A CT scan of abdomen is equal to 400 X-rays in terms of the radiation exposure to the patient. Spiral CT of Abdomen is equal to 300 X-rays. Don’t rub your eyes in disbelief. It is true! You are not the only one; many experienced doctors whom you trust your life with are also unaware of these facts. A study involving 130 doctors, which was published in British Medical Journal, has shown that most of the doctors are unaware of the radiation hazard that their patients are exposed to when they are subjected to various diagnostic tests. It is estimated, the study goes on to say, that about 100-250 deaths occur each year in United Kingdom from cancer, directly related to medical exposure to radiation.
The situation in India could probably be worse. Not that the awareness levels among doctors are low. But there is a growing perception that the medical profession is witnessing decline in ethical standards, and patients are subjected to many expensive, needless, repetitive and potentially hazardous investigations. The media reports are corroborating such a perception. For instance, a few months ago, a leading daily has carried a series of reports on growing nexus between hospitals and the diagnostic centers. This nexus is resulting not only in fleecing the patients, but also in submitting them to unnecessary diagnostic tests. There were also instances where doctors have subjected their patients to complex surgeries without factoring their old age, all for a quick profit. This is in gross violation of the Indian Medical Association’s Code of Ethics, which clearly states that a physician must uphold the dignity and honour of his profession, the prime object of the medical profession is to render service to humanity; and reward or financial gain ought to be a subordinate consideration. Sadly, not only have kickbacks from diagnostic centers became common, but numerous media reports also suggest that there have been instances of gross medical neglect and high incidence of corruption in health care. The CGHS scam is one such glaring instance. However, the response from the medical fraternity to growing incidence of corrupt medical practices has been a deafening silence.
Such indifference will only result in outside agencies/government stepping in. More state regulation will only result in more corruption and further complication of the existing problems. Therefore, doctors, diagnostic centers and hospitals must start taking steps which will facilitate quality health care to all the patients at reasonable costs. We need to remember that in spite of declining ethical standards, there are many honest and competent doctors, pathologists and radiologists. They should come together to identify and standardize best medical practices. An internal institutional mechanism in hospitals must be created to oversee the various medical practices. Similar to ombudsmen in banks, every hospital can have an internal vigilance officer of credibility. An independent accreditation system to rate various hospitals can be examined. The accreditation mechanism could be structured along the lines of CRISIL, which rates financial institutions and is respected by the government and corporate sector alike. The accreditation system has many other advantages such as identifying best practices and the possibility of replicating them in other hospitals. This will also help patients make informed choices, and will propel various hospitals and individuals to upgrade their capacities.
Private sector is playing a dominant role in medical care, accounting for 80% of the ambulatory care and 60 % of patient care. This role of private sector is bound to grow, and the doctors will have to ensure that the profits of hospitals will not be at the cost of the community and patients. Introduction of ethics as a part of curriculum will equip medical students to deal with complex issues while delivering medical care. In a country where the ‘out-of-pocket’ expense on health care is one of the highest in the world, the decline in the ethical standards and the loss of confidence in health fraternity does not portend well for social stability. The medical profession would be wise to seize the initiative and set things right by establishing credible institutions and practices.