'Killer Nexus' Between Doctors And Diagnostic Centres

By Kunal Swamy | Hyderabad

INSIGHT The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine honestly. The oath however seems to have lost its relevance these days. 

The understanding between diagnostic centers and a large number of doctors referring patients for a variety of diagnostic tests has become a standard practice in Hyderabad which is mushrooming with hospitals. The gullible patients believe the doctor, in the interest of their well being.

Pathological tests were in recent decades, virtually the preserve of corner-store pathologists. Today they are a big business, with more than 8,000 diagnostic centers laboratories carrying out around 1 lakh tests daily. These range from routine examinations of blood sugar and cholesterol levels to complicated hormonal assays and immunological investigations. A number of pharmaceutical majors, home-grown laboratory chains and foreign players have set up shop in the city in the last five years.
Observe and understand these questions while you are making your bill in any diagnostic centre: Name, age, name of the doctor referred by (the doctor), age, sex is understood. But one cannot understand the reason behind the question, referred by “which doctor”. Do they call the doctor to discuss the symptoms or the test?

This is a travesty tale. Those who are meant to cure, have become the disease. For here’s a malaise that has spread far and wide across the city, state and country.

It is an open secret that diagnostic centers survive on prescription. According to industry sources, laboratories and diagnostic centers blatantly offer cuts to doctors who refer patients to them. Similarly, doctors from smaller clinics expect commissions when they refer patients to specialists at other clinics or hospitals. The cuts are said to range from 10% to 20%.Depending on the kind of test, most physicians directly receive their “fees” from the diagnostic centers.

But rogue operators collecting kickbacks are tarnishing the reputation of healthcare. It is time someone spoke about this so that the unethical practice is checked,” says Dr Vijayraghavan, a leading orthopadecian, who is not practicing now.

The mushrooming diagnostic centers are finding it difficult to survive the competition and to keep their income steady. They need to “attract” the doctors with various cuts. Super-specialty doctors demand 40 to 50 per cent cut in the overall bill, charged to the patient by the diagnostic centres. The patient ends up paying extra and he is the end user and the billing adds to the suffering. 

This is not about your neighbourhood private doctor alone. The malady is much more widespread. So widespread, there is no escaping it. Government hospitals, dispensaries, private hospitals, and individual practitioners big and small —- most doctors are getting fat envelopes under the table, courtesy prescriptions they write to diagnostic centers. 

The arithmetic is simple: In the case of an MRI, it is 40 percent; for a CT scan, he gets 30 percent. Thus, an MRI that costs Rs 5,000 to the patient brings Rs 2,000 to the doctor; a CT scan gets him Rs 1,000 and the list goes on.

These tests are undoubtedly important tools in diagnosis, and this has led to a situation where doctors send patients straight away for a series of tests without waiting to check for symptoms in making diagnoses. "In the past, diagnostic tools were few, and a doctor depended on the patient’s symptoms and observations. 

Today most doctors and consultants hardly have the time or the inclination to listen to the patient,'' said a doctor who did not want to be named. This gives rise to the question: Are these tests used for the benefit of patients or are they simple money spinning tactics, putting the patient and his family in unfounded fear.

Professionals or traders let the Hippocrates oath be reminded.