Several years ago, I did a monthly column in the monthly magazine
of IMA Mumbai West "Medical Image". It involved publishing opinions
of doctors on different issues and the column was named 'WHITEQUOTES'.
Once I asked the doctors about Cut practice and following is the
article:
IMA-NOVEMBER
IMA-NOV.
WHITEQUOTES
According to the MCI Act of 2002, splitting of fees
(cut-practice) is designated as illegal and unethical. One study done in
Ahmedabad (Bhat, IIM-A, 2003) found that 40% doctors engaged in this practice.
Many doctors are probably not aware of the legal and ethical implications of
this practice and regard it as a ‘necessary evil’. So we asked some members to
respond to this contentious issue, and following are their responses:
Ideally while giving referrals, the primary consideration
should be the expertise of the consultant. However, in cut-practice this is
overtaken by monetary considerations. So, merit and skill are compromised.
Ultimately patient loses out on good care.
Dr Sudhir Warrier, Orthopaedic surgeon, Dadar
It is widespread practice nowadays. In my opinion
established consultants do not need to oblige anyone for referrals, but for
fresh consultants it becomes difficult to get any work. The young specialists
do not get work, not because they are worse doctors, but because they are raw
and not known. So, to get referrals they offer financial incentives. By and
large it is not right, but it becomes a question of survival for some.
Dr Ashok Shetty, Family Physician, Marol
I am against cut-practice as it is totally against medical
ethics. We (doctors) should all come out in open against it- let the patient
decide where to go for treatment. I don’t know about other fields, but in our
field where we deal with life and death, this is completely unjustifiable.
Dr Neemish Kamat, Radiologist, Vile Parle West
There are two outlooks to it: Some people regard it as a
professional kind of sharing of money, without any other connotation. The
second aspect is that it may affect transparency in work, increases cost to
patient and creates unnecessary obligations to the consultant. Patients may
become suspicious and the Family Physician may lose the patient’s trust, which
is not such a pleasant thing.
Dr Priyadarshini Gokhale, Family Physician, Bandra West
It is a current trend, so much so that it is becoming
impossible for young doctors to establish practice without this system. So some
consultants are forced to accept it, even though it is unethical. Maybe, some senior consultants with an
independent practice should leave this system. This practice has started as all
the consultants are competing for attention of the limited number of patients
who are capable of paying for their treatment.
Dr Rajiv Tungare, Consultant Physician, Goregaon.
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