In a groundbreaking story, British Medical Journal (BMJ 2015;351:h4312) highlighted the corruption that plagues the doctors in the corporate hospitals. Citing various instances of unnecessary revenue targets put by corporate bosses in front of doctors, forces specialists to prescribe unnecessary investigations, even indulge in unnecessary surgeries.
In the article, Meera Kay, journalist, Bangalore interviews industry professional and organisations to seek their response on the present situation. She further highlighted the development of many portals and second opinion sites that have risen due to premise of overprescription of surgeries by doctors.
“For seven years I had to bear the burden of doing unnecessary investigations and procedures, including angioplasty, under pressure from the management of the hospital,” Gautam Mistry, a cardiologist in Kolkata, told The BMJ.
What Mistry is describing is one of the best kept secrets of India’s private healthcare sector—consultants hired by private hospitals have to meet targets for generating revenue by overprescribing diagnostic tests and avoidable surgeries. No data exist on the prevalence of such targets, and Mistry did not disclose details of what targets he had been set.
“Significant numbers of patients must be advised to be admitted for surgery or medical procedures that bring in real financial profit for the hospital,” explained Kunal Saha, adjunct professor and HIV/AIDS consultant in Ohio, United States, and president of People for Better Treatment, a non-governmental organisation that promotes corruption free healthcare in India.
“Needless surgery, even simple procedures like tonsillectomy or appendectomy, may cause unexpected hazards for the patient,” he said.
Unnecessary surgery not only comes with the risk of harm but also burdens patients and their families financially, often directly. “In the absence of any effective medical insurance system, most ordinary patients in India are forced to pay the hefty hospital bills out of their own pockets,” Saha said.
Such unethical practices are widely known about in medical circles but public discourse has been lacking. “Doctors who face pressure from hospital management to overprescribe surgeries or investigations fear for their livelihood,” Mistry told The BMJ. “They also need to practise for a certain number of years, and by complaining they would be jeopardising their career.”
In taking the Hippocratic oath every doctor pledges to uphold ethical standards. Yet allegations such as these indicate an inability of some doctors to regulate themselves. The Medical Council of India (MCI) is responsible for institutional regulation of medical services. But its reputation is in tatters—its inability to collect data on alleged medical negligence and general failure to bring prosecutions do not instill confidence.3
The cry for transparency at all levels of the MCI is growing ever louder in India.4 Saha said that the MCI had unequivocal and stringent provisions against unethical medical practice by registered physicians, which clearly encompass the deliberate referral for unnecessary medical or surgical procedures. But, “such medical laws are hardly enforced by the Machiavellian MCI and other state medical councils that have always worked only to maintain the hitherto ‘untouchable’ status of the Indian medical community,” he said.
“A radical change in the structure and functioning of the MCI is the need of the hour,” Arun Gadre, coordinator at Support for Advocacy and Training to Health Initiatives (SATHI) told The BMJ. “The elected members are all doctors, which could result in a biased outlook.” He said that the Clinical Establishments (Registration and Regulation) Act 2010, which is not uniformly implemented in India,5 should be enforced by the government, because it has provisions to check the prescription of surgeries and investigation. He said that all practice should be evidence based, with standard treatment guidelines.
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