Features Saturday, March 21, 2015 - 05:30
Monalisa Das | March 6, 2015 | 04:23 pm IST Follow @Mona_Lisa_Das A leading cardiologist in a corporate hospital in an Indian city was approached by a junior specialist with a problem he didn't seem to have an answer to. Each day, the hospital sees around 100 people in the OPD (Cardiology). 10-15 of them are usually referred for a procedure, like an angioplasty. The process of referring patients for procedures is also known as conversion rate. The management of the hospital had asked the junior specialist to increase the conversion rate to 40 percent and if he failed to do so, he would be shown the door. "What could I tell him (the junior specialist)?", asked the senior doctor, who was unaffected by the management pressure since he was an established doctor and also ran his private practice. This is just one of the several conversations that Dr Arun Gadre, a former gynecologist and now a health activist, had with doctors from across the country while researching for his project. Dr Gadre, who worked as a gynecologist for two decades in a district in Maharashtra, conducted interviews with 78 doctors in India in 2014 in an effort to find out about malpractice in India’s private healthcare sector. The British Medical Journal (BMJ) published parts of the study and its findings late last month. The three common malpractices in the sector, as found in Dr Gadre's paper, are kickbacks for referrals, irrational drug prescribing, and unnecessary interventions. The private healthcare system largely treats patients as revenue generators, without rationality or medical logic, Dr Gadre writes in his study. In Maharashtra,a general practitioner said that doctors get Rs 30,000- Rs 40,000 (£300-400; €450-550; $500-650) for referring patients for angioplasty. A pathologist said that of 150 doctors contacted only three were willing to refer patients for investigations without kickbacks. Speaking to The News Minute, Dr Gadre says that over the last two decades, the virus of commercialisation has spread across the health care sector in the country and has reached suffocating proportions. "A certain patient is sent 60 km away for a test because a doctor sitting in the city is getting commission for it. We are not treating patients as human beings. It is disgusting", says Dr Gadre, adding that 'the root of the problem is commodification of medical care'. The study published in the BMJ states that though many doctors in Maharashtra are trained in homeopathy and ayurveda, they practise allopathic medicine using cursory knowledge imparted by drug company representatives. A little girl was given corticosteroids by a homeopath for red eyes, and long term use led to a cataract that required surgery. Of the several doctors interviewed, many mentioned unnecessary investigations and surgical procedures. 'One example was gynaecologists performing sonography without indications in pregnant women who complain of trivial pain in their abdomens, then fabricating false reports of cervical abnormalities and advising the women to have cervical stitches, with the pretext of preventing miscarriage. Few patients request a second opinion, and the doctor does not give them any documents to avoid being found out', says the study. The malpractices across the health care sector is much more common today than when Dr Gadre had begun his practice, he says. "Today, there is stiff competition amongst doctors and other medical specialists too, especially for a new comer. A new comer must have spend around Rs 30 lakh on his studies. To set up his own practice, he will need a huge investment and so might resort to malpractices to earn commission", he explains. Take the example of the "sink test" as explained by a pathologist to Dr Gadre. 'The referring doctor advises a battery of laboratory tests despite no suspicion of pathology. Only a few of the tests are performed, and the extra blood collected is dumped in the sink. Fabricated results are given in the normal range for all tests that were not performed. The patient pays a large sum, which is shared by the referring doctor and the pathologist', states the paper. A physician also mentioned that pathologists pleased referring doctors by giving false reports, such as labelling healthy patients as having diabetes so that they are dependent on the referring doctor for life. When asked if doctors often succumb to pressure of their orgnaisations, Dr Gadre says, no one can pressurise an individual to act against their wishes, and this applies more to referral doctors. "Some of them depend on commission for their survival", he says. However, Dr Gadre feels that one cannot generalise in such a situation. "There is a section of doctors, a small one, and they are fighting against the commercialisation of the health sector. There are good hospitals too", he says. What needs to change is the attitude with which the sector at present is run. Dr Gadre states that "it functions as an industry where commodities are brought and sold and the only motive seems to be generating profit." Amidst the concerns surrounding the deterioration of rationality and ethics in India's health care sector, the roles of medical specialists also seems to be affected. A universal health care system can perhaps be a solution to the problem, Dr Gadre feels. "Several countries across the world, including UK, Canada, Europe and Thailand have accepted this system. Then why can't India?", he asks, adding "We are moving towards the Public Private Partnership (PPP) model, but there is no accountability in the sector, which is scary". "The Medical Council of India (MCI) is not so visible in implementing guidelines. It can definitely control the problems if it takes a pro-active role", Dr Gadre concludes. All the interviews by Dr Gadre will be compiled into a book and published by Penguin later this year. Tweet Follow @thenewsminute Read: Medical Council acts against doctors who went on pharma junket- Will this act as deterrent?

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