The movement to curtail un-necessary investigations is picking up. Several doctors from all over India and across disciplines are joining hands to fight against the menace of unnecessary investigations. The Society for Less Investigative Medicine (SLIM), initiated by a few cardiologists in the All India Institute of Medical Sciences (AIIMS) in Delhi, is now gaining ground.
According to a report in TOI, SLIM will start off by putting together a list of what investigations ought not to be done in normal circumstances in different fields of medicine accompanied by a detailed explanation of how over-diagnosis from such tests could lead to unnecessary treatment that would not only be a waste of resources but could also harm patients.
Such lists have been produced by doctors in several countries looking to cut down on over-investigation and consequent over-diagnosis. While SLIM mirrors this global movement now spanning 12 countries, one of its initiators, Dr Balram Bhargava of the AIIMS cardiology department, pointed out that SLIM would be rooted in the reality of medicine as practiced in India and would look to tackle problems specific to the Indian context. The website missionslim.org is still under construction. Doctors from across the country and non-medical professionals “frustrated by the sheer avarice on display in the entire field of medicine” have expressed their desire to be part of the SLIM initiative.
Dr Samiran Nundy, chairman of the department of surgical gastroenterology and organ transplantation at Delhi’s Sir Ganga Ram Hospital, said that though many doctors justified over-investigation as necessary for a precise diagnosis and to prevent getting sued, the real reasons may often be to provide corporate hospitals, laboratories and imaging outfits with more profits to justify the astronomical doctors’ salaries as well as to generate kickbacks.
“We need to get together in India to produce guidelines for investigation for patients with a vast variety of disorders. Our problems are different, our resources are scarce, patients are poor and these guidelines, if suggested by an authoritative organization, will do a lot to bring down corruption in healthcare,” said Dr Nundy.
Eminent cardiologist and president of the Public Health Foundation of India Dr K Srinath Reddy said that he joined SLIM because he was fully convinced that inappropriate medical care was common, frequently involving unnecessary investigations and interventions. “This has both financial and health costs which are unacceptable. There are many doctors, in both public and private sectors, who share this view and would like to reverse this trend, restoring science and sanctity to patterns of medical practice,” said Dr Reddy.
Asked about a private healthcare ‘industry’ looking for high growth in India, Dr Reddy said that while it was expected that the industry will push for profit maximization, it was still unacceptable to practice scientifically and ethically bad, exploitative and dangerous medicine just to make more money. “Growth of India’s health care facilities should serve to fill healthcare gaps and respond to unmet needs, not to generate ill-gotten gains from a profligate use of technologies even when not needed. Growth is desirable, but it cannot be cancerous. The medical profession must return to its ethical moorings and restore purity to its practice,” said Dr Reddy.
“We have unwittingly been complicit in creating an epidemic of misinformed doctors and misinformed patients contributing to considerable harm and great expense to our national economies. The root causes include biased funding of research, biased reporting in medical journals, commercial conflicts of interest and a lack of understanding amongst doctors and patients of health statistics and risk,” said Dr Aseem Malhotra, consultant clinical associate to the Academy of Medical Royal Colleges in the UK.
We believe that doctors have to make medical services more affordable to protect their own reputation and that of noble profession to which they belong.