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Thursday, 15 June 2017

Are holier than thou the best ?................ by Dr Neeraj Nagpal

Are  holier  than  thou  the  best ?

Dear  Dr  Ramakant  Panda

I  am  the  best  endoscopist  in  the  city. Dr  D...., Dr S......, Dr M......  are  all  novices  when  compared  to  me. They  cause  complications, cheat  patients, and  do  not  know  anything  about  their  subject.  Obviously  these  statements  made  to  patients  would  be  patently  false  and  should  be    punishable. But Sir, if  jousting  of  this  kind  is blatantly  wrong , so  also  is  claiming  to  be  more  honest  than  others  in huge   hoardings. When  you  claim  not  to  give  commissions  to  doctors  you  imply  that  all  others  give  commission  to  doctors  and  hence  you  are  the  best. This  is  not  only  blatantly  false  propaganda but  also  unethical  act  as  a  medical  professional  which  if  only  our  medical  associations / councils  had  some  testosterone  should  be  sufficient  to  debar  you  from  practice  of  medicine  for  bringing  the  profession  into  disrepute.

However  I  come  to  a  more  important  issue  which  needs urgent  discussion. What  is  cheating ? Is  charging  Rs  3000  for  a  CT  Scan  and  spending   500  towards direct  business  development (commission)  cheating  or  is  charging  6000  and  spending  2000  in  a  different  method  of  business development  by  putting  hoardings  in  prominent  places  which  cost  50000  per  month  cheating. After  all  why  does  Asian  Heart  Institute  need  its  name  on  a  bill  board  in  the first  place  if  not  for  business  sourcing.  To  answer  the  question  we  need  to  first decide  what  is  a  rational, reasonable  , fair  price  for  a  test / procedure / surgery   which  gives  a  reasonable  earning  to  the  doctor  as  well  as  does  not  fleece  the  patient  keeping  cost  of  equipment, infrastructure , human  resource and  utilities  in  mind.

The  only  reference  on  charges  of  medical  procedures  is  the  CGHS  handbook  and  this  is  if  anything  the  source  of  corruption  in  medical  profession. Rates  of  procedures  have  been  included  which  are  at  best  laughable  for  want  of  a  more  appropriate  word . Hospitals  bill  unnecessary  procedures, medicines  and  lab  investigations  to  sustain  and  to  survive  in-spite  of  delayed  payments  and  commissions  needed  to  be  paid  to  release  the  bills  raised . Hospitals  need  a  department  to  deal  with  CGHS, ECHS, and  other  empanelments  which  is  beyond  the  resources  of  a  professional  running  a  small  establishment.   

A  video  UGI Endoscope  costs  about  20  lacs  and  its  life  is  about  3  years . Leaving  aside  the  cost  of  his  expertise a  doctor  needs  to  do   3-4 UGIE  per  day  for  3  years  6  days  per  week  to  recover  the  cost  at  CGHS  rates if  one  has  to  pay salaries in time, pay  for  infrastructure loans and  utility  bills.  If  no  earning  is  to  accrue  to  the  doctor  why  should  he  work  and  be  liable  to  pay  compensation  in  crores  for  one  accident.

What  is  needed  is  an  authentic  rate  list  which  is  reasonable  to  both  the  consumer  as  well  as  the  service  provider. Having  written  multiple  times  about  this  and  uselessly looking  up  to  big brother  IMA  to  do  something  about  it , MLAG  has  now  decided  to  compile  a  genuine  rate  list  which  would  be  put  forth  for  future  use. I  request  all  doctors / nursing  homes, hospitals  to  kindly  use  the  CHHS  book and  let  MLAG  know  what  is  a  genuine  rate  for  all  procedures  given  in  the  book  and  done  by  them. Central  as  well  as  various  state  Governments  are  keen  on  bringing  out  and  enforcing  rates  of  medical  procedures. It  is  upto  us  to  prepare  a  rate  list  which  would  be  fair  to  all  lest  we  crib  later  and  find unethical  solutions  to  low  rates  prescribed  by  the  Government.

MLAG  will  advertise  in  National  Newspapers  soon  to  collect  this data. Meanwhile  I  request  all  to  kindly  share  your  rates  for  various  medical  procedures  as  per  the  CGHS  list  of  procedures  along  with  the  type  of  establishment  graded  as  follows
1)      Clinic  only
2)      Clinic  &  Day  care  centre
3)      Nursing  home/ Hospital without  OT / labour  Room
4)      Nursing  Home / Hospital  with  OT/ Labour  Room  but  without  24  hr  emergency
5)      Nursing  Home/ Hospital  with  OT / Labour Room and  24  hr  emergency  but  no  ICU
6)      Nursing  home with OT, 24 hr Emergency , ICU and Blood  Bank
7)      Teaching  Hospital / Corporate Hospital with  NABH / JCI  Accredition

Kindly  send  your  rates  with  the  serial  number  of  CGHS  list  to  . Please  note  that  this  is  not  a  quotation  for  lowest  rates  acceptable  but  your  genuine  rates  which  you  charge  your  normal  patients  or  would  charge  your  normal  patients  if  CGHS etc  was  not  on  the  scene.
Dr  Neeraj  Nagpal 
Convenor,Medicos  Legal  Action  Group,   Managing Director MLAG  Indemnity, 
Ex  President  IMA  Chandigarh
Director Hope Gastrointestinal Diagnostic Clinic,
1184, Sector 21 B Chandigarh  
09316517176  , 9814013735
0172; 4633735, 2707935, 2706024, 5087794
For  Contributions; "Medicos  Legal  Action Group"  Ac  No 499601010036479  IFSC  code  UBIN0549967 Union  Bank Sector  35 C Chandigarh;

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