Are corporates effecting Medical Practice?
21st century saw corporate giants enter into health care areas and have affected Medical Practice a lot. Few decades back, there were only public sector hospitals in most cities and very few private hospitals that too owned by a doctor or a group of doctors.
Entry of corporate into medical system has caused a significant change in the healthcare ecosystem and medical practice in India. With deep pockets and endless resources corporate giants have brought latest high end technology available to the patients, which if we would have relied only on public sector hospitals, might have taken couple decades more to come to India. Corporates, with their targeted business strategies, discipline, strict timelines and expert and efficient manpower has brought a culture of safer, cleaner, comfortable and higher efficiency into the hospitals. Overall corporate sector has made hospitals bigger, with all specialties and superspecialities, and all kind of diagnostic tools under one roof. These hospitals with their well defined strict protocol related health care have increased the efficiency of Medical and Para Medical staff as compared to govt. hospitals. This has led to improved patient safety, and faster initiation of treatment and shorter recovery time. And finally they have increased the salaries of their staff as well.
With all these goodies, corporate culture has caused some negative impact on medical practice too. All the luxuries and comfort of corporate hospitals demand investment and expenditure, which indirectly cause targets for each consultant working there to set on a higher level. These high targets cause a serious impact on medical practice and even on medical ethics. Some times such target force doctors to adopt certain practices he would have not done in different circumstances. The NEWS article recently published in TOI (mentioned below) describes such situation.
CHENNAI: The numbers speak of Chennai’s rise as a medical capital: More than two lakh cataract surgeries in a year, a two-fold jump in caesarean section, a sharp spiral in hysterectomies. They also belie an uncomfortable truth: Doctors are increasingly becoming scalpel-happy.
If your doctor asks you to undergo a cataract surgery, hysterectomy, gall bladder or tonsils removal, or an operation of the lower-back, please take a second opinion. Wide-ranging interviews with surgeons who testified before an NGO on corrupt practices in hospitals told TOI that often patients are forced to undergo unnecessary surgeries.
A senior orthopedic surgeon in a corporate hospital explained the reason behind this unsettling trend: “We have a quota to meet every month. Many of us see patients as a potential candidate on our operating table. Only two out of five, however, agree. Many go for a second opinion – and don’t return.”
The surgeon is among the 78 medical practitioners who provided testimony to Pune-based NGO SATHI (Support for Advocacy and Training to Health Initiatives) that compiled a report on unethical practices and corruption in healthcare. From Chennai, 12 doctors testified.
SATHI coordinator Dr Abhay Shukla said elective surgeries (that do not involve a medical emergency) are the most popular. “Many of these surgeries don’t involve too many risks, while at the same time fetches more revenue for the hospitals,” he said.
SATHI in February compiled a report on corrupt practices in healthcare. “A doctor said he was pulled up by the hospital administration for having only a 10% ‘conversion rate’ – referring to the number of patients who were advised to undergo surgery,” said Dr Shukla. “To be fair, the doctors are not entirely at fault. For a Rs2 lakh surgery, the doctor, probably gets Rs25,000, while the rest goes to the hospital,” he said.
Most of the doctors TOI spoke to preferred to talk on condition of anonymity. “It is easier to practice independently. It gives you more freedom to serve your patients’ interest. But, more people are drawn to the glamour attached to corporate hospitals,” said a cardio-thoracic surgeon at a multi-specialty hospital. He said doctors in his hospital are paid according to the number of procedures they undertake.
Dr George Thomas, former editor of the Indian Journal of Medical Ethics, said the country has few guidelines to check the practice. “Any system that rewards a doctor for the number procedures he does is liable to abuse,” he said. In many other countries, treatment procedures are framed by associations of different specialties along with government organizations.
Not every patient, however, is falling prey – many go for a second opinion. A patient narrated how his shoulder pain got better with exercise although a cardiac surgery was prescribed, while another spoke of how physiotherapy cured his back pain for which a surgery was recommended.
NEWS Source: TOI
