5. COMMISSIONS/CUT PRACTICE A pathologist in a big city shared, 'I did a job in a private set-up for fourteen years. Since the past eight months, I am running my own private practice, having left my lab in the city. A lot of very problematic things are going on nowadays.
If I practise ethically, no patients are sent to me. One is expected to do all kinds of things: giving cuts, throwing parties with liquor thrown in, giving doctors whatever reports they want—for example, presenting the Widal Test for typhoid in a way that the doctor can admit the patient, even when he does not have typhoid. Out of 150 doctors whom I am in contact with, there are at the most three or four doctors who find my reports excellent and therefore send me patients without expecting anything in return. Just three or four! Today I am able to manage only because I have other sources of livelihood. '
'Nowadays doctors don't record the [patient's] history properly,' said Dr Punyabrata Goon, a GP in Kolkata. 'They don't even examine the patient. They just write out a list of investigations. Because they get a commission for doing that. Almost all the laboratories in our area give 50 per cent commission and almost all the doctors accept these commissions. For many doctors, the money earned through commissions is much more than that earned from fees.
In our area, the commission rates are: X-rays 25 per cent, and 33 per cent for MRIs and CT scans.
A paediatrician in Delhi, Sanjay Bhatnagar explained how the system is harmful: 'I don't take cuts. I tell patients to go wherever they please to get the investigations done. The patient then goes to his own GP and asks him where he should do the test. The general practitioner gives him a slip referring him to a pathologist, and gets a cut for this. But I have no faith in that report. Unfortunately I cannot even tell the patient where the problem lies. ' A big city physician explains how even those who refuse to take cuts are drawn into the system: 'The routine hospital charges actually include the cuts. And even though I do not take cuts, this extra amount is not reduced from my patients' bills. Given this situation, many people ask me what I achieve by not taking cuts. I don't know. I consider taking cuts to be unethical and I don't take them. When I inquired, I was told that the hospital transfers the cuts that I do not take to a separate fund, which is used for emergency expenditures! '
'Nowadays the charges in the medical sector have increased to the extent that even I wonder whether I will be able to afford them in future,' lamented Dr Pratibha Kulkarni, a gynaecologist from Pune.
Most private hospitals, whether small or Big, are part of this system, though the latter are more transparent. A GP practising in a metropolis explained, 'The running charges in a small hospital are the same as in a multi-speciality hospital. But in the multi-speciality hospitals to which I send my patients, there is a rate chart, there is transparency. In small hospitals, protocols and rules are not followed for diagnosis and treatment. They charge whatever they want, and they extract as much money as they can from patients. I will not support the practice of cuts. Neither do I take cuts. Some general practitioners say that there is an outrageous disparity between their bills and those charged by specialists and hospitals. People do not pay even a little extra money to a general practitioner. But they will pay whatever specialists and hospitals demand. Then what is wrong with taking a share of that money? But I don't agree with this practice. Why should I cut into my patients' pockets when I refer a case that I cannot manage, to a specialist or hospital? No. Cuts cannot be justified whatever the reason behind them. Yes, one thing should change: One should ensure that hospitals and specialists levy only reasonable charges—we need a system where the current anarchy does not continue. '
reasonable c not continue.' need a system where the current anarchy does The cuts come under all sorts of heads. Dr Suchitra, a GP from Chennai, revealed, 'I happily refused to become a person who accepts commissions. Once a laboratory PRO visited me. He offered me a certain percentage as "IC". I did not even know what IC stood for. Apparently, it means "Interpretation Charges". What blasted interpretation? There is nothing in the laboratory report on which I can use my knowledge. This was nothing but a cut under a cute name. I refused, and told them to give the cut to the patient.' 'The way the "cuts" system works is, it actually operates against those who refuse to take them,'
If I practise ethically, no patients are sent to me. One is expected to do all kinds of things: giving cuts, throwing parties with liquor thrown in, giving doctors whatever reports they want—for example, presenting the Widal Test for typhoid in a way that the doctor can admit the patient, even when he does not have typhoid. Out of 150 doctors whom I am in contact with, there are at the most three or four doctors who find my reports excellent and therefore send me patients without expecting anything in return. Just three or four! Today I am able to manage only because I have other sources of livelihood. '
'Nowadays doctors don't record the [patient's] history properly,' said Dr Punyabrata Goon, a GP in Kolkata. 'They don't even examine the patient. They just write out a list of investigations. Because they get a commission for doing that. Almost all the laboratories in our area give 50 per cent commission and almost all the doctors accept these commissions. For many doctors, the money earned through commissions is much more than that earned from fees.
In our area, the commission rates are: X-rays 25 per cent, and 33 per cent for MRIs and CT scans.
A paediatrician in Delhi, Sanjay Bhatnagar explained how the system is harmful: 'I don't take cuts. I tell patients to go wherever they please to get the investigations done. The patient then goes to his own GP and asks him where he should do the test. The general practitioner gives him a slip referring him to a pathologist, and gets a cut for this. But I have no faith in that report. Unfortunately I cannot even tell the patient where the problem lies. ' A big city physician explains how even those who refuse to take cuts are drawn into the system: 'The routine hospital charges actually include the cuts. And even though I do not take cuts, this extra amount is not reduced from my patients' bills. Given this situation, many people ask me what I achieve by not taking cuts. I don't know. I consider taking cuts to be unethical and I don't take them. When I inquired, I was told that the hospital transfers the cuts that I do not take to a separate fund, which is used for emergency expenditures! '
'Nowadays the charges in the medical sector have increased to the extent that even I wonder whether I will be able to afford them in future,' lamented Dr Pratibha Kulkarni, a gynaecologist from Pune.
Most private hospitals, whether small or Big, are part of this system, though the latter are more transparent. A GP practising in a metropolis explained, 'The running charges in a small hospital are the same as in a multi-speciality hospital. But in the multi-speciality hospitals to which I send my patients, there is a rate chart, there is transparency. In small hospitals, protocols and rules are not followed for diagnosis and treatment. They charge whatever they want, and they extract as much money as they can from patients. I will not support the practice of cuts. Neither do I take cuts. Some general practitioners say that there is an outrageous disparity between their bills and those charged by specialists and hospitals. People do not pay even a little extra money to a general practitioner. But they will pay whatever specialists and hospitals demand. Then what is wrong with taking a share of that money? But I don't agree with this practice. Why should I cut into my patients' pockets when I refer a case that I cannot manage, to a specialist or hospital? No. Cuts cannot be justified whatever the reason behind them. Yes, one thing should change: One should ensure that hospitals and specialists levy only reasonable charges—we need a system where the current anarchy does not continue. '
reasonable c not continue.' need a system where the current anarchy does The cuts come under all sorts of heads. Dr Suchitra, a GP from Chennai, revealed, 'I happily refused to become a person who accepts commissions. Once a laboratory PRO visited me. He offered me a certain percentage as "IC". I did not even know what IC stood for. Apparently, it means "Interpretation Charges". What blasted interpretation? There is nothing in the laboratory report on which I can use my knowledge. This was nothing but a cut under a cute name. I refused, and told them to give the cut to the patient.' 'The way the "cuts" system works is, it actually operates against those who refuse to take them,'
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