The field of Medicine is now deemed the most dirty and corrupt. At one end Government and the media are bent upon tarnishing the image of the doctors and at the other end newer laws are being framed to ensure that the doctor will constantly be under fear of persecution. Now, the disease and diagnosis has taken a back seat, instead how best could one defend ones action in the court of law, giving all the best to fill the PCPNDT form, writing all prescriptions in CAPITAL and in generic, and if you fail to…well, now the patient has a new weapon to flog the doctor to wave off his fees! Can even the best doctor justify charging even a nominal fee? With so much hard pressed to deliver the best and unsure of his wages, can a doctor perform?  The side effects of not paying the doctor’s fee are obvious. Doctors often indulge in unethical practices by referrals for cuts, doing surgery or ICU admission, when not required or treating a dead patient. The practice of going to a specialist or super-specialist has the potential of going on the wrong path. If you have tummy discomfort and you go to a liver specialist with the belief that it could be a liver problem, you are likely to be investigated for liver ailments and often given medical treatment for the same. Si is your decision to consult a kidney doctor? Suppose you go to surgeon in the first instance? To a man with a hammer, every problem looks like a nail. Surgeons like to solve medical problems by cutting, just as physicians first seek solutions with drugs. So, if you take your medical problem to a surgeon first, the chances are that you will unnecessarily end up on the operation table. Instead, please go to an ordinary GP first

Like all other professionals, doctor also needs to make his both ends meet. Traditionally medical service has been taken as an act of charity and demand of any fee is taken as extortion. When fee is not paid doctor may indulge in devious practices.  Some doctors are bribed to get patients and get passed their inflated bills, false insurance bills, fake medical certificates, and manipulation of medico legal cases.  Harshness on the profession is on the rise. West Bengal Clinical Establishment Bill, 2017, touted as a step to introduce transparency, trust, and accountability into the medical care system, is an example of high-handedness. It provides for up to three-year jail terms and trials under the IPC for offenders and fines up to Rs 50 lakh in case of death of patients due to medical negligence. The bill states that hospitals are mandated to declare bed charges, ICU charges and package costs, which can’t be altered.  Its administrators will be jailed and hospital will be closed if medical negligence is found.  Over pricing bills, unnecessarily detaining patients, unwanted or un-required investigations or medicines will be investigated by a ‘Commission of retired Judges and Bureaucrats’, which will fix responsibility.

The existence of private healthcare sector is due to the inability of the government to provide medical care to its citizens. Transparency essentially is the need of an hour, but adding the clause that the costs can’t be altered takes away the freedom of updating pricing and keep up with inflationary costs of providing the services from the hospitals. And since the charges can’t be altered, doctors may lose the pace with the innovations in medicine. The bill emphasizes on providing a proper estimate of costs. And the final bill cannot exceed more than a percentage of the estimate provided. The field of medicine involves far too many variables to accurately predict the outcomes. New discoveries add new variables! How do we expect to have a 100% predictive model? One of the norms includes penal measures in cases of medical negligence. Absolutely, the fast-paced judicial proceedings are what should be aimed in every malpractice. But with the rise in the defensive practice, it will eventually lead to additional costs of care provision, by sharing the cost burden of litigation/insurances and by making doctors more averse to procedures/modalities that have higher mortality rates. The Act mandates the release the body of a patient even if the bill for treatment has not been paid, but will the government undertake to give some compensation to hospitals in case of non-payment of bills?

This all is expected without providing any financial incentives or logistic support to those doctors who venture to set up their clinics with high debts and no assured returns.
Ethical and unethical

No doubt a doctor is duty bound to practice ethical medicine.  But in a private set up, billing process has to begin right at the time when the patient arrives at clinic, with registration charges. Patient may also be billed for facilities provided in the clinic or hospital for once or multiple times. Charges for making patient summary, charges for the assistant/nursing staff/paramedical staff, charges for drugs and materials used, issuing a certificate, investigations with no subsidy, dispensing medicines with no subsidy, administrative charges, charges for utility services etc. are other heads under which the patient can be charged  and the  charges are legal and ethical. Such Charges are displayed or communicated to patient in advance, but may vary from doctor to doctor and hospitals to hospitals, and they are at liberty to keep their own charge of any service provided, investigations done. Accepting rebates and commission from diagnostic centers/laboratories and hospitals or fee splitting without involving any service for the referring, recommending implants/ stents/ medicines, vaccines or procuring of any patient is unethical. Any income generated out of such practices is unethical earning. Referral fee is not a consultation fee, it is a commission being paid to a middleman. It adds to the patient’s cost, which means that it’s ultimately the poor patient who ends up paying for this. Most doctors ( and hospitals) treat these referral fees as the cost of doing business. They are cleverly disguised, by being called “medical management fees”.
Any advertising or marketing medical practice for earning, cuts, concessions, rebates, making false bills, issuing fake certificates, not giving first aid to accident, rape or severely injured or serious patients and unnecessary detention of a patient or a dead body, un-reporting of notifiable diseases, medico legal cases and shifting patients from government to private hospitals are grossly unethical practices. Doctors need to shun such practices at all costs. However, doctors have a right to charge fee rationally. Doctors have a right to charge extra for emergency appointments, same day appointments and routine appointments. They have a right to charge extra for night visits or for long consultations.  They have a right to charge for briefing senior specialist or for visiting patients when they are admitted in a hospital under a specialist.  They have a right to charge for telephonic consultation or for reviewing reports or for giving opinions only on reports.

Doctors’ fee should not be a matter of debate!!

It is not uncommon that the patient alleges negligence when a fat bill is served at the end of hospital stay. Recent case of an Egyptian patient Eman Ahmed’s surgery was a ‘proud moment in Indian medical history,’ when she was leaving India, her weight had dropped to 176.6 kg from 500 kg. “The team of doctors at Saifee Hospital Mumbai did a fabulous job. She is stable and all parameters are under control. While there were all smiles at her sister’s face, it turned into a frown of rejection when the bill was served after months of dedicated service. Such examples of reaction to hospital’s/doctor’s fee are not uncommon in India where fee for service is the norm and payments are not made in advance.

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