New Delhi: For years, Indians have suspected that doctors operate unnecessarily, order unwarranted tests and procedures, take kickbacks for referring patients and behave like rapacious robber barons rather than carers.
Now the horror stories that used to form the subject of dinner-table banter – such as cardiac surgery prescribed for a shoulder pain that got better with exercise – are coming straight from the horse’s mouth.
In a report released this week, 78 doctors – half of whom have identified themselves – provided testimony of the greed and corruption that seem to have become endemic in the Indian medical profession.
They have told the Pune-based NGO which produced the report, SATHI (Support for Advocacy and Training to Health Initiatives), that private hospitals have become so commercialised that maximising profit underpins every aspect of treatment.
One doctor said that in monthly meetings with the hospital chief executive, he is reprimanded for having only a 10 per cent “conversion rate” – a reference to how many outpatients seen by a doctor are advised to undergo surgery.
“He tells me the conversion rate should be 40 per cent and that unless I increase it, I will have to leave the hospital,” the doctor said.
SATHI co-ordinator Abhay Shukla said the report is significant because, while evidence of corruption has been building up for some years, it has come largely from social organisations, field studies or patient anecdotes.
“This is the first time doctors have blown the whistle. Normally doctors never speak against one another. Their testimony shows we are on the edge of a severe crisis requiring regulation,” Dr Shukla said.
In the report, doctors talk of how a reference for an angioplasty can earn a doctor a kickback; of how doctors order CT scans and MRIs that are not required; and of doctors referring patients to a clinic for electrocardiograms purely for the sake of getting the commission.
Given the gruesome state of most Indian government hospitals, where there are sometimes two patients to a bed, private hospitals have flourished.
Having made massive investments and faced with intense competition, many hospitals try to recoup their investment through such unethical means, including setting revenue “targets” for doctors to meet.
The SATHI report comes soon after MediAngels, a Mumbai medical centre that offers second opinions, reported last month that almost 44 per cent of 12,500 patients who had been advised surgery for stents, knee replacements, cancer, and infertility, were advised against it by their second-opinion consultants.
And last year, a debate about the kickbacks and bribes that oil almost every part of the healthcare system was sparked by an article in the British Medical Journal by doctor David Berger.
Based on six months working as a volunteer physician in an Indian hospital, Dr Berger described unnecessary X-rays, MRIs, hysterectomies, routine bribe-taking and “needless deaths”.
The only solution to this corruption, Dr Shukla said, is regulation. He called the regulation of the Indian Medical Council “minimal”, with hardly any doctor ever being disciplined or struck off.
“Other sectors are regulated – telecom, petroleum, electricity – why not private medicine? The Indian Medical Council says the problem is confined to a few black sheep. But you need a microscope to find a white sheep,” Dr Shukla added.
A senior urologist at Apollo Hospital in New Delhi, Narasimhan Subramanian, agrees that a clear framework on testing and treatment is vital. Having seen such guidelines work in Britain, where he has practised, Dr Subramanian said that simple rules, such as those governing the treatment of patients brought into casualty with a head injury, worked well.
“The protocol tells doctors that they need not order a CT scan unless the patient has lost consciousness, is bleeding from the ear or nose, is vomiting or a gash is visible,” he said.
Signs of change in India are appearing. Last June, senior cardiologists at India’s top government hospital launched an organisation called the Society for Less Investigative Medicine to campaign against unnecessary investigations. They are hoping that other medical disciplines will follow suit.