What is a cut practice?
All doctors qualified to practice modern medicine take the classical Hippocratic Oath before beginning their professional career. However, when they start practicing in real life, they start making so called ‘practical’ adjustments during his clinical and therapeutic decisions. Sometimes they get open offers of referral of patients for a predetermined and regularized practice of fee-sharing (‘cut practice’).
In this blog I have tried to highlight different aspects of cut-practice.
As the name cut practice itself suggest that there is something fishy. In fact, this is one of the several reasons for the increase in health care costs. As a Kid, I was always wondering that the Doctor to whom I am being referred must be the best doctor in the area and I never doubted that there could be any ‘practical adjustments’ involved in it.
While in general doctors at village level (or clinics with lesser facility/expertise) recommends you to visit some doctor in a city as there will be better medical facility and expertise available at the referred doctor’s facility, sometimes you feel really bad when you realize that you ended us visiting a doctor who you would not have liked to see, if you could have taken an independent decision. Thus hurts even more when referring doctor’s charge usually get added on to the referred specialist’s fees and are paid unknowingly by the patient.
How often do you realize that you must have bought medicine near to Doctor’s clinic? Well, specially, if you are not living close to the doctor’s clinic then it becomes a real pain. You are usually left with two options
1) Either go back near to Doctor’s clinic and get the medicine or
2) Rely on pharmacists near your house to provide you a right substitute
I am sure, you would like to avoid both these scenarios.
Cut practice occurs in many forms:
• Giving a share of fees to the referring doctor.
• Referring patients for unnecessary consultations or tests to ensure a kickback from the consultant or laboratory.
• Giving expensive gifts periodically to the referring doctor.
• Appointing junior specialists to a super specialty hospital so that procedural work is always referred by them to you.
• Unnecessary admissions in nursing homes/hospitals.
• Sponsoring of a conference or payment of travel expenses by a company in return for the use of its equipment or prescription of its drugs.
Ugh, while this may sound completely unethical in health care business, people find it perfectly fine in other businesses. Have you ever thought about how one can offer 75% discounts on cloths? Well, doesn’t that say that the actual cost is not even 10 % of the overall price that the customer is being asked to pay for? Well, yes, here you justify that price by using technical terms like transportation, distribution, storage and marketing costs.
However, in case of health care, the similar practice look really bad. Remember that doctor’s are still being seen next only to god as they save life of the people. Hence, when the same people come to know about their involvement in such practices, they get hurt even more. The basic problem is that, that the patients are neither aware of their rights in getting information nor do they take any action against the doctors if they know that the doctors are involved in malpractice.
Recently, one of my Colleague’s mother suffered multiple fracture. The doctor was prescribing a very costly medicine (approximately INR 2500/- per tablet) without writing the medicine name and he was asking to deposit that money so that he can order for the medicine. Although there is a substitute for same medicine at the cost of INR 40/- per tablet, doctor forced the patient to buy the costly medicine. Interestingly, this medicine was to strengthen the brittle bones and it was not something very urgently needed for the treatment. This definitely hurts the credibility of health care business. However, this is kind of thing where it is extremely difficult for the patient or his/her relatives to call wrong because doctor can always justify his action and he can always prove that he is doing things for the better health of the patient. However, patient must be given choices and allowed to take an informed decision.
While so far it looked like some of the doctor’s are really messing up the good efforts by many other doctors, the situation has improved quite a lot in recent pasts:
1) Although every doctor determines his/her professional fees on the basis of experience, wisdom and self perceptionof the level of skills required for a particular treatment, they have started quoting same price for all the patients. Hence, patient is not charged more because doctor has to share fees with someone else as well.
2) Also, as long as the patient is aware of the sum to be paid before the service is rendered it should not be considered as bad as cut practice term make it look.
3) Many times you can compare and calculate the referred doctor’s fee and service cost with other competitive doctors and take more informed decisions
Unfortunately, these improvement in health care practices are not yet used effectively by the patients.
How we can control this cut practice
1) Public Education or awareness on such cut practices is the first step of controlling.
2) We must have strong local or national medical association or federations, with the strong code of ethics.
3) Themselves medical doctors should talk and conduct meetings to prohibit and condemn the cut practice.
4) Consumer protection act needs to be implemented in order to stop this cut practice.
5) The monthly salary and other benefits of full time doctors especially in teaching hospitals should be such that they are able to maintain a decent standard of living
6) Each general practitioner must charge a publicly stated fee from the patient for the act of medical examination, making a diagnosis and recommending appropriate treatment or referral to an appropriate consultant or hospital
7) A body of government appointed experts should monitor the performance of various procedures to ensure that they are based on scientifically valid indications
Having said that, any controlling steps will work only when patient increases its own awareness and doctors involved in such practices decide to lower down the overall cost of health care.