A scene at a private medical college hospital. A patient who was brought to the ICU was pronounced dead on arrival by junior doctors, but the senior doctor did not agree with them and instructed the staff to put the ‘patient’ on ventilator. A number of tests followed. After about three hours, the hospital authorities handed the person’s relatives a bill of Rs 26,000 along with the death certificate!
In another incident, the doctors ‘treated’ a 74-year-old woman who was dead even before reaching the same hospital and collected Rs 26,000 from her relatives towards the bill!
This is not a one-off incident. Such ugly scenes and unscrupulous practices get repeated every day, thanks to the cut-throat competition among corporate hospitals and the large-scale commercialisation of healthcare in the State’s private sector.
It is the duty of the doctors to let patients know the kind of tests they have to undergo. However, they conveniently forget that the patients have the right to seek answers to three basic questions to understand their condition.
To improve the healthcare sector in the State, these questions need to be raised frequently by patients in our hospitals. What are the treatments planned? How will I be treated? When will the treatment start?
The hospital as well as the doctors are obliged to inform the patients about the probable diagnosis, treatment planned, and the prognosis of the disease. Unfortunately, a section of medical practitioners pretends that they are not answerable to anybody.
Among the States in India, Kerala desperately needs a system called medical auditing. As per records, Clinical Audit was introduced by Florence Nightingale during the 1853-55 period. The process envisages improving the quality of services delivered at hospitals through monitoring and regulation. It has been made mandatory in hospitals in the United States and European countries. However, in India, it is followed only by the Army Medical Corps.
It took me three years of strenuous efforts to implement this system in Oman when I was the director of the Armed Forces Medical Services in that country a few years ago. Care and treatment protocols for each disease were prepared and they are made compulsory in the hospital. The number of diagnostic tests ordered by the doctors decreased by 50 per cent in two years. There was a significant drop in the CT scans and X-rays as well. In recognition of this achievement, I was conferred the medal for distinguished and meritorious services by the Ministry of Defence, Oman.
The Clinical Audit system should focus on processes involved in three priority areas: the stages of diagnosis, treatment, as well as the advanced services that include surgeries.
Most of the doctors prefer short-cut but costly methods to diagnose illness when the reality is that only a few patients need to be undergone high-cost and risky tests.
Many medical practitioners concede that many a time, profit-driven hospitals try to maximise number of surgeries and procedures, even if they are unnecessary. The doctors too get hefty commission, amounting to one third of the total charges, through this unethical ‘cut practice’. Many doctors working in the State’s private hospitals are under pressure to carry out unnecessary tests and procedures to meet revenue targets.
How many patients are aware of the fact that if they undergo a CT scan of abdomen, they will be subjected to radiation levels of 500 chest X-rays. If the patient is referred to another hospital, he/she will have to repeat all these tests!
Now, voices have been raised against such unwarranted practices from different parts of the world. In an opinion poll conducted among the doctors registered with the American Board of Internal Medicine, 91 per cent stood against extensive and needless check-ups and tests. They also demanded a legislation to prevent such practices. In India too there are efforts to bring about a change. An organisation called SLIM (Society of Less Investigative Medicine) has been formed at the Delhi-based All India Institute of Medical Sciences (AIIMS) to push this cause. The forum has pledged to work towards cutting down the number of tests undertaken by various departments of the hospital, including the cardiology division.
In a recent announcement, the World Health Organisation (WHO) has warned about an apocalyptic threat from antibiotic resistant bugs. The report stated that overuse and misuse of antibiotics have led to the rise of the antibiotic resistance. Alarmingly, we don't have new antibiotics that we can rely on in the immediate future.
If a person gets infected by the MRSA, E-coli or the NDM-1 bacteria, all that the doctors can do for the patient is to pray for him or her! The indiscriminate use of antibiotics is the only reason for this terrible situation.
Notably, the countries consuming the most antibiotics overall are India and China. In most of the other countries, doctors prescribe antibiotics more judiciously because they are answerable to the Medical Audit Committee. The license of the first-time offenders would be suspended for three months. The punishment would be for six months for the second-time offence and if the person repeats the mistake, he/she would face a lifetime ban.
Doctors persuading patients into surgery or other unnecessary procedures is a common sight in our hospitals. A study of the natural delivery birth versus Caesarean section would bring about glaring anomalies between them. The WHO advises that caesarean rates in any country should account for no more than 10-15 per cent of all births. On the contrary, it is natural delivery which has become so rare in our hospitals! There is also a trend of planning caesarean deliveries in accordance with an auspicious time!
In the western countries, it is not easy to consult a specialist doctor. A patient will have to go to a general practitioner first, and the patient would be referred to the specialist only if it is necessary.
In our country, there no such system. People would consult a specialist doctor even for a mild headache. If the patient hesitates, the hospital authorities would refer the person to the specialist doctor.
To put curbs on such unhealthy practices, Medical Auditing should be made mandatory. A team under the Director of Health Services would be kept ready to conduct surprise inspections at all hospitals.
(The author, a native of Mayyanad in Kollam, is the former director of the Armed Forces Medical Services, Sultanate of Oman)
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