Monday, June 4, 2012

Shaming the hippocratic oath

Shaming the hippocratic oath



 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.


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