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BLIND FAITH: poor patients leave the hospital thankful to their doctors for getting them discounts

Afzal could not pay a lot, but Dr Mishra could not care less – he wanted the right percentage at the right time. According to him, “It was all symbiosis.” Later, the director of this reporter’s adopted centre, Dr Praveen Gulati, explained: “Safdarjung is a poor place. The doctors want discounts for patients and themselves.” What is happening in Safdarjung is happening in aiims and all other hospitals across the country.

Doctors are aware that recommending diagnostic centres would certainly raise patients’ suspicion, so it is always done under the garb of attractive discounts.

The doctor always tells his patients that by sending them to a chosen centre he is ensuring a lower cost. And he is. The fact is that he makes more as commission than the patients get as discounts. For instance, while the doctor ensures Rs 1,000 as discount out of Rs 8,000 for an mri, he receives another Rs 1,500 or 2,500 as his cut.
And, all this time, the patient goes back home thinking his doctor is God. This reporter witnessed, many a time, the glee on the faces of the poor patients, calling up their doctor to thank him. On other times, patients called up this reporter, demanding a discount, using doctors’ references.

In government hospitals, a stench of disease follows and corruption follows the patients. The system – the peons, the junior residents (essentially, trainees), even the security guards — plays along with the doctors.

There is a placard pasted outside the opd, which says medical representatives are allowed inside only after 12.30pm (once the morning opd is over). But, many representatives, including this reporter, could buy unimpeachable impunity after paying the price of just a few cups of tea.

Inside, there is another way to get cases, independent of the doctors: to gain the support of the peons.

They have a little less – if not equal – opportunity as a doctor to influence a patient’s decision. Often, they become the walking stick for those who have come from distant rural parts. As Anil Anand, a senior pro working with Delhi MR Centre, told this reporter: “The doctor can influence a patient only so much… what can the doctor do if the peon changes a patient’s decision outside?”

So, the centres fix salaries for loyal peons too. And for those who send in cases randomly, centres pay up a commission of 20 percent. In aiims alone, MR Centre, Green Park, had, according to SK Tyagarajan, its senior representative, about 10 peons on its rolls. And each was “being paid about Rs 10,000 a month”.

August 28, 2004

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