An email falsely claiming to have been written by a renowned doctor and Padma Bhushan awardee titled “How Indian Doctors Loot Patients” has gone viral on the internet—is it because there is a lot of truth in what it says?

An email titled “How Indian Doctors Loot Patients” is bound to grab attention. After all, each one of us is grappling with soaring medical costs and shortage of high quality healthcare facilities. But what catches your attention even more is the claim that this mail is written by highly reputed Professor Dr BM Hegde (www.bmhegde.com).

Dr Hegde, a Padma Bhushan awardee and the former Vice Chancellor of Manipal University at Mangalore and Editor-in-Chief of The Journal of the Science of Healing Outcomes, has a string of degrees to his credit (MD, FRCP, FRCPE, FRCPG, FRCPI, FACC and FAMS). Dr Hegde vehemently denies having anything to do with the email—but to understand why the email was sent under his name, there are a few factors to consider.

The email, claiming to be based on “observations either completely or partially true”, exposes numerous ways in which a cozy system of referrals and pass-backs is looting patients. For instance it says (this is an edited version):

* Many doctors get a 40%-60% kickback for prescribing various pathology, radiology tests, X-rays, MRIs etc from the laboratories. Often, this income is more than consulting fees charged.

* Many doctors and GPs get a 30%-40% pass-back for referring patients to consultants, specialists & surgeons.

* Many doctors get 30%-40% of total hospital charges when they recommend hospitalisation. Even private nursing homes pay and this includes the charges for ICU, bed, nursing care, surgery.

* Many doctors prescribe what are called ‘Sink Tests’—i.e., tests that are simply not needed and merely inflate bills and earn commission from the laboratories. These are usually pathology tests where samples (of blood, urine etc) collected are simply thrown into the sink.

* Many doctors admit patients to hospital for “keeping (them) under observation”, if they complain of being unwell; they do this even when fully aware that the patient is “safe”. These ‘safe’ patients are put on a saline drip with mild sedation, and sent home after 3-4 days after charging them a fat amount for ICU, bed charges, visiting doctors’ fees.

* Some ICUs do not even have the necessary intensive care equipment. Only “safe patients” are admitted to these ICUs (usually part of private nursing homes where the doctor-owner is a call away), while those who require genuine emergency care are usually referred to hospitals that have proper ICUs.

* Some doctors are known to perform unnecessary Caesarean surgeries and hysterectomies to keep the cash register ringing.

* Cosmetic surgery is advertised through newspapers making them appear as easy as facials and waxing. The Indian Medical Council has strict rules against such misrepresentation. But nobody is interested in taking action.

* Even doctors in prestigious hospitals find ways to provide indirect kickbacks since there is a give-and-take involved. If a doctor fails to refer a certain number of patients he is quietly dumped—so he admits patients even when there is no need.

*The most reprehensible is the claim of "Emergency Surgery" that is apparently performed on dead bodies by some hospitals. The email says, “If a surgeon hurriedly wheels your patient from the ICU to the operation theatre, refuses to let you inside and gets you to sign a consent form for “an emergency operation to save his life”, your patient may already be dead. The “emergency operation” is for inflating the bill and you are allowed to claim the body only after paying added charges for the operating theatre, surgeons’ fees etc.

* The email says young surgeons who have heavy education loans to pay back and also need to build a reputation tend to recommend surgery more easily. To them, “every case seems fit for cutting. But with age, experience and prosperity, many surgeons lose their taste for cutting, and stop recommending operations”.

* Finally, it says, to a man with a hammer, every problem looks like a nail. So 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.

The startling contents strike a chord with almost every reader and their explosive nature make it clear why the writer needed to attach a renowned name to the claims. We wrote to Dr Hegde to verify whether he had indeed written this email, especially since some doctors had congratulated him for his boldness. When Dr Hegde denied it, we did a Google search to try and track the origin of the email—it goes back many months and has been posted on numerous blogs and has gathered supporting messages and congratulations as it circulated through email forwards. Sadly for this highly revered profession, the most people seem to think that too many doctors in India have forgotten the Hippocratic Oath they take swearing to practice medicine ethically (see http://en.wikipedia.org/wiki/Hippocratic_Oath) —to them, medicine has turned into a lucrative business.

Our attempt to trace the origin of this email only revealed more dubious practices. Many doctors told us that the contents are certainly true. A family of doctors which runs a small private hospital tells Moneylife that refusing to play ball with this dubious system earns them constant opprobrium from colleagues in the fraternity.

The sister of a skin specialist tells us how she is disgusted to see him filling out envelopes with passbacks for referrals every weekend. He insists it is an “accepted market practice” and his practice will vanish if he doesn’t fall in line.

A communications expert connected with a large heart hospital tells us that surgeons get a passback on every valve used in heart surgery—he further adds that the passback is heftier for the more expensive imported valves even though the quality is almost the same. The doctor helpfully gives the patient a choice instead of making a recommendation—needless to say, those who can afford it take the expensive option —nobody knows that the doctor is a beneficiary.

The list of such malpractices to downright cheating and fraud is apparently long—and frightening—and the Indian Medical Council is doing nothing.