Book Reviews
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.

‘Right to die with dignity and living will are important for all of us’
On Thursday, California became the sixth state in the US to allow assisted suicide, following Oregon, Washington and Vermont. A few countries in Europe too allow assisted suicide. Coincidentally, Moneylife Foundation organised a discussion on the right to die with dignity, living will and euthanasia in its Knowledge Centre at Dadar, Mumbai.
 
In India euthanasia is illegal and is classified as murder. Living will is not recognised. Indeed, a pending bill on these issues has clear provisions asking doctors not to take cognisance of living will and medical power of attorney given to a doctor to put one to death. However, there are complex issues involved and it is not easy to take sides on this issue. Moneylife Foundation which takes up many citizen’s issues, invited Dr Suren Dhelia, a senior physician practising in South Mumbai and the Joint Secretary of Society for Right to Die with Dignity, and RN Bhaskar, a senior journalist, who has worked with several leading business papers and magazines to discuss this issue.
 
Bhaskar who is, or has been, a Consulting Editor with Free Press Journal and Forbes India, DNA, Business India and others, opened the discussion with a short presentation on the case of Aruna Shanbaug who was in a state of permanent vegetative state (PVS) after being raped and assaulted by a ward boy at Mumbai’s KEM Hospital. He explained how this case focused the country’s attention on the issue of euthanasia as it was debated and discussed all the way up to the Supreme Court, which eventually turned down a petition to let Ms Shanbaug die. Bhaskar explained the many dimensions of the issue that Supreme Court went into. Interestingly, the apex court hinted at the fact that had Ms Shanbaug had a living will expressing her preference to die in case she was in a PVS, the court might have considered it.
 
Dr Dhelia explained the many terms associated with the topics and the international scenario. He offered several strong ethical, philosophical and medical reasons why India must recognise doctor-assisted death, living will and medical power of attorney. The session ended with questions and answers from a packed audience, eager to know the ramifications of the issues.
 

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Nifty, Sensex may remain under pressure – Thursday closing report
We had mentioned in Wednesday’s closing report that Nifty, Sensex were struggling to head higher. The major indices of the Indian stock markets suffered a correction on Thursday and closed with losses of upto 0.95% over Wednesday’s close. The trends of the major indices in the course of Thursday’s trading are given in the table below:
 
 
 
Key Indian equity market indices were trading in the red during the afternoon session on Thursday as technology related stocks plunged. Good buying was observed in metal and oil and gas sectors. Selling pressure was seen in IT and technology, media and entertainment (TECK). Cues from Asian markets were in the negative and the major indices of the Indian stock markets also fell accordingly.
 
The US dollar dropped against most major currencies as investors lowered expectations for an interest-rate hike as early as June. In late New York trading on Wednesday, the euro rose to $1.1400 from $1.1365 of the previous session, and the British pound decreased to $1.4508 from $1.4564. The Australian dollar went up to $0.7472 from $0.7455. The dollar bought 106.86 Japanese yen, lower than 107.29 yen of the previous session. The dollar fell to 0.9587 Swiss francs from 0.9650 Swiss francs, and it inched down to 1.2711 Canadian dollars from 1.2767 Canadian dollars. Federal Reserve Chair Janet Yellen said on Monday that further US interest rate-hikes are likely on the way, but did not mention the timing of the hikes. She did not give a time-frame for raising interest rates like she did in May, which was interpreted by many market observers as "dovish".
 
The Indian rupee did not benefit from the troubles of the US dollar vis-à-vis other currencies. The US dollar was at Rs66.7755, up 0.45% in the afternoon on Thursday. Exporting companies in India are likely to come under revenue pressure. Overall, interest rates and currency markets are likely to have a bearing on FII (foreign institutional investors) investments in Indian stock markets rather than just corporate performance.
 
The Karnataka government on Wednesday announced a new retail trade policy to attract fresh investments into the state. "The policy relaxes retail norms and listing of food and grocery business under 'essential services' to protect establishments from closing during shutdowns and increases stocking limit," state Law Minister T.B. Jayachandra told reporters after the cabinet approved the policy. The new policy also allows the state labour department to simplify labour laws and prevent workers of retailers from resorting to strike or agitation under the Shops and Establishments Act. "The policy enables business establishments to work long hours and engage women workforce in night shift with conditions to ensure their safety and security," Jayachandra said. The government is of the view that the new policy would generate jobs and create opportunities for taking retail trade to rural areas and expand its presence in cities and towns across the state of Karnataka.
 
US stocks traded mostly higher as investors shifted their focus from a possible interest rate hike to gains in oil prices. The Dow Jones Industrial Average rose 30.51 points, or 0.17%, to 17,968.79 on Wednesday. The S&P 500 gained 1.85 points, or 0. 09%, to 2,113.98. The Nasdaq Composite Index ticked up 1.15 points, or 0.02%, to 4,962.90. Oil prices extended recent gains to trade nearly 1% higher on Wednesday. Both Brent and WTI held strong above $50 a barrel in early session, helped by a larger-than-expected US crude stockpile draw. US stocks closed mixed on Tuesday, as Wall Street continued to assess US Federal Reserve Chair Janet Yellen's speech on the US economy.
 
The top gainers and top losers of the major Indian indices are given in the table below:
 
 
The closing values of the major Asian indices are given in the table below:
 

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