Tag: medical industry

MP doctor arrest: flawed justice: reminiscent of Hammurabi’s era of medical regulation

A doctor has been arrested in Madhya Pradesh’s Chhindwara after a toxic batch of Coldrif cough syrup allegedly caused the deaths of 18 children across two states, exposing alarming lapses in drug quality control. Of the total deaths, 14 were reported from Chhindwara alone, where the syrup was reportedly prescribed illegally by Dr Praveen Soni. Police have arrested a doctor for alleged negligence and registered a case against the manufacturer of a 'toxic' cough syrup after the death of 14 children in Chhindwara due to suspected renal failure, officials said on Sunday. The Madhya Pradesh government has banned the sale of Coldrif cough syrup, with officials stating the drug samples have been found to contain a highly toxic substance.

A doctor has been arrested in Madhya Pradesh’s Chhindwara after a toxic batch of Coldrif cough syrup allegedly caused the deaths of 18 children across two states, exposing alarming lapses in drug quality control.

 Strangely enough, when the drug manufacturer and the drug controller are responsible for the quality of drug, the doctors are the one who is arrested.  Does that imply that doctors should now stop expecting justice from courts and Government?

 The whole process appeared flawed from the root. Blame for the poor quality of drugs manufactured is passed on the prescribing doctor.

  Even for complexities of medical science and uncertainties of the outcome, blame can conveniently be passed on doctors due to application of average wisdom.

 This strange kind of justice delivery has unmasked the everyday struggle of the doctors in the present era.  The unjustified arrest just for prescribing a medicine has depicted the plight of doctors- being undervalued and demonized, forced to work as a sub-servant, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment.  This incident has unveiled the despondency, moral burden, and injustice that doctors work with.

 An effort to govern or regulate the medical profession is not new. Hammurabi had initiated to write the rules of the game. This single professional species was managed with cruel regulation around 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.

Hammurabi 5000 years ago,  was  not even at the   doorstep of medical science, but he promulgated some rules. It is difficult to say whether he was naive or brilliant enough to make it more mathematical. He fixed heavy prize for saving lives and used to cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.   After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still remains somewhat  unfair to doctors.  In other words, it has not attained enough evolution and maturity. 

Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to regulate medical profession, even  when the medical science was not even developed enough to deal with most of diseases.  Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times.  Almost universally, the earlier work or contribution of a doctor to society is not taken into account.  Even for complexities of medical science and uncertainties of the outcome, blame can conveniently be passed on doctors due to application of average wisdom.

    Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished.

Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake.  Such harsh regulatory systems will dissuade other good people joining the profession, again resulting in further inhibition and flourishing of profession for the good.  Obviously, harsher penalties will discourage a physician surplus.

Today the global system of medical regulation, is becoming somewhat similar, to those ancient regulations in terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects. And this is even though now we are very well conversant with the known uncertainty and complexity of the human body and despite cognizance of the poor prognosis in many disease states.

Fear factors of injustice to  doctors and impact of present legal complexities is already at par with that of Hammurabi’s era.

Advantages-Disadvantage of being a doctor

25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

0

Medical Emergencies- Flying a crashed plane. Comparing airline industry to healthcare is incorrect

Comparing airline industry & health care is fallacious, an oversimplification; apples to musk-melons Basic difference is that ‘Patients are not aeroplanes, and hospitals are not production lines’. The issue of patient safety has been gaining increased traction year on year and the issue is in right direction. Hospitals, doctors and administration need to vigorously address shortcomings and strive toward minimum errors and desired goals of safety. Patient safety is of paramount importance; therefore it is an serious issue. It should be achieved by good ground work and not by sensationalizing and mischaracterizing the real basic issues, transparent safety culture, adequate number of staff and resources. There is a recurrent old argument and temptation to ask about why healthcare can't be as safe as airline travel. There can be many apt comparisons that may be possible between aviation and health care especially taking into account the risk involved. But the doctors who treat critical emergencies, have insight looking at life and death situations directly, know that comparing both would be just an oversimplification of the real basic issues. At most of the points, the comparison is a complete fallacy; and like comparing apples to musk-melons.

The issue of patient safety has been gaining increased traction year on year and the issue is in right direction.  Hospitals, doctors and administration need to vigorously address shortcomings and strive toward minimum errors and desired goals of safety.   Patient safety is of paramount importance; therefore, it is a serious issue. It should be achieved by good groundwork and not by sensationalizing and mischaracterizing the real basic issues, transparent safety culture, adequate number of staff and resources.

There is a recurrent old argument and temptation to ask about why healthcare can’t be as safe as airline travel.   There can be many apt comparisons that may be possible between aviation and health care especially taking into account the risk involved. But the doctors who treat critical emergencies, have  insight looking at life and death situations directly,  know  that comparing both would be just an oversimplification of the real basic issues.

  At most of the points, the comparison is a complete fallacy; and like comparing apples to muskmelons.

It is beyond doubt that air-industry maintains truly an impressive system which is well-designed to achieve the safety results that it does.  But, the kind of comparison that some health care safety leaders make in which they compare the  mortality data of acute hospital care and airline fatal accident rates is more of a word play and not so appropriate. This comparison is dangerous because it misses the key points for improvement. Such comparisons merely present over-simplified and convenient tool for the health quality experts, who themselves have never been a front-line health worker at any point of time, but still pretend to pioneer the quality in health industry.  For the quality improvement the leaders need to be grounded in the reality of emergency front line medicine to be effective.

  1. Aircrafts  are engineered to be in the best possible shape before they fly. Patients, on the other hand, patients  are in the worst shape when they enter the emergency of the hospital.

Medicine is by nature, a much more risky work than flying along with vulnerability to death always.

  • The aircrafts are required to regularly demonstrate that the performance of their critical systems meets or exceeds strict standards. If systems are not operating well the plane will not be allowed to fly.

But all the patients, (aeroplane metaphor) are already sick; doctors are expected to fly such aeroplanes, who are in crashed condition universally. Doctors do not have the luxury to replace any part.  For example, when doctors treat an elderly with heart failure, chronic kidney failure and pneumonia, they try to keep them “flying” despite multiple sub optimally functioning critical systems.

  •  In other words, doctors have to fly crashed planes always on every day basis, something that never happens even once in aviation industry.
  • Has any Pilot ever tried to fly  a plane in which engine power is only 25 percent of normal with  other systems are functioning  sub-optimally  and  the fuel tank is leaking?  What will be standard procedure (SOP)  for Pilot to fly this plane? But everyday doctors try to fly such planes and they have to fly it no matter how many systems are non-functional.  Moreover, doctors can be sued on some flimsy grounds in case they fail or an accident happens in an effort to keep this plane in the air.  Treating a critical illness is like an effort to keep such planes in air with suboptimal functioning systems.

Obviously the comparison is a bit overzealous.

  •   What would be chances that a fully checked plane with a trained pilot will crash after flight takes off. Now compare the chances of patient who lands in emergency, and treatment is started.

By a simple common sense, are two situations comparable?

Former has no chance (almost Zero percent) of crash whereas in a critical emergency patient, the chances of crash are 100 % to start with.

  • Communication of passengers to the pilot about what he should do and what he should not while flying the plane is nil. Whereas doctors are continuously bombarded with google knowledge of patients and interference by relatives and questioned about every action.
  •   Doctors are expected to make future prediction about what can happen, how he will be able to keep the crashed plane in the air and take consent, based on few assumptions. Doctors can be harassed and dragged to courts if such predictions fail.
  • Airlines will always have full staff to serve promptly during a flight. The pilot will be totally dedicated to flying the plane, and will not fly without the co-pilot and crew. On the other hand, front line healthcare workers know it well the fact that patient safety incidents and errors tend to occur when they are struggling with staffing levels and feel grossly overworked.

Fatigue and overwork is too common scenario among front line healthcare staff in clinical settings.

  • A pilot is also only ever going to fly one plane at a time. It is not realistic for a doctor or nurse to be allocated to just one patient, but the workflow is very different, with healthcare tasks frequently interrupted with new clinical issues and emergency situations. Consequently, insufficient staffing can have an acute effect on outcomes and the ability to perform safely.
  • Aviation industry is too predictable and on the contrary, health care is combination of uncountable unpredictable risk factors, be it allocation of staff or risk of death or resource prediction and complexity of communication.
  • Aviation is more of mechanical milieu, whereas health care deals with emotion and compassion. The two industries are vastly heterogeneous, and to say that safety in medicine should follow in the path of flying airplanes, grossly oversimplifies a complex problem.
  •    Last but not the least; health care involves lot of financial uncertainties and arrangements. Needless to say, doctors carry the blame for financial hardship of the patients, even if they are not responsible for costs. The mammoth industry remains hidden and doctors are blamed as they are the only front man visible.
  • Basic difference lies in the fact that patients are real living people, whereas airplanes are simply machines, whose codes and protocols are well defined and limited to within human capabilities. The importance of human contact, empathy, compassion, interact and listen to concerns, and the ability to spend adequate time with patients,  should be  always be the first pillar of promoting a culture of safety.
  •   Exhortations by armchair preachers to learn oversimplified improvement examples from aviation can provoke considerable frustration and skepticism among clinicians exposed to the unique challenges, difficult working conditions and everyday complexities.  Patients are not aeroplanes, and hospitals are not production lines.

Most unfortunate part is the assumption that every sick person who dies in a hospital from an adverse event is an example of a truly preventable death rather than clinicians trying their best to keep someone alive and eventually failing.

  1.  Checklists and documentation to improve systems are wonderful in mechanical areas like operative care and inserting central lines, but have limited role and can only go so far without the most important virtues of being a doctor or nurse. It means more than mechanically following protocols and doing paper work in real sense.

In health care merely providing check list and doing extra- paper work may be counterproductive for many reasons.  Increase in time for voluminous documentations will consume time and forces health care workers to focus on paper work and takes them away from patient’s real issues.

Completed paper work and excessive documentation provides a false assurance of quality work, which may or may not reflect true picture of patient care. Even after full documentation,  still  it will be required  to be carried out in a diligent manner, a  task which is different from mechanical  task of mere check list  of other  industries . Learning from other industries seems to offer a simple shortcut to anyone trying to improve healthcare, but its utility is limited only for documentation purposes and not real quality. Caring for patients is radically different from flying aeroplanes. Healthcare is unique in the intimacy, complexity, and sensitivity of the services it provides as well as the trust, compassion, and empathy that underpin it.

Merely completing protocols mechanically and excessive documentation will result in decline in quality actually.  Simply importing and applying a ready-made tool will lead to situation, where quality will exist only on papers and merely reduced to a number to the satisfaction of so called ‘pioneers’ of quality.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

1

Physical/Legal violence against doctors: reminiscent of realms of ancient Hammurabi medical regulation

Physical/Legal violence against doctors: reminiscent of realms of ancient Hammurabi medical regulation The painful incident of Kolkata Doctor rape and murder had unmasked the everyday struggle of the doctors in the present era. Her supreme sacrifice depicted the plight of doctors- being undervalued and demonized, forced to work as a sub-servant, irresp

                  The painful incident of Kolkata Doctor rape and murder had unmasked the everyday struggle of the doctors in the present era. Her supreme sacrifice depicted the plight of doctors- being undervalued and demonized, forced to work as a sub-servant, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment.  Her murder has unveiled the despondency, moral burden and injustice that doctors work with.

With the evolution of medical science and medical care intertwined with medical business, braided changes in medical regulation is not an far off expectation. But reticulation of evolution to modern medicine and health care has not happened in isolation. Simultaneously there has been progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care has also ushered.  Every one now wishes to live longer  and  dreams of better quality of life with support of progressive medical care.  Opportunities projected by advancements in health care, have shown that these dreams can be a real possibility, in many cases. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and investors putting money into health care, which was unthinkable few decades back in the past.  This reticulation of business and health care allowed health care to be controlled  in some way by administrators and investors. Away from the health providers, who actually treated the patients.

As it is no more simply treating a disease and involves many more issues.  New model of medical regulation and business in  health care is  still  not a mature process. It has emerged and progressed in  just  for few decades, as compared to  medical treatments and systems that existed since ancient times. It is still in infancy and still has to go a  long way to do real justice to every one.   No one really knows how to regulate this difficult area, which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and  relief , sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects. Most difficult part is amalgamation of  intricacies of science with minds of  patient and doctor’s skill in  newly evolved milieu of financial complexities.  Results are not encouraging for the medical profession.

 An effort to govern or  regulate the medical profession  is not new. Hammurabi had initiated to  write the rules of the game. This single professional species was managed with cruel regulation around 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.

Hammurabi  5000 years ago,  was  not even at the   doorstep of medical science, but he  promulgated some rules. It is difficult to say whether he was naive or  brilliant  enough to make it more mathematical. He fixed  heavy prize for saving lives and used to  cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.   After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly  knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still  remains  somewhat  unfair to doctors.  In other words, it has not attained enough  evolution and maturity. 


  Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical  science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to  regulate medical profession, even  when the medical science was not even developed enough to deal with most of diseases.  Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times.  Almost universally, the earlier work or contribution of  a doctor  to society is  not taken into account.  Even for complexities of medical science and uncertainties of the outcome, blame can  conveniently be  passed on doctors due to application of average wisdom.

    Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished.

Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake.  Such harsh regulatory systems will dissuade  other good people joining the profession, again  resulting in  further inhibition and flourishing of profession for the good.  Obviously, harsher  penalties will discourage a physician surplus.

Today the global system of medical regulation, is becoming somewhat similar, to those ancient regulations in  terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects. And this is even though now we are very well conversant with the known uncertainty and complexity of the human body and despite cognizance of the poor prognosis in many disease states.

Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

2

Spurious medicine hits high- Ganja-laced chocolates as Ayurvedic medicine for Diabetes

Spurious medicine hits high- Ganja-laced chocolates as ayurvedic medicine for Diabetes In the absence of strict Government control, all kinds of dubious assertions

In the absence of strict Government control, all kinds of dubious assertions are available about curing all types of ailments.  These alleged remedies, and the belief systems, are based on the facts that can neither be proved nor disapproved. They are dangerous to life of patients, which is why it is necessary to fight them and refute them.  But who should fight? Patients themselves are blinded by a projected faith and false belief about definite cure.

While pharmaceuticals and scientific drugs are regulated to some extent, but side effects and harms associated with various  health products   worth billions of market  remain untested and unregulated.  

    It has become a common practice to advertise health products (especially alternate medicine) that claim to be panacea for all ailments, enhance immunity, to increase power and health by creating an impression on minds on various platforms. Instead of producing scientific evidence, such products and therapies are sold under disguise of natural therapies or alternate medicines. The objective evidence or global neutral trial for the claimed efficacy or about real side effects is always missing.

     No one can deny that the knowledge circulated through various media plays an important role in reframing the narrative in patient’s or people’s mind. These can be in form of advertisements in television or articles in newspapers. The subjectivity of such advertisements creating new impressions and replacing previous ones, right or wrong cannot be denied.

    A frightening scenario is emerging as there seems to be an epidemic about fake or substandard medicines, spurious drugs and heightened belief in marketed therapies by advertisements.  An epidemic of ignorance that causes people to believe in pseudoscience or merely in projected promise of cure. A hope of miracle is flashed to patients, who have been given a ‘no hope’ by scientific medicine. Such patients are an easy prey for such fraudsters. It is not uncommon that lethal substances like steroids, hormones and heavy metals are given in dangerous doses.

Chocolates come as ‘Ayurvedic Aushadh’

      Synopsis Cyberabad police raided a kirana store in Petbasheerabad, seizing ganja-infused chocolates marketed as ayurvedic medicine. The chocolates contained 14 grams of cannabis per 100 grams and claimed to treat indigestion. The Telangana anti-narcotics bureau has notified UP and Rajasthan police about manufacturers in these states producing similar drug-laced products. In an emerging trend, ganja-laced chocolates made in Uttar Pradesh guised as ayurvedic medicine are making becoming popular in Hyderabad. Wrapped in attractive packaging, the chocolates come with ‘Ayurvedic Aushadh’ printed on wrappers, reported ToI. On Sunday, Cyberabad police seized a substantial shipment of drug-infused chocolates from a kirana store in Petbasheerabad. The packaging of the seized chocolates indicated that each 100 grams contained 14 grams of cannabis.

        Additionally, the label suggested that the chocolates could be consumed twice daily to alleviate indigestion and other stomach-related problems when mixed with water.

The chocolate cover also mentions that it can be consumed twice a day to treat indigestion and other stomach-related issues, is also used as a medication for diabetes. Meanwhile, Telangana anti-narcotics bureau has identified several private players in UP and Rajasthan manufacturing ganja-laced chocolates and has alerted the respective state police departments.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

0

What is wrong with medical profession?  Choosing medical career- a mistake?

It is not easy to practice as doctor these days. Media full of doctors bashing, credibility crisis and regulators perpetually hounding doctors, who are forced to work under imposed medicolegal sword. There is no day that passes when system does not perpetuate negativity against medical profession. Doctors, ebbed from all sides, have lost the dignity and independence. Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses. The complex medical skill, the years of passionate, merciless excruciating medical learning is placed at the disposal of administrators, who themselves have already failed to develop a good health care system in real sense. Doctors have become soft targets for populist attention mongering and transforming social nuisance into messiah of the deprived by administrators -by sprouting the fraudulent generalities. All the calculations that usually precede the enslavement of medicine, everything gets discussed by administrators and industry - except the well-being of the doctors and nurses. Doctors have often wondered at the smugness with which administrators assert their right to enslave them, to control their work, to force their will, to violate their conscience, to stifle their mind. Irony is that while administrators do this, still they depend on the same doctors for saving lives -whose life they have throttled, who resent the treatment meted out to the health care workers.

    It is not easy to practice as doctor these days. Media full of doctors bashing, credibility crisis and regulators perpetually hounding doctors, who are forced to work under imposed medicolegal sword. There is no day that passes when system does not perpetuate negativity against medical profession.  Doctors, ebbed from all sides, have lost the dignity and independence.        Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.

    The complex medical skill, the years of passionate, merciless excruciating medical learning   is placed at the disposal of administrators, who themselves have already failed to develop a good health care system in real sense.  Doctors have become soft targets for populist attention mongering and transforming social nuisance into messiah of the deprived  by administrators -by sprouting the fraudulent generalities.

   All the calculations that usually precede the enslavement of medicine, everything gets discussed by administrators and industry – except the well-being of the doctors and nurses.

     Doctors have often wondered at the smugness with which administrators assert their right to enslave them, to control their work, to force their will, to violate their conscience, to stifle their mind. Irony is that while administrators do this, still they depend on the same doctors for saving lives -whose life they have throttled, who resent   the treatment meted out to the health care workers. 

          In todays’ era there has been bullying of doctors by administrative systems, new unreasonable laws, which use pressure tactics on medical professionals to get their own way – no less than enslavement.

Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted   about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession.

  1.  Medical courses are comparatively lengthy and expensive study course and difficult training with slave like duties. “enslavement of doctors”.
  2.   Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice. 
  3.  Hostile environment for doctors to begin: Suddenly young and bright children complete  training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
  4. Difficult start of career:  After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and  treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
  5. The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
  6. Blamed for all malaise: The society gets biased because of the   media reports and some celebrity talking glib against medical profession. The blame for inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
  7. Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
  8. Risk doctoring himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include   tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.21 occupational risks to doctors and nurses
  9. Unrealistic expectations of society:  Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.
  10. Retrospective analysis of doctor’s every action continues all the life. It could be by  patients and relatives every day  in the form of  “ Why this was not done before?” Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.

The decision taken in emergency will be questioned  and  in retrospect they may not turn out to be the best one, but later retrospective analysis along with wisdom of hindsight with luxury of time, may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.

11. Physical assault, routine instances of verbal abuse and threat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent  people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.

12. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.

13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession:  zero fee and fixed commission ads on television by lawyers in health systems are a common advertisement to harass doctors.  They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such   relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations.  This encouragement and instigation of lawsuit against doctors is a  major disadvantage for medical profession.

14. Overall, a complex scenario for doctors: There is increasing discontentment among doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of  medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult.

In this era, a thought is gradually getting prevalent-‘Is choosing medical career or becoming a doctor is a mistake?

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Exorbitantly expensive medical education and lowered merit

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Comparing airline industry & health care is fallacious, an oversimplification; apples to musk-melons

Comparing airline industry & health care is fallacious, an oversimplification; apples to musk-melons Basic difference is that ‘Patients are not aeroplanes, and hospitals are not production lines’. The issue of patient safety has been gaining increased traction year on year and the issue is in right direction. Hospitals, doctors and administration need to vigorously address shortcomings and strive toward minimum errors and desired goals of safety. Patient safety is of paramount importance; therefore it is an serious issue. It should be achieved by good ground work and not by sensationalizing and mischaracterizing the real basic issues, transparent safety culture, adequate number of staff and resources. There is a recurrent old argument and temptation to ask about why healthcare can't be as safe as airline travel. There can be many apt comparisons that may be possible between aviation and health care especially taking into account the risk involved. But the doctors who treat critical emergencies, have insight looking at life and death situations directly, know that comparing both would be just an oversimplification of the real basic issues. At most of the points, the comparison is a complete fallacy; and like comparing apples to musk-melons.

 

 

The issue of patient safety has been gaining increased traction year on year and the issue is in right direction.  Hospitals, doctors and administration need to vigorously address shortcomings and strive toward minimum errors and desired goals of safety.   Patient safety is of paramount importance; therefore it is an serious issue. It should be achieved by good ground work and not by sensationalizing and mischaracterizing the real basic issues, transparent safety culture, adequate number of staff and resources.

There is a recurrent old argument and temptation to ask about why healthcare can’t be as safe as airline travel.   There can be many apt comparisons that may be possible between aviation and health care especially taking into account the risk involved. But the doctors who treat critical emergencies,  have  insight looking at life and death situations directly,  know  that comparing both would be just an oversimplification of the real basic issues.

  At most of the points, the comparison is a complete fallacy; and like comparing apples to musk-melons.

It is beyond doubt that air-industry maintains truly an impressive system which is well-designed to achieve the safety results that it does.  But , the kind of  comparison  that  some health care safety leaders make in which they compare the  mortality data of acute hospital care and airline fatal accident rates is more of a word play and not so appropriate. This comparison is dangerous because it misses the key points for improvement. Such comparisons  merely present over-simplified and convenient tool for the health quality experts, who themselves have never been a front line health workers at any point of time, but still pretend to pioneer the  quality in health industry.  For the quality improvement the leaders need to be grounded in the reality of emergency front line medicine to be really effective.

  1. Aircrafts  are engineered to be in the best possible shape before they fly. Patients, on the other hand, patients  are in the worst shape when they enter the emergency of the hospital.

Medicine is by nature, a much more risky work than flying along with vulnerability to death always.

  1. The aircrafts are required to regularly demonstrate that the performance of their critical systems meets or exceeds strict standards. If systems are not operating well the plane will not be allowed to fly.

But all the patients, (aeroplane metaphor) are already sick; doctors are expected to fly such aeroplanes, who are in crashed condition universally. Doctors do not have the luxury to replace any part.  For example, when doctors treat an elderly with heart failure, chronic kidney failure and pneumonia, they try to keep them “flying” despite multiple sub optimally functioning critical systems.

  1.  In other words, doctors have to fly crashed planes always on every day basis, something that never happens even once in aviation industry.
  2. Has any Pilot ever tried to fly  a plane in which engine power is only 25 percent of normal with  other systems are functioning  sub optimally  and  the fuel tank is leaking?  What will be standard procedure (SOP)  for Pilot to fly this plane? But everyday doctors try to fly such planes and they have to fly it no matter how many systems are non-functional.  Moreover, doctors can be sued on some flimsy grounds in case they fail or an accident happens in an effort to keep this plane in the air.  Treating a critical illness is like an effort to keep such planes in air with suboptimal functioning systems.

Obviously the comparison is a bit overzealous.

  1.   What would be chances that a fully checked plane with a trained pilot will crash after flight takes off. Now compare the chances of patient who lands in emergency, and treatment is started.

By a simple common sense, are two situations comparable?

Former has no chance (almost Zero percent) of crash whereas in a critical emergency patient, the chances of crash are 100 % to start with.

  1. Communication of passengers to the pilot about what he should do and what he should not while flying the plane is nil. Whereas doctors are continuously bombarded with google knowledge of patients and interference by relatives and questioned about every action.
  2.   Doctors are expected to make future prediction about what can happen, how he will be able to keep the crashed plane in the air and take consent, based on few assumptions. Doctors can be harassed and dragged to courts if such predictions fail.
  3. Airlines will always have full staff to serve promptly during a flight. The pilot will be totally dedicated to flying the plane, and will not fly without the co-pilot and crew. On the other hand, front line healthcare workers know it well the fact that patient safety incidents and errors tend to occur when they are struggling with staffing levels and feel grossly overworked.

Fatigue and overwork is too common scenario among front line healthcare staff in clinical settings.

  1. A pilot is also only ever going to fly one plane at a time. It is not realistic for a doctor or nurse to be allocated to just one patient, but the workflow is very different, with healthcare tasks frequently interrupted with new clinical issues and emergency situations. Consequently, insufficient staffing can have an acute effect on outcomes and the ability to perform safely.
  2. Aviation industry is too predictable and on the contrary, health care is combination of uncountable unpredictable risk factors, be it allocation of staff or risk of death or resource prediction and complexity of communication.
  3. Aviation is more of mechanical milieu, whereas health care deals with emotion and compassion. The two industries are vastly heterogeneous, and to say that safety in medicine should follow in the path of flying airplanes, grossly oversimplifies a complex problem.
  4.    Last but not the least; health care involves lot of financial uncertainties and arrangements. Needless to say, doctors carry the blame for financial hardship of the patients, even if they are not responsible for costs. The mammoth industry remains hidden and doctors are blamed as they are the only front man visible.
  5. Basic difference lies in the fact that patients are real living people, whereas airplanes are simply machines, whose codes and protocols are well defined and limited to within human capabilities. The importance of human contact, empathy, compassion, interact and listen to concerns, and the ability to spend adequate time with patients,  should be  always be the first pillar of promoting a culture of safety.
  6.   Exhortations by armchair preachers to learn oversimplified improvement examples from aviation can provoke considerable frustration and skepticism among clinicians exposed to the unique challenges, difficult working conditions and everyday complexities.  Patients are not aeroplanes, and hospitals are not production lines.

Most unfortunate part is the assumption that every sick person who dies in a hospital from an adverse event is an example of a truly preventable death rather than clinicians trying their best to keep someone alive and eventually failing.

  1.  Checklists and documentation to improve systems are wonderful in mechanical areas like operative care and inserting central lines, but have limited role and can only go so far without the most important virtues of being a doctor or nurse. It means more than mechanically following protocols and doing paper work in real sense.

In health care merely providing check list and doing extra- paper work may be counterproductive for many reasons.  Increase in time for voluminous documentations will consume time and forces health care workers to focus on paper work and takes them away from patient’s real issues.

Completed paper work and excessive documentation provides a false assurance of quality work, which may or may not reflect true picture of patient care. Even after full documentation,  still  it will be required  to be carried out in a diligent manner, a  task which is different from mechanical  task of mere check list  of other  industries . Learning from other industries seems to offer a simple shortcut to anyone trying to improve healthcare, but its utility is limited only for documentation purposes and not real quality. Caring for patients is radically different from flying aeroplanes. Healthcare is unique in the intimacy, complexity, and sensitivity of the services it provides as well as the trust, compassion, and empathy that underpin it.

Merely completing protocols mechanically and excessive documentation will result in decline in quality actually.  Simply importing and applying a ready-made tool will lead to situation, where quality will exist only on papers and merely  reduced to a number to the satisfaction of so called ‘pioneers’ of quality.

Advantages-Disadvantage of being a doctor

25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

 

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

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Syndicate Supplying Fake Cancer drug Busted #Spurious-Medicine

To make big money, Pradhan got his cousin Shubham Manna and Ram Kumar involved in his plan and started making spurious cancer drugs. “He had been providing spurious medicines at a discounted 50% of market prices. He was manufacturing and supplying more than 21 spurious cancer medicines of various companies of different countries,” special commissioner (crime) Ravindra Yadav said. The syndicate comprised highly-qualified and well-earning individuals. Manna had completed his BTech and served in MNCs before joining hands with Pradhan. Police said his job was to generate barcodes, emboss batch numbers and expiry dates on medicines. He also looked after overall packaging of the spurious medicines. International syndicate used to procure capsules and manufactured fake medicines by filling them with starch.

The rise in “falsified and substandard medicines” has become a “public health emergency”. A surge in counterfeit and poor quality medicines means that thousands of patient  a year are thought to die after receiving shoddy or outright fake drugs intended to treat ailments. Most of the deaths are in countries where a high demand for drugs combines with poor surveillance, quality control and regulations to make it easy for criminal gangs and cartels to infiltrate the market.

There is an  urgent  need for  effort to combat a “pandemic of bad drugs” that is thought to kill hundreds of thousands of people globally every year.

More are thought to die from poor or counterfeit vaccines and antibiotics used to treat or prevent acute infections and diseases. Beyond the fakes that are made and sold by criminal gangs are poor-quality medicines that lack sufficient active ingredients to work properly, or fail to dissolve correctly when taken. Sloppy manufacturing is often to blame, but others are sold past their shelf life or have degraded in poor storage conditions.

    Governments and pharmaceutical companies had to improve the security of the drug supply chain in all countries from the point of manufacture to the patient. Regarding online pharmacies, there is poor public understanding of how to differentiate between a legitimate online pharmacy and an illegal one. Illegal online pharmacies and the sale of medicines via social media platforms pose the greatest risk to the  public.

Deadly Cocktail: to Make  Fake Cancer Drugs- Syndicate Manufacturing & supplying over 21 Spurious Medicines

To make big money, Pradhan got his cousin Shubham Manna and Ram Kumar involved in his plan and started making spurious cancer drugs. “He had been providing spurious medicines at a discounted 50% of market prices. He was manufacturing and supplying more than 21 spurious cancer medicines of various companies of different countries,” special commissioner (crime) Ravindra Yadav said. The syndicate comprised highly-qualified and well-earning individuals. Manna had completed his BTech and served in MNCs before joining hands with Pradhan. Police said his job was to generate barcodes, emboss batch numbers and expiry dates on medicines. He also looked after overall packaging of the spurious medicines. International syndicate used to procure capsules and manufactured fake medicines by filling them with starch.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

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Compare Reaction to  Death of “Hundreds of healthy people” to  single “perceived negligence” in Hospital  #Morbi-Gujarat

Compare Reaction to Death of “Hundreds of healthy people” to single “perceived negligence” in Hospital #Morbi-Gujarat Reaction to ‘Death’ in this new era of consumerism has become a story of paradox. Massive civil negligence and 141 deaths but there are no punching bags as are doctors for revenge in case of a hospitalized death. Just Compare the media projection, burden of negligence and accountability of hundreds of healthy deaths by civic negligence to the one hospital death by disease. Death is the inevitable conclusion of life, a universal destiny that all living creatures share. Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. Multiple Deaths in healthy people by civic negligence:

Reaction to ‘Death’ in this  new era  of consumerism has become a story of paradox. Massive civil negligence  and 141 deaths but there are no punching bags  as are  doctors  for revenge in case of a hospitalized death.     Just Compare the media  projection, burden of negligence and accountability of  hundreds of healthy deaths by civic negligence   to the  one hospital death by disease. 

     Death is the inevitable conclusion of life, a universal destiny that all living creatures share.   Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. 

Multiple Deaths in healthy people by civic negligence:

Large numbers of death and morbidity happen amongst absolutely healthy population due to preventable causes like open manholes, drains, live electric wires, water contamination, dengue, malaria, recurring floods  etc. The number of   people dying are in hundreds and thousands, and are almost entirely of healthy people, who otherwise were not at risk of death. In fact the burden of   negligence here is massive and these deaths are unpardonable.  Timely action could have prevented these normal people from death. 

Collapse of a pedestrian bridge that killed at least 141 people. #Morbi-Gujarat.

Police in the Indian state of Gujarat have arrested nine people in connection with the collapse of a pedestrian bridge that killed at least 141 people. Four of those detained are employees of a firm contracted to maintain the bridge in the town of Morbi.

Hundreds were on the structure when it gave way, sending people screaming for help into the river below in the dark.

Hopes of finding more survivors are fading. Many children, women and elderly people are among the dead.

The 140-year-old suspension bridge – a major local tourist attraction – had been reopened only last week after being repaired.

Single  Death in Hospital due to disease:

      Reaction to single “in Hospital” medicalized death  is a paradox.   The media has instead, focused on the stray and occasional incidents of perceived alleged negligence in hospital deaths which could have occurred due to critical medical condition of patient.  However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault. 

     In present era, the expectation of medicalized death has come to be seen as a civic right and Doctors’ responsibility. People now have less understanding and acceptance of hospital  death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.

Point to ponder-Misplaced priorities:

Who is to be blamed for the deaths of healthy people which occur because of civic negligence?  Here relatives are actually  helpless and the vital questions may go unanswered .  There are no punching bags  as are  doctors  for revenge. Any stray incident of death of an already ill patient is blown out of proportion by media  forgetting the fact that thousands of patients are saved everyday by  Doctors.   

      It is time to check the  emotional reactions to single hospital death due to a disease as compared to hundreds of death  of healthy people due to civil negligence.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

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Projection of  Inflated Cost of Medical Education- Global Exploitation of Young Doctors

Educating a doctor cost less what medical colleges claim- a global phenomenon. Instead of often repeated statements about high expense on running medical college and projecting it as a hard fact. The amount spent on medical students by all medical colleges should be made transparent by all institutions. The frequent statement is made that cost of making a doctor is very high and gleefully propagated by the private medical colleges to extract millions out of young medical students . Such statements without any actual public data is repeated to the extent that it is firmly entrenched in public mind without any real evidence. High cost is the reason with an intention to exploit the young doctors in various ways to get cheap labour and extract millions from aspiring doctors by private medical colleges. The basis of such calculation should be transparent for every medical college and all institutions. In any medical college, only the Departments of Anatomy and Physiology are purely for medical students. The remaining subjects taught in medical colleges across the country are related to patient care and medical education is only a by-product. All the medical teachers are actually doctors involved in treatment of patients, running the hospital and students observe the treatment and learn medicine. The interns and postgraduate students provide the cheap and labour and actually save the costs of running the hospital. Therefore if some college is actually spending millions to produce one MBBS doctor , it is a either an inefficient model or costs are inflated and exaggerated to exploit the young doctors.

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Educating a doctor cost less what   medical colleges  claim- a global phenomenon.

   Instead of   often  repeated statements  about high expense on running medical college and  projecting it   as a  hard  fact, the amount spent  on  medical students by all medical colleges should be made transparent by all institutions. The  frequent  statement  is made that  cost of  making a doctor is very high and  gleefully  propagated  by  the  private medical colleges to extract millions out of  young  medical students . 

Such statements without any actual public data  is repeated  to the   extent  that  it  is  firmly  entrenched  in  public  mind without any real evidence.

     High cost  is  the  reason    with an intention  to  exploit the young doctors in various ways to get cheap labour and extract  millions from aspiring doctors  by private medical colleges.

      The  basis  of  such calculation should be transparent for every medical college and all institutions. 

       In any medical college,  only the   Departments  of  Anatomy and Physiology  are purely for medical students. The  remaining  subjects  taught  in  medical  colleges  across  the  country  are  related  to  patient 

care  and  medical  education  is only  a  by-product.  All the medical teachers are actually doctors involved in treatment of patients, running  the hospital  and students observe the treatment and learn medicine. The interns and  postgraduate  students  provide the cheap and labour and actually save the costs of running the hospital.

 Therefore   if  some college   is  actually  spending  millions   to  produce  one  MBBS  doctor ,  it  is  a  either an   inefficient  model   or costs are inflated and exaggerated to exploit the young doctors.

Educating a doctor cost less what   medical colleges claim

The average cost of producing a doctor or nurse went down across most parts of the world between 2008 and 2018, but almost tripled in China and doubled in India, a Lancet study shows. Despite this, the estimated expenditure per medical graduate in China at $41,000 is higher only than in sub-Saharan Africa and about 42% lower than in India ($70,000) against a global average of $114,000. The pattern was the same for nurses with the estimated expenditure per nursing graduate dropping across the world while it went up by 167% in China and doubled in India. The only other region where the per graduate cost went up was in North Africa, where cost per doctor went up by 47% and by 25% for nurses. Approximately $110 billion was invested globally by governments and students’ families in medical and nursing education in 2018. Of this, $60.9 billion was invested in doctors and $48.8 billion was invested in nurses and midwives, the study estimated.

The paper looks at important developments in medical education to assess potential progress and issues with education of health professionals after the Covid-19 pandemic. Mean costs in 2018 were $114,000 per doctor and $32,000 per nurse. In 2008, China had the lowest estimated expenditure per medical graduate at just $14,000 (Rs 6 lakh) followed by India, where it was just $35,000 (Rs 15 lakh at the 2008 exchange rate of Rs 43 to a dollar). This is much lower than the estimate of Rs 1 crore or more that Indian colleges widely claim as expenditure per medical graduate.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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CCI investigates India’s largest hospital chains’ Practices

The CCI (The Competition Commission of India) investigation is the first such action against exorbitant prices of medicines and services fixed by hospitals, which have operated free of regulation so far. A four-year investigation by India’s fair-trade regulator has concluded that some of India’s largest hospital chains abused their dominance through exorbitant pricing of medical services and products in contravention of competition laws. The Competition Commission of India (CCI) will soon meet to weigh in on the responses by Apollo Hospitals, Max Healthcare, Fortis Healthcare, Sir Ganga Ram Hospital, Batra Hospital & Medical Research and St. Stephen’s Hospital. It will then decide

The potential penalty by India’s fair trade regulator could be steep. The CCI  (The Competition Commission of India)  investigation is the first such action against exorbitant prices of medicines and services fixed by hospitals, which have operated free of regulation so far.

A four-year investigation by India’s fair-trade regulator has concluded that some of India’s largest hospital chains abused their dominance through exorbitant pricing of medical services and products in contravention of competition laws.

The Competition Commission of India (CCI) will soon meet to weigh in on the responses by Apollo Hospitals, Max Healthcare, Fortis Healthcare, Sir Ganga Ram Hospital, Batra Hospital & Medical Research and St. Stephen’s Hospital. It will then decide whether to impose penalties, said people familiar with the matter.

The CCI can impose a penalty of up to 10 percent of the average turnover for the past three preceding financial years of an enterprise that has violated competition laws. The penalties could be steep. Apollo Hospitals posted an average turnover of Rs 12,206 crore and Fortis Rs 4,834 crore in the past three financial years.

The CCI’s director-general found that 12 super-speciality hospitals of these chains that operate in the National Capital Region abused their positions of dominance by charging “unfair and excessive prices” for renting rooms, medicines, medical tests, medical devices, and consumables, according to a copy of the summary report that Moneycontrol reviewed.

Some hospital room rents exceeded those charged by 3-star and 4-star hotels, according to the findings by the DG, who examines anti-competitive practices.

Significance of the investigation

The CCI investigation is the first such action against exorbitant prices of medicines and services fixed by hospitals, which have operated unencumbered by regulation so far. The watchdog’s action could potentially rein in the prices of medicines and healthcare equipment, or at the very least, bring transparency in the way hospitals sell these items, according to competition lawyers.

Of the 12 hospitals that faced CCI scrutiny, six belonged to Max  and two to Fortis.

The CCI and the hospital chains had no comment for this article.

Overcharging without checks

Exorbitant pricing is a common thread running through the CCI investigation report. The hospitals were found to charge more for certain medical tests as well as for X-rays, MRI and ultrasound scans than rates offered by other diagnostic centres. For consumables such as syringes and surgical blades, hospitals charged rates that were higher than those of other consumable makers, according to the CCI report.

The only exception was medicines, which hospitals sold at the maximum retail price, although they earned significant profits by procuring them at lower prices.

The CCI selected the hospitals for investigation on the basis of the number of doctors, paramedics, beds, and turnover for the period 2015-2018. The investigation found that these hospitals do not allow the use of purchase of consumables, medical devices, medicines and medical test results from outside, adding that patients use the service of in-house pharmacy and laboratories for ease of convenience.

Investigative reports pertaining to each of the hospital chains were submitted by the DG to the CCI on December 24, 2021. The CCI forwarded a copy of these reports to the hospitals on July 12, 2022, and sought their responses, according to the people, who did not want to be identified.

The CCI has been examining the pharmaceutical sector in India for years, scrutinising the pricing of medicines by healthcare companies. On April 19, 2020, it cautioned businesses, including healthcare companies, against taking advantage of Covid-19 to contravene competition laws.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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