Monday, November 02, 2015

Does your doctor give kickbacks ?


It is an open secret that most Indian doctors will give and take cuts, kickbacks, and commissions. These may either come from pharmaceutical companies for prescribing their drugs ; from hospitals for filling their beds; from consultants for referrals for surgery; or from diagnostic centers , for sending patients for scans and lab tests. These have pretty much become a fact of life , and in fact doctors, who don’t take cuts and kickbacks are considered to be abnormal , because they don’t do so. After all, what the majority does becomes the norm, and lots of doctors can’t understand why any doctor would want to take such a high moral ground and refuse to accept cuts.

Lots of doctors need to justify to themselves why they take cuts. After all, it causes a lot of cognitive dissonance knowing that you are doing something which is not correct. I came across an interesting justification today. This specialist said - “Rather than refuse to take the cuts from the hospitals I send my patient to, I collect these cheques and deposit them in my bank account. If I didn’t take them , in any case the money would just end up in the hospital's bank balance, so why does refusing to accept this help - it just makes the hospital richer ! The money belongs to me , as they were going to give it to me as a cut. This is why I accept it and I put it in what I call my Robinhood account, which I then use for treating poor patients.” He seems to be very pleased and proud of himself for coming up with such a smart solution. I agree the name he has given his account is extremely clever , but it doesn’t change the fact that it is still an unethical thing to do.

In his heart of hearts , he knows that. He is intelligent, and know that his action fails the New York Times front page ethics test, which basically states that if your action was reported on the front page of the New York Times, would you be able to live with this fact ?

I agree it can be hard to refuse the temptation, and it is extremely easy to fall to the seductive lure of accepting easy money. However, at the end of the day , it is worthwhile taking the higher moral ground, because it lets you sleep much better at night. Otherwise, you do end up with some short-term gain, but you end up creating a lot of long-term pain for yourself . It can be hard to live with yourself when you know that what you are doing is wrong. By condoning kickbacks , what doctors fail to realize is they are allowing corruption to enter into the system, and this is true whether you accept the kickback , or whether you give it. And just like many doctors accept kickbacks, many of them give cuts to general practitioners to refer patients to them. The moment corruption enters healthcare, openness and transparency disappears . The trust element, which is such an integral part of the doctor patient relationship, then dies a natural death. Once trust is missing, then it becomes very hard for patients to repose their faith in their doctor.

Specialists need to realise that even from a financial point of view, giving kickbacks it is a very short sighted thing to do. It appears to be a quick fix, but if you are willing to give cuts in order to get patients, you end up signing away over 30% to 40% of your lifetime income to a middleman - someone who adds no value , either to you or your patients; and someone who has absolutely no loyalty to you whatsoever. This means that once you go down this spiral, it become progressively worse. You are trapped into doing this all your life because you end up competing with other consultants . If they keep on increasing the percentage of the fees which they are willing to give away to the middleman for the referral, you will find increasingly hard to match them, which is why doctors find themselves stuck in a race to the bottom .

Smart doctors have a long-term perspective , and who understand that there are better ways of creating loyal patients. These methods may take a longer time to deliver results, but they are far more cost effective in the long run. Doctors need to think about the lifetime cost of giving cuts , and how much they are forced to sacrifice ( both morally and financially) by using this tempting shortcut to get more patients.

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