It’s Impossible To Trust Indian Doctors Again After Reading Excerpts From This Book

Behold the rise of ‘hospital malls.’ Where doctors send patients for umpteen unnecessary tests and procedures, partially off their own accord, and partially due to the very tight leash pharmaceutical companies have them on. Make no mistake either, these companies are more than willing to yank the medical professionals in whatever direction they choose. Far away from a patient’s care all the way to wherever the profit is. And when these very men in whose hands we entrust our lives are so susceptible to the pressures of the market, unwitting patients have no option but to shell out money they can’t afford to spend. These sweeping statements aren’t the basis of an upcoming sci-fi novel by Robin Cook. They are actually the legitimate findings from a very real study conducted by two Indian doctors, Dr. Arun Gadre and Dr. Abhay Shukla with the help of SATHI, Pune (Support for Advocacy and Training to Health Initiatives.)

In their book, ‘Dissenting Diagnosis,’ 78 doctors from seven cities and 17 towns across the country have been interviewed about their experience of the commercialization of the health industry. Right from General Practitioners, ENT specialists, ophthalmologists, surgeons, cardiologists, diabetologists, anesthesiologists, gynaecologists and more have been documented in this tell-all with some revealing their names while others preferred to remain anonymous. With great concerns for the health sector, growing unethical practices and the misuse of the Private Public Partnership model in hospitals, this book tries to deal with the rot that is spreading its tentacles far and wide in the medical industry. Because as they so succinctly put it in their book, “If the medical sector is left to the mercy of the market, and if the foundation of the whole business is profit, where does it leave or take all of us?”

With permission from the authors, here are some of the flaring malpractices they uncovered, supported by excerpts from their book.

‘Cut’ based practice and bribery: Of the doctors, By the doctors, For the doctors

In the book, a doctor reveals how many of his peers get cuts and kick-backs for performing unnecessary surgeries and suggesting unwanted tests. He said,”One patient turned up at a hospital for an operation as he had been diagnosed with hernia. But it wasn’t a hernia at all! Sometimes even when there is no serious ailment, a pretence of surgery is performed. Nothing is really wrong with the patient. But he is given anesthesia and some stitches are put on the skin, to show that an “operation” has been done. A huge, completely unnecessary bill is charged.”

In addition to this horror, doctors are allegedly routinely bribed with foreign trips, monthly alcohol parties and even diamond necklaces for the doctor’s wife. A Judge, who needed a medical report from a government sponsored doctor for his promotion was actually given a report of high blood pressure when an independent report suggested that everything was normal. The doctor asked for a bribe to change the reports to which the judge didn’t comply. In a similar way, a completely normal person was diagnosed with diabetes by a pathologist so that he could get a cut from the referring doctor. Such anecdote suggest that nobody is safe from this systematic bribery occurring at every level.

‘Sink’ Tests

Now imagine giving your blood, urine, and much more for testing but somebody is simply throwing it into a sink, without testing. Welcome to the world of ‘sink tests.’ As explained in the book by a pathologist himself, ‘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. Many doctors have inadequate knowledge of new tests that have developed—and no desire to learn about them. A new test for TB has been developed. It is clearly written in the test information that it cannot be performed on blood, but only on abdominal and lung fluids. Nevertheless, certain doctors give instructions to perform this test on blood samples. As pathologists, we don’t try to enlighten the doctors on such issues, because then their pride is hurt, and then they stop sending us samples.’

The use of railway touts and auto rickshaw drivers for patient referral

Dr Subhash Patil, a gynaecologist from Sangli, Maharashtra, described how even going to a hospital of your own choice can be a problem: ‘At 2 a.m., autorickshaw drivers here tell patients directly, “I don’t know the hospital you are talking about.” Because he will take the patient only to the hospital that offers him a cut.

Dr. Abhay Shukla said that it is a common tactic of Public Relations Officers (PRO) of hospitals. “His main job is to ensure that the beds in his hospital are full. For this, he offers commissions to rural doctors, unqualified doctors, non MBBS doctors and quacks. He is running an industry that needs raw material and for them, it is the patient. These doctors in small towns and villages are now agents of these people. their main income comes from referrals. These marketing agents also rope in touts at railway stations who promote their hospitals to travellers. They also get motorcycle doctors in villages, who are basically quacks, to also get them patients. It is a nexus, a racket.”

It gets worse for pregnant women

Pregnant women are the best targets as they willingly get all tests that are recommended to them done for the sake of their unborn child. A gynaecologist observed how pregnant women were asked to do regular heamograms and kidney, liver function tests when there was no need to. Another one also mentioned how a woman was declared infertile after various tests at a big hospital when actually she was three months pregnant. Many mothers were asked to not breast-feed the baby so powder milk consumption could be driven up, a nod towards the murky role pharmaceutical companies are also playing in this show.

A big-city general surgeon informed Gadre and , ‘A gynaecologist put a stitch in a pregnant woman’s uterus. Thereafter, probably due to the needle having mistakenly caused some damage to the membranes around the foetus, she began to drip fluid. Being worried, after a couple of days she went back to the gynaecologist. Her houseman removed the stitch and delivered the baby. But due to the earlier damage, she developed a severe infection. She was admitted to a corporate hospital, which performed a sonography every day. Every sonography report showed pus formation in her lower abdomen. That pus could have been immediately removed by just inserting a needle. But they were not doing anything. When I inquired, I came to know a shocking reality. That corporate hospital has a totally irrational rule: to charge double when the case enters the second week of admission and onwards. I’m sure that all this time-wasting was done in her case, so that they could charge the patient at double rates.

An eye for an eye

The book also mentions an instance that would bring chills down anybody’s spine. It suggests a homeopathic doctor advised steroid based drops for a 4-year-old girl. the girl had to undergo an eye surgery as she developed cataract from the drops. Old people who need better spectacles have been advised to undergo cataract surgery, which rob them of their insurance.

Death is just as profitable too

If you were wondering about where the conscience of these people lie, you should know that even the death of a patient can be profitable for some hospitals. In an excerpt from the book a doctor shares a terrifying tale. “I’ll tell you a true story. There was a death in a corporate hospital in the nearby city. A bill of Rs 16 lakh was prepared for a simple case of heart attack. The relatives didn’t have the money so the corporate hospital hid the dead body! Finally the DSP had to raid the hospital.”

Dying patients are often told they have a chance of survival so the bills keep raking up. Many people have and also been on the verge of selling their homes to pay these costs. Many lives have been lost to negligence. A doctor himself died when the hospital he was admitted to did not carry the life changing sonography that was suggested by another Doctor from outside the hospital till the last minute. It was too late and the doctor died but a bill of Rs. 8 lakh was made for the wife to pay. The deceased doctor’s friends demanded an explanation and after a volley of threats, the cost was brought down to Rs. 4 lakh.

Ultimately, the book does share a few positive points as well through their chapters. Interesting interviews have doctors emphasizing on a good relationship between the doctors and patients and their claims as to how a patient’s blood sugar comes down after talking to an empathetic doctor. There are situations where doctors have to give up their practice as well due to non-compliance with peer pressure, or because patients who go with the herd mentality. The real question that arises is if doctors are working only to earn as much money as possible or follow the sacred hippocrates oath? Could the government bring a change by allocating more percentage of its GDP to healthcare and regulating the pharma industry that pushes expensive medicines down a patients throat?

Dr. Shukla is optimistic as the parliamentary committee on health and the Supreme Court are coming down heavily on the Medical Council of India(MCI). “MCI is supposed to regulate the doctors around the country but have clearly failed to do so. Anybody can charge any amount for any procedure. Both the parliament and SC have been vocal about their failure and have asked for its re-organisation and ensure ethical conduct.” On top of all of this, the doctors even organized a coalition in Delhi, which was supported by many national medical networks. As they said themselves, “we now see an organised voice coming from every corner of the nation where doctors feel suffocated and isolated in being ethical. There is a collective interest in reforming the system.” We can only hope that more doctors resonate with their sentiment.

[Excerpted with permission from ‘Dissenting Diagnosis’ by Dr.Arun Gadre and Dr.Abhay Shukla and publishers Penguin Random House.]