows where he should stop. Approaching specialist directly or corporate hospitals at the first instance, you might end up with unnecessary tests & procedures and exorbitant bills even for a normal ailment.
This is an article by Dr B M Hegde, MD, FRCP, FRCPE, FRCPG, FRCPI, FACC, FAMS - Padma Bhushan Awardee 2010.
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.
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The article missed an usual item. Kickbacks from medical shops which is variable depending upon factors like proximity, volumes etc but the amounts are significant. A medical shop attached to a busy nursing home usually pays up entire electricity bill apart from goodwill amount of few lakhs of rupees and attending to doctor's sundry needs.
My View:
You and your family should have a family physician with whom you should develop good relationship. Overtime he will be well conversant with your family health issues. Use his referral contacts in case any specialist requirements. Take his help at every stage including second opinion etc. Being a family friend he would be equally concerned about your well being and what you can afford and what you can't. He may not be a saint at least he knows where he should stop. Approaching specialist directly or corporate hospitals at the first instance, you might end up with unnecessary tests & procedures and exorbitant bills even for a normal ailment.
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