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The Sick Healthcare System
Medical malpractices are widespread. In fact, while we come across cases of financial mis-selling every day, we believe that these are mild, compared to the gross abuses by hospitals, doctors and pharmaceutical companies. Stories of pass-backs between physicians, pathologists and surgeons; unnecessary or wrong procedures; massive over-billing by five-star hospitals; and overmedication, are rife. Despite a ghastly fire at a hospital in Kolkata that killed more than 100 people, nothing really happened to the owners of the hospital; it is back in business. Unfortunately, there is an unwritten code among doctors not to rock this gravy train. It is extremely hard for the families of patients to fight medical malpractices and get justice because they would simply not find a doctor to come forward and testify in court, as would be required.
 
This book is an attempt to expose many of these malpractices. In a remarkable effort, Dr Arun Gadre and Dr Abhay Shukla have put together interviews and comments of conscientious doctors about malpractices. The best way to review this book is to quote passages from it so that readers get its flavour.
 
Wasteful Investigations: “A pathologist from a metropolitan city revealed how many unnecessary investigations are advised. Take typhoid, for example. If the blood test is performed before the 5th day, it does not reveal anything. But it is carried out every alternate day from the first day. The more expensive a test, the more it is prescribed. A sputum examination is generally sufficient to diagnose tuberculosis in the lungs. But the simple reality is that no test can detect it when the tuberculosis is elsewhere in the body—in the stomach, bones, or lymph nodes. But expensive tests, like TB Gold and TB Platinum, are prescribed. The more expensive the test, the more the commission.”
 
The pathologist explained the phenomena of ‘sink tests’. “This means the sample is just thrown into the sink without testing. The doctor prescribes tests, which by mutual understanding are not actually carried out by the pathologist, who collects the money for the test, and without testing, he merely gives a ‘normal’ report. Just one more way of increasing the commission.” 
 
Role of Pharma Companies: “Unfortunately, we doctors have pharmaceutical companies as teachers,” laments Dr Gautam Mistry, a cardiologist in Kolkata. “There is a need to quickly set up an independent mechanism... whereby every year doctors can prescribe those medicines only after studying through this system... not after having been tutored by medical representatives... attracted by the inducements offered by pharmaceutical companies, even doctors from rural areas are prescribing a new blood-pressure medication, which is very expensive. In fact, it is many times more expensive than the effective medicines used earlier. Patients have to take blood-pressure medication for their entire lives, and despite all this, there is not a single piece of evidence demonstrating the efficacy of this medicine! It has become a common practice to bring expensive new medicines to market in place of useful cheaper medicines just to increase profits. There is no scientific evidence that these medicines are more effective than the earlier ones. Yet, these medicines are promoted,” Dr Mistry adds.
 
Unnecessary Procedures: “Every week, I come across two to three elderly persons who only need proper spectacles,” said an ophthalmologist working in one of the country’s metropolises. But they have been told to get operated for cataract (which they don’t even have), and they are told the charges are Rs30,000-40,000. Those who have insurance fall into the trap and go in for the surgery. Those who don’t have insurance come to me for a second opinion, and they are saved!”
 
Role of Insurance: “Due to insurance, patients feel that they should get treatment in a five-star hospital. They don’t care about what the quality of treatment is,” says Satish Gosain, a general practitioner from Delhi. On the subject of insurance, Dr Sanjay Bhatnagar, a paediatrician in Delhi mentions, “having taken insurance, a patient feels like a king. The patient casually uses the insurance like a debit card. They ask me: ‘Can you get me admitted and help me earn some money?’ I refuse. But I know of some hospitals where they don’t actually admit patients, but merely prepare the paperwork. The hospital, the patient and the TPA share the proceeds.”
 
The least we can all do to support these courageous doctors is buy this book, read it and gift it to as many people as we can. 

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COMMENTS

sundararaman gopalakrishnan

6 months ago

Good review..I plan to buy this book if it is on Amazon in Kindle/e book format

unnikrishnan mazhuvancherry

6 months ago

On the one hand, the authors lament that the doctor’s education comes from the pharma companies. On the other, there is a general tendency among Indian doctors ( as a monolithic political community, not as individuals) to never allow any meaningful role for other healthcare professionals, or share the professional space with them, except as 'subordinates' who take orders. A “prestige based hierarchy” runs the health care system. The pharmacists, who are supposed to be drug experts, have never played a role in India. The medical council is not likely to allow such a thing to happen. There is very little task sharing ( an new buzzword) between the various health care professionals. I have not read the book , so I have no idea if this possibility has been discussed.
India had a very robust public health system before the revised medical curriculum incorporated public health into the MBBS syllabus. Public health is much more than the “social and preventive medicine’ that they study in classrooms. It is more inclusive, multidisciplinary.
Indian society looks up at the doctor with a great deal of awe and respect. It is essentially a hangover of the feudal arrogance that rules India even today. Indians give great importance to unchallenged authority and are willing to ‘donate’ more than a crore to win a backdoor entry into a medical college. I don’t think it makes economic sense. Nor is it driven by passion.

suneel kumar gupta

6 months ago

I strongly believe that insurance companies are also hand in glove with the medical fraternity. When a patient is hospitalized, rather than family members, a doctor assigned by insurance company should follow up his treatment / diagnosis. This way even insurance companies willsave a lot of money and also guilty may be punished. A layman can't learn so many technicalities.

Vaibhav Dhoka

6 months ago

All malpractices mentioned on rise it all started with entry of corp orates in medical field.Equally availability of information on google is playing havoc.New generation collect information on google and waste doctors time and confuse him and about insurance lass is spoken is good.

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