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Doctors or Demons

Most of us consider doctors as next to God if not God. We still have many doctors with impeccable ethical records. However, there are many others - not so ethical, and their number is on the rise who don’t think twice before taking their patients for a ride. 

The public is losing their trust in doctors. They see doctors as driven for profit. They feel doctor don’t listen to their concerns anymore and don’t care what they want or need.

The arrest of 14 practicing doctors from Parsa, Chitwan , Biratnagar in coordination with Central Investigation Bureau of Nepal and district police offices for driven patients for profit . 

Some of the common tactics used by money-minded doctors to cheat or fleece gullible patients of their hard earned money are:

Prescribing more tests than necessary to be done at preferred labs( whether in-house at big hospitals or outside labs) for hefty commissions. Sometimes these tests are not even conducted on the samples taken, and fake results are given. 

Keeping you admitted at hospital rooms when you're fit to be discharged. A doctor attempted this trick recently at a private hospital in Nepalgunj. 

Prescribing expensive medicines/ vaccines when cheaper and quality substitutes are available.Often many such medicines/vaccines are available only at prescribed chemist shops. That benefits pharma companies and the doctors who prescribe them but inflate the bills for patients.

Charging patients at different rates for the same treatment.Private hospitals and clinics are charging according to the room a patient selects even for the same operation by the same doctors in the same operation theatre.

Fake operations this is how it happens. A doctor can assess that you can be made to pay. He will say that you need an urgent operation when you don’t really need it. If you’re still not convinced he’ll say that he needs to send a tissue from your throat for testing whether it has a cancerous cell. Most of us don’t argue with our doctors. So you’ll agree. He’ll admit you and give you anaesthesia.

Unconscious you will be wheeled into operation theatre where your conscious relatives will not be allowed. After few hours, you’ll be taken out drowsy. After you wake up the doctor will come and say that he has sent your tissue for testing though he doesn’t think you got cancer but he wants to be doubly sure. Can you argue? This happens with many patients. After the operation, the doctor simply forget that he has to discuss the test results before the operation he was very concerned. When relatives approach them to discuss the results of the test even without looking at the reports doctors smile and say nothing to worry.   

Use of stent in heart disease treatment even if not needed – 1 stent may cost a patient anything between Rs. 40,000 -100,000 or more depending upon the status of hospitals or pockets of gullible patients. It's not uncommon to give stents to patients at 3 times the import price. Worse, it may be harmful and may cause death yet doctors take bribes to recommend stents. 

Gynecologists at private hospitals are well known to force pregnant women to go for C-section which pays better than normal deliveries.

Last but not the least, is luring poor and uneducated people for agreeing to donate organs, kidney in particular, for which there is no dearth of high paying customers as highlighted by the arrests at Kavre, Nepal .  

With profit making being their main motive, private hospitals are pushing doctors through a system of incentives and disincentives to over-bill using whatever means – ethical or unethical – they can think of. With seats in the subsidized government medical colleges being limited, many medical aspirants opt for private medical colleges that charge hefty capitation fees. This makes doctors vulnerable to the whims of private hospitals that pay good money to their empanelled doctors – needed to recover high investments in medical education.

NMC is not effective in checking malpractices and corruption in medical field, a system of the standardized treatment protocol may help check some abuse but may constrain doctors in treatment. In some cases, it may raise the cost of treatment. Preferred hospital network system though has improved convenience, but is enough to check unscrupulous doctors.

Can economics provide any insights to help addressing the growing menace of medical malpractices? I had like to submit that tweaking the system of incentives and disincentives, and improved access to information and a more transparent healthcare market more transparent will help. 

Increasing the supply of seats in govt. medical colleges and capping capitation fee will reduce the investment cost of medical students and hence their vulnerabilities to give in to uncontrolled pursuit of profit by private hospitals that pushes them to cheat and overbill.

Mandatory recording, archiving and sharing of the recording with patients or their representatives

At present, private hospitals do publish the credential of its specialist doctors like education and past experience. How about adding the following information as well say about its gynaecologists:

  • Total deliveries in the last 3 years
  • Normal deliveries
  • C-section

Such information will help patients take informed decisions about which doctor to go to for a treatment. Maybe, the doctors (especially those who're ethical and there are still many) should come forward and provide the above information whether asked or not. 

Rating and ranking of top specialist doctors in fraud prone specializations such as kidney transplant, gynaecology and heart - by a third party independent agency and the ratings to be made available online – without any restrictions

Rating of hospitals based on basic infrastructure, charges, indicators of ethical business practices like how many medical malpractice suits filed against... 

The above measures can check most of the malpractices but not all. For serious deviant, stringent punishments including permanent disbarment and imprisonment will be needed.

Aggrieved patients should take their grievances to consumer courts which are cheaper, faster and don’t require lawyers for representation. In addition, given the pervasiveness of the internet and social media, it's important that we share our experiences good as well as bad with doctors and hospitals. If we do, unethical doctors and hospitals will start losing patients that will force them to change their ways. Similarly, good doctors and hospitals should be promoted. 

Next time, when you’re being discharged from a private hospital, please check whether you have your kidneys intact or not. (Another friend smsed me this joke that didn’t make me laugh…try laughing yourself) 

 

 

 

 

 

 

 

 

 

 

 


 

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