* * MUST READ & SHARE * * Lets be Hopeful & Respect Honest Doctors ** PATIENTS PAY THE PRICE - AIIMS doctors wage war on unnecessary medical tests ... ..... Slam Annual Check-Ups As Waste Of Money .... Top cardiologists of the All India Institute of Medical Sciences (AIIMS) in Delhi have decided to start an initiative called the Society for Less Investigative Medicine (SLIM)—a movement that aims to take on the growing menace of excessive medical investigations, starting with cardiology. Several studies globally have conclusively established that generalized annual health check-ups are unnecessary and add enormously to healthcare costs without any commensurate benefits. Several other screening tests and investigations have also been similarly shown to make little sense—other than adding to the bank balance of diagnostic centres and doctors who get a cut for sending patients for tests and investigations. This unhealthy practice has prompted Prof Balram Bhargava of the cardiology department in AIIMS, one of the key people behind SLIM, to raise an alarm over over-investigation, a practice that has become rampant simply because economic incentives were skewed in favour of recommend ing unnecessary tests. “But there is no regulation or audits on investigations to determine if they are necessary ,“ said Dr Bhargava. “Even in the US, where privatization is rampant, there are audits and guidelines regarding investigations and the health information technology used in most of the developed countries make it possible to retrieve and check data to see if a particular investigation or procedure was necessary. We need similar checks to stop this practice.” Rather than preventive check-ups of CT scans, angiograms and treadmill tests, it’s more useful to track risk factors, said Dr Bhargava. He pointed out the government too was wasting a lot of money by offering annual check-ups to its Group ‘ A’ officers above 40 under the Central Government Health Scheme. Already a number of top doctors have endorsed the scathing criticism of Dr Samiran Nundy, one of India’s leading gastroenterologists, of kickbacks and bribes that oil every part of the healthcare machinery (as reported by TOI on Saturday). One of the doctors, Dr M K Mani, chief nephrologist in Apollo Hospital in Chennai, has drawn the MCIs attention to this, but to no avail. SLIM is envisaged as an initiative to sensitise people about the kind of unnecessary investigations being pushed and will also draw up guidelines on when investigations or screening is required. “To begin with, we will be drawing up guidelines for investigations and procedures related to cardiology. Then we will be reaching out to doctors from other disciplines to draw up similar guidelines for their own fields so that there is a readily available check-list on what circumstances warrant different kinds of diagnostic tests and proce dures,“ explained Dr Bhargava, adding that in the UK such dubious practices could invite strong action from the General Medical Council, which was an effective deterrent. In a recent article in the British Medical Journal (BMJ) titled `General health checks dont work, Prof Peter C Gotzche, medical researcher and director of the Nordic Cochrane Centre, along with two doctors, wrote that systematic trials in Europe and the US have found that general health check-ups had no effect on total mortality or on mortality due to cardiovascular disease or cancer. “Screening programmes for healthy people are justifiable only when randomized trials clearly show that benefits outweigh harms. *************************************************************************** ******************************************************************************** *** Docs to draw up rules for med tests *** Top cardiologists of the All India Institute of Medical Sciences (AIIMS) in Delhi have decided to start an initiative called the Society for Less Investigative Medicine (SLIM)—a movement that aims to take on the growing menace of excessive medical investigations, starting with cardiology. Several studies globally have conclusively established that generalized annual health check-ups are unnecessary and add enormously to healthcare costs without any commensurate benefits. Several other screening tests and investigations have also been similarly shown to make little sense—other than adding to the bank balance of diagnostic centres and doctors who get a cut for sending patients for tests and investigations. This unhealthy practice has prompted Prof Balram Bhargava of the cardiology department in AIIMS, one of the key people behind SLIM, to raise an alarm over over-investigation, a practice that has become rampant simply because economic incentives were skewed in favour of recommend ing unnecessary tests. “But there is no regulation or audits on investigations to determine if they are necessary ,“ said Dr Bhargava. “Even in the US, where privatization is rampant, there are audits and guidelines regarding investigations and the health information technology used in most of the developed countries make it possible to retrieve and check data to see if a particular investigation or procedure was necessary. We need similar checks to stop this practice.” Rather than preventive check-ups of CT scans, angiograms and treadmill tests, it’s more useful to track risk factors, said Dr Bhargava. He pointed out the government too was wasting a lot of money by offering annual check-ups to its Group ‘ A’ officers above 40 under the Central Government Health Scheme. Already a number of top doctors have endorsed the scathing criticism of Dr Samiran Nundy, one of India’s leading gastroenterologists, of kickbacks and bribes that oil every part of the healthcare machinery (as reported by TOI on Saturday). One of the doctors, Dr M K Mani, chief nephrologist in Apollo Hospital in Chennai, has drawn the MCIs attention to this, but to no avail. SLIM is envisaged as an initiative to sensitise people about the kind of unnecessary investigations being pushed and will also draw up guidelines on when investigations or screening is required. “To begin with, we will be drawing up guidelines for investigations and procedures related to cardiology. Then we will be reaching out to doctors from other disciplines to draw up similar guidelines for their own fields so that there is a readily available check-list on what circumstances warrant different kinds of diagnostic tests and proce dures,“ explained Dr Bhargava, adding that in the UK such dubious practices could invite strong action from the General Medical Council, which was an effective deterrent. In a recent article in the British Medical Journal (BMJ) titled `General health checks dont work, Prof Peter C Gotzche, medical researcher and director of the Nordic Cochrane Centre, along with two doctors, wrote that systematic trials in Europe and the US have found that general health check-ups had no effect on total mortality or on mortality due to cardiovascular disease or cancer. “Screening programmes for healthy people are justifiable only when randomized trials clearly show that benefits outweigh harms. ******************************************************************** ********************************************************************* **** Row over docs getting cuts for patient referrals ***** Eminent doctors across India are unified in their opinion that doctors play a key role in “the kickbacks and bribes that oil every part of the healthcare machinery“. The debate was sparked by an article in the British Medical Journal on corruption in the Indian medical practice a couple of months ago followed by an editorial on the same issue in the latest issue of the British journal written by Dr Samiran Nundy , one of Indias leading gastroenterologists. Dr Nundy said corruption was all pervasive in healthcare delivery in the country , starting with capitation fees for entry into medical colleges. An editorial by Dr Nundy , chairman of the department of surgical gastroenterology and organ transplan tation at Sir Ganga Ram Hospital, titled `Corruption in Indian Medicine, came out just as the Kokilaben Dhirubai Ambani Hospital (KDAH) in Mumbai acknowledged, in a letter to the Maharashtra Medical Council, that it offered “incentives to doctors“ to refer patients to the hospital (first reported in TOI on May 13 with a followup on June 15). TMMC stated that the hospital had been sending out forms to various doctors to enroll in a forum promising a reward of Rs 1 lakh for 40 admissions per annum, Rs 1.5 lakh for 50 admissions and Rs 2.5 lakh for 75 admissions. The article to which Dr Nundy responded was written by an Australian doctor, Dr David Berger, who had volunteered in a small charitable hospital in the Himalayas. He spoke of how reference for an electrocardiogram (ECG) at a private heart clinic or other investigations attracted 1015% kickback to the referring doctor. “I saw one patient with no apparent structural heart disease and uncomplicated essential hypertension who had been followed up by a city cardiologist with an echocardiogram every three months, a totally unnecessary investigation,“ said Dr Berger. “In many of our five-star corporate hospitals, where the main motive seems to be profit for the shareholders, there is an institutionalized system of so called `facilitation charges or fees for `diagnostic help given to physicians who refer patients regularly and for expensive procedures like organ transplants which may reach Rs 1-2 lakh,“ said Dr Nundy , adding that doctors were confronted by financial officers of hospitals asking them to justify whether they deserved their salaries especially when the revenue they generated for the hospital from investigations and operations fell short of set goals. The “temptation“ to do “unnecessary investigations like CT scans and MRI“ and “unnecessary procedures like C-sections and hyterectomies“ was “hard to resist“, he added. Dr M K Mani, chief neph rologist in Apollo Hospital Chennai, told TOI that the practice of doctors getting kickbacks from any expensive operation or diagnostic procedure was pervasive and openly done. “In the case of doctors who have pointedly refused to take such `cuts, it is given back to the patients as discounts. But hospitals have not stopped this practice and doctors who take such cuts continue to do so. In 1995, I had filed a complaint with the medical council with all the relevant proof and yet the council took no action,“ said Dr Mani. Dr Mani had been given cheques as “professional charges“ by an institution for referring patients for a particular procedure. He wrote to the medical council stating that the councils guidelines clearly stated that it was not acceptable for medical practitioners to indulge in fee splitting. “It is a common practice for institutions running high tech and high cost investigations and treatments to offer inducements to doctors who refer patients to them for investigation or treatment. I believe this practice is no less reprehensible, and no less detrimental to the interests of the patient,“ Dr Mani had said in his complaint to the council. Dr Sanjay Nagral, surgical gastroenterologist in Jaslok Hospital in Mumbai and a member of the editorial board of the Indian Journal of Medical Ethics, believes that the widespread practice of cuts is linked to the way the private sector, which has grown to dominate healthcare in India, is vying for the market. In the case of nationalized healthcare, as in the UK, doctors are paid a full time salary so that there is no incentive for them to recommend unnecessary procedures or investigations, Dr Nagral said to TOI. ********************************************************************** *** `Kickbacks for docs rampant in many corporate hospitals *** Eminent doctors across India are unified in their opinion that doctors play a key role in “the kickbacks and bribes that oil every part of the healthcare machinery“. The debate was sparked by an article in the British Medical Journal on corruption in the Indian medical practice a couple of months ago followed by an editorial on the same issue in the latest issue of the British journal written by Dr Samiran Nundy , one of Indias leading gastroenterologists. Dr Nundy said corruption was all pervasive in healthcare delivery in the country , starting with capitation fees for entry into medical colleges. An editorial by Dr Nundy , chairman of the department of surgical gastroenterology and organ transplan tation at Sir Ganga Ram Hospital, titled `Corruption in Indian Medicine, came out just as the Kokilaben Dhirubai Ambani Hospital (KDAH) in Mumbai acknowledged, in a letter to the Maharashtra Medical Council, that it offered “incentives to doctors“ to refer patients to the hospital (first reported in TOI on May 13 with a followup on June 15). TMMC stated that the hospital had been sending out forms to various doctors to enroll in a forum promising a reward of Rs 1 lakh for 40 admissions per annum, Rs 1.5 lakh for 50 admissions and Rs 2.5 lakh for 75 admissions. The article to which Dr Nundy responded was written by an Australian doctor, Dr David Berger, who had volunteered in a small charitable hospital in the Himalayas. He spoke of how reference for an electrocardiogram (ECG) at a private heart clinic or other investigations attracted 1015% kickback to the referring doctor. “I saw one patient with no apparent structural heart disease and uncomplicated essential hypertension who had been followed up by a city cardiologist with an echocardiogram every three months, a totally unnecessary investigation,“ said Dr Berger. “In many of our five-star corporate hospitals, where the main motive seems to be profit for the shareholders, there is an institutionalized system of so called `facilitation charges or fees for `diagnostic help given to physicians who refer patients regularly and for expensive procedures like organ transplants which may reach Rs 1-2 lakh,“ said Dr Nundy , adding that doctors were confronted by financial officers of hospitals asking them to justify whether they deserved their salaries especially when the revenue they generated for the hospital from investigations and operations fell short of set goals. The “temptation“ to do “unnecessary investigations like CT scans and MRI“ and “unnecessary procedures like C-sections and hyterectomies“ was “hard to resist“, he added. Dr M K Mani, chief nephrologist in Apollo Hospital Chennai, told TOI that the practice of doctors getting kickbacks from any expensive operation or diagnostic procedure was pervasive and openly done. “In the case of doctors who have pointedly refused to take such `cuts, it is given back to the patients as discounts. But hospitals have not stopped this practice and doctors who take such cuts continue to do so. In 1995, I had filed a complaint with the medical council with all the relevant proof and yet the council took no action,“ said Dr Mani. Dr Mani had been given cheques as “professional charges“ by an institution for referring patients for a particular procedure. He wrote to the medical council stating that the councils guidelines clearly stated that it was not acceptable for medical practitioners to indulge in fee splitting. “It is a common practice for institutions running high tech and high cost investigations and treatments to offer inducements to doctors who refer patients to them for investigation or treatment. I believe this practice is no less reprehensible, and no less detrimental to the interests of the patient,“ Dr Mani had said in his complaint to the council. Dr Sanjay Nagral, surgical gastroenterologist in Jaslok Hospital in Mumbai and a member of the editorial board of the Indian Journal of Medical Ethics, believes that the widespread practice of cuts is linked to the way the private sector, which has grown to dominate healthcare in India, is vying for the market. In the case of nationalized healthcare, as in the UK, doctors are paid a full time salary so that there is no incentive for them to recommend unnecessary procedures or investigations, Dr Nagral said to TOI. Unlik
Posted on: Sun, 29 Jun 2014 09:16:16 +0000
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