Getting the treatment you need, not one doctors want
India's private healthcare sector treats patients as revenue generators by prescribing expensive drugs, getting kickbacks for referrals, and doing unnecessary tests and surgeries.columns Updated: Mar 01, 2015 12:34 IST
You have fever and fear of swine flu -- influenza A (H1N1), to purists -- pushes up your blood pressure more than your body temperature. You rush to a doctor hoping he'll put your fretful mind at rest by diagnosing it as seasonal flu.
You have no such luck. The doctor prescribes a battery of unpronounceable tests done using technology you're told is developed by NASA to explore the universe. The hi-tech equipment explores your sickened little body instead and throws up colourful screenshots of your innards that make as little sense as images of star clusters without captions. Next you're given a bill accompanied with an inconclusive result and advice to go for more tests.
It's about now you start wondering whether you'd be better off popping two crocins and staying home. And, as you hand over hard-earned money, you wonder whether the tests were needed at all.
Going by the confessions of friends and colleagues of the Pune-based gynaecologist Dr Arun Gadre, many of the tests you undergo are not needed at all.
India's private healthcare sector treats patients as revenue generators by prescribing expensive drugs, getting kickbacks for referrals, and doing unnecessary tests and surgeries, writes Dr Gadre in British Medical Journal this week (http://bit.ly/1N4HOh9).
To find out about malpractice in India's private sector, Gadre interviewed 78 doctors -- from Bangalore, Chennai, Delhi, Kolkata, Mumbai and Pune -- and published their candid testimonies of corruption and malpractice in his book in Marathi, Kaifiyat-Pramanik Doctoranchi (Reflections By Sincere Doctors).
Kickbacks appear to be the norm. A physician from Maharashtra said doctors get Rs 30,000- Rs 40,000 for referring patients for angioplasty. A pathologist said of 150 doctors he got in touch with, only three were willing to refer patients for investigations without kickbacks.
Irrational prescriptions are common. Doctors trained in homeopathy and ayurveda prescribe allopathic medicine promoted by drug company representatives. A horrifying story recounted is that of a little girl given corticosteroids by a homeopath for conjunctivitis, long-term use of which led to cataract that needed surgery.
Apparently "sink tests" are common. Labs perform only a few of the tests asked for, with the extra blood thrown down the sink. Fabricated results are given in the normal range for all tests that were not done.
The most alarming story was that of a pathologist obliging referring doctors by giving false reports, such as labelling healthy people as diabetics to make them dependent on the referring doctor for life.
The BMJ article underscores the need for stringent, transparent, and mandatory regulation of the health sector, including small home-based clinics.
The only way to ensure quality is sticking to an old-style family physician (or internist as they are now called) who treats symptoms holistically and refers you to a specialist or hospital only when needed. Going to the same physician also adds to his understanding of your medical history - such as past diseases, other medications you are on, allergies etc -- which makes continuing care personalised and easier for both you and your doctor. Your family doctor is also more likely to take calls and discuss your over-all medical history with a specialist, if needed.
Referral is needed only in 5-10% cases, so when an internists equipped to handle 90% of everyday ailments, it makes sense to make it your first port of call. It'll not only save you time and money, but will also ensure you get the treatment you need, and not one the doctor wants.