Doctors in India plan to launch network against corruption and unethical practices

A group of doctors in India have announced plans to launch a campaign to curb what some of its members describe as rampant commercialisation trends and widespread unethical and irrational practices in the healthcare sector across the country.

The group, which includes senior consultants and surgeons in the private healthcare sector, community medicine specialists, and medical college faculty staff, proposed last week to establish a network for ethical, rational, and “decommercialised” healthcare and to urge other like-minded doctors to join the organisation.

The move came amid growing concerns among medical staff that ethical standards in Indian medical practice have fallen alarmingly low. Members of the group cited abundant anecdotal evidence of doctors seeking and paying commissions for referring patients to other doctors or of corporate hospitals’ management pushing doctors to prescribe unnecessary tests or treatment, among other examples of ethical breaches.

Suchitra Radhakrishnan, a GP in Chennai who is a member of the group, told The BMJ, “No one documents such practices—but people in healthcare circles know that they occur, and most doctors hesitate to talk about such issues.”

The proposal for the network came after a six month effort by Arun Gadre, a gynaecologist, and Abhay Shukla, a community medicine specialist, to find doctors across India who were unhappy with such trends in medical practice and who were willing to articulate their concerns. Shukla, coordinator of the Support for Advocacy and Training to Health Initiatives, a nongovernment organisation in Pune, said, “We want the network to be a ‘conscience pricker’—we believe there are many doctors in the country who are frustrated and feel helpless.”

Gadre and Shukla have documented testimonies from 78 doctors in a report that shows a range of unethical practices, such as manipulating diagnostic tests and prescribing unnecessary medicines to surgeries that cannot be justified on medical grounds. Of the 78 doctors, 37 agreed to be named in the report.

Gautam Mistry, an interventional cardiologist in Kolkata and a member of the group, told The BMJ, “There is intense pressure on doctors in some corporate hospitals to admit patients even without any indication; this was among the factors that made me leave the hospital where I worked.”

The network, which hopes to reach out to medical staff through its members’ personal contacts and a website, will take public stands on key issues in ethical and rational practice. Gadre said, “An important task ahead is to get the government to regulate the private medical sector.”

Samiran Nundy, senior gastrointestinal surgeon at the Sir Ganga Ram Hospital in New Delhi and editor of Current Medicine Research and Practice, told The BMJ, “I’m optimistic that this campaign will expand—such a movement gains credibility when it is driven by doctors.” In a commentary1 published last year in response to an article in The BMJ,2 Nundy had issued a call to curb corruption in Indian medicine, saying that “the silent minority must try and do something about it.”

But members of the group have warned that the network will have only a limited capacity to bring about change and will require support from the government, as well as from bodies such as the Medical Council of India, the nation’s apex regulatory body for doctors. Chandrakant Pandav, a professor of community medicine at the All India Institute of Medical Sciences in New Delhi, which hosted the group’s meeting last week, said, “Strong support from the government and the Medical Council [of India] will be crucial for this to succeed.”

Nundy added, “Exemplary punishment is necessary for deterrence.”