The Times of India newspaper carried a write up by a person who was a former IT secretary of the Government of Karnataka. Judging by the incredibly unscientific nature of his article—lies, hearsay, unsubstantiated statements, etc this article required a quiet delivery into the dustbin. Unfortunately, this was approved and thought fit for publication by a leading National daily. This was forwarded to me and I was forced to put it up in it’s entirety and then counter it.
Crass commercialisation and corruption are eroding the vitals of India's healthcare system
Doctors have demanded an apology from Aamir Khan, for having highlighted medical malpractices on a TV show. However, the fact of the matter is that while corruption in public sector and government has always been the focus of media, corruption in private clinics is seldom brought out. Catastrophic illness in the family is the number one reason for rural indebtedness. Healthcare expenses have become prohibitive even for upper-middle-class families. The most important reason for expensive and uncertain healthcare has been corrupt healthcare practices in India.
Consider a real case of a person who met with an accident near Electronics City, located on the outskirts of Bangalore. The patient was lying in a pool of blood and many IT professionals passed by. No one stopped to pick him up in a car, for fear of loss of time and later mindless police investigations and prolonged court procedures. A rickshaw driver picked up the patient. He could have taken the patient to Nara-yana Hrudayalaya which is just two km from the place of accident. The driver, however, decided to take him through the by-now infamous Bangalore traffic for over 25 km, to a hospital in the city centre. That hospital pays Rs 3,000 to a taxi driver for bringing a serious patient.
The misuse did not stop there. The hospital authorities called for the patient's wife. She rushed in the next half hour. The hospital charged Rs 3 lakh to her credit card as advance payment. A credit limit of Rs 3 lakh is rich by Indian standards. But she was not allowed to see her husband, and had to wait anxiously for over 45 minutes. She could not bear it anymore and barged into the hospital room. The technicians were repairing the ventilator. She immediately shifted her husband to another hospital. The doctors tried to revive the patient's brain for 15 days, but did not succeed.
The unethical practice of hospitals encouraging incentive payments to taxi drivers goes unabated. The result could be fatal for the patient. This can happen to any one of us in any city. What else do hospitals do?
They encourage doctors to prescribe too many tests, particularly the expensive ones. An MRI or a CT scan can cost Rs 10,000. The doctor gets one-third the amount as commission, for the prescription. The commission to the doctor is often paid by cash, but some pay by cheque too. Primarily it is not illegal if the doctor receives commission money in India. In the US, the Stark law prohibits such payments. The doctors who receive such payments could be debarred from practice for life. In India, the healthcare regulator, the Medical Council of India, has punished no one. Physicians have to declare any beneficial interest they may have with diagnostic clinics. Why can't India have similar regulation?
Consider kidney stones, most prevalent in India, due to our spicy diet. Many urologists prescribe surgeries for removal of kidney stones. The surgery is expensive and painful. Advanced lithotripsy uses laser beams to break the stones. Even technicians can be trained to use the lithotripsy machines. The machines work well for stones around 4 mm or less. But even if they are detected, doctors wait to prescribe surgeries that are invasive and expensive. No wonder, surgical procedures have gone up 20% over the last four years.
A leading orthopaedic surgeon in Bangalore often pres-cribes knee replacement. The surgery used to be undertaken for old people unable to walk. Smooth-talking doctors now convince even youngsters to go for it. The average age of patients in knee replacement has been going down. The hidden reason for such prescription is said to be prostheses suppliers who dole out Rs 25,000 per surgery. The same applies to cardiac operations supported by stent manufacturers.
Hospital-related infections are a major cause of deterioration or even death of patients. In the US, such deaths account for 20% of total mortality in hospitals. The figure in India is lower, but wrongly calcu-lated. Sometimes very serious patients are discharged with a recommendation to try another hospital, fully knowing the patient will die soon. The hospital's reported death rate comes down. The patient may die during tortuous travel in ambulance vans. Deaths in Indian hospitals are rarely investi-gated in detail. Senior doctors object to the review of their decisions by any committee. Most hospitals that depend on star doctors do not want to antagonise them. Patients pay with their lives and with their hard-earned savings for medical callousness.
Pharmaceutical companies pamper healthcare professionals with conferences in exotic vacation spots abroad. Hospitals sponsor physicians' airfare. The pharmacy companies buy tickets for wife and children. The net result of course is that patients end up buying expensive medicines.
While many are aware of these malpractices, they look the other way. How can one improve the system? First, the industry needs treatment protocols based on Indian conditions. Second, a systematic physician credentialing system should mandatorily track all the treatments, surgeries, outcomes, problems, deaths for each doctor and make this information public. Most important, a comprehensive regulation that brings more transparency in hospital operations and gives more rights to patients is long overdue.
The writer is the founder of Brickwork Group and a former IT secretary, government of Karnataka.
MY REPLY:-
This TOI article was forwarded to me. I am penning my reactions to such sensation mongering, factually incorrect and biased article .
1)The most important reason for expensive and uncertain healthcare has been corrupt healthcare practices in India.
From where has this supposedly erudite writer got this information? Or is he giving an armchair dialogue??This could have been ignored as an Amir Khan show littered with biased untruths---had it not been printed in the TOI which lately has been more interested in opinionated facts(?) rather than hard core news reporting together with hyperventilation and slanging verbal matches. The reason for increased costs lies in rising prices for drugs, equipments, salaries, fuel prices etc.etc.for which Doctors are in NO way responsible.
2) The technicians were repairing the ventilator…
Impossible to comment on an one sided description. What was the hospital’s explanation? It is difficult to believe that a Private Hospital willing to give Rs. 3000 to a Taxidriver for bringing in emergency cases—had only ONE ventilator available and that too not functioning properly!!!! The practice of taking advanced payment for critical cases stemmed from the fact that many such cases refused to pay the bill later. In fact, the biggest losses incurred by private hospitals are unpaid bills… It is unfortunate that the patient died—but probably the intensity of the trauma was also a factor.
3) The unethical practice of hospitals encouraging incentive payments to taxi drivers goes unabated….This is a shameful practice and should be stopped. In fact, in Kolkata the few clinics and hospitals who started this system—quickly opted out as they found it counter productive(demands became higher etc).
4) They encourage doctors to prescribe too many tests, particularly the expensive ones. An MRI or a CT scan can cost Rs 10,000. The doctor gets one-third the amount as commission, for the prescription. The commission to the doctor is often paid by cash, but some pay by cheque too.---Again not at all UNIVERSALLY applicable. There are thousands of doctors who do not take commissions. To say ALL CT and MRI’s are unnecessary and recommended for the sole purpose of making a quick buck is wrong, false and fabricated. Both of these are excellent investigating tools and the demand by patients are to get quick, reliable diagnosis and treatment . Our text books recommend these investigations in many cases.
5) . Primarily it is not illegal if the doctor receives commission money in India.
Even then a vast majority of doctors do not give or take commission.Are there any reliable statistics on these issues or are all this another example of creative research!!!!!
6) The machines work well for stones around 4 mm or less. But even if they are detected, doctors wait to prescribe surgeries that are invasive and expensive.
There are also many cases of failed lithotripsy which have to be operated, stones greater than 4-5 mm have to be operated, a small stone causing hydronephrosis has to be operated etc, etc. To know all about it—I recommend that this SPECIAL, all knowing IT specialist takes a MBBS course, specialise And then comment!!!!!… It is funny how IT specialists to rickshawallas and TOI editors know all about surgical indications---and we as specialists know so little. Is it time for us to comment on IT activities???? Number of surgeries have gone up because of better investigations, better equipments, more skilled surgeons and better ,properly equipped hospitals!!!! But then some persons live in a warped Time Zone and refuse to support Change, no matter how better are the results!!!
7) The average age of patients in knee replacement has been going down. The hidden reason for such prescription is said to be prostheses suppliers who dole out Rs 25,000 per surgery.
This is akin to droppings from a chaste animal!!!! What sort of a world does this person live in where the vision is jaundiced and and so bigoted!!! The reason the age group of Knee Replacements are going down is due to the presence of long lasting implants, and because there were no effective alternatives, in these patients whose best years of their lives were being tragically lost.
Rs.25000/ per implant? Only partially possible if the surgeon is the dealer himself.
8) Sometimes very serious patients are discharged with a recommendation to try another hospital, fully knowing the patient will die soon. The hospital's reported death rate comes down. The patient may die during tortuous travel in ambulance vans.
This is straight out of a film script!!!! How can such trash be accepted for publication? The clinical skills of doctors must have been phenomenal---that they can estimate the duration of Traffic jams, and the time of death so accurately that the patient can die EXACTLY in the ambulance !!!!
9) Pharmaceutical companies pamper healthcare professionals with conferences in exotic vacation spots abroad. Hospitals sponsor physicians' airfare. The pharmacy companies buy tickets for wife and children. The net result of course is that patients end up buying expensive medicines.
All these companies have their own ethical standards plus their industry directives. Plus governmental regulations. The prices of medicines are set by government—and health Care professionals have nothing to do with it!!!
The last para is the typical mumbo jumbo of a confused presentation. Of course we need industry standards and regulations. So when have Doctors wanted otherwise?
My plea is to everybody with no knowledge about the medical profession to stop these silly articles. But then , with these people like this writer and Amir Khan around you can be sure of the spread of stupidity…
