‘When The Heart Speaks’: Book by cardiologist exposes ‘cut practice’ in Indian healthcare

PTI, Sep 11, 2022, 12:10 PM IST

Be it doctors charging patients for coronary stents without allegedly implanting them or getting commissions from labs for their referrals, a new book ‘When the Heart Speaks’ brings to the fore the infamous ”cut practice” in India’s healthcare system.

The book is a memoir of noted cardiologist Dr Upendra Kaul. One of its chapters – ‘Experience in Private Cardiology Hospitals’ – exposes how the ”unholy nexus” between doctors and pharmaceutical companies is resulting in patients being subjected to unnecessary surgeries, tests, and medicines.

Dr Kaul had his first encounter with the ”cut practice” in 1997 when a doctor demanded Rs 30,000 as his share for referring five of his patients to him for angioplasty. At that time, ”every referred case for angiography and angioplasty used to get a kickback of Rs 5,000 and Rs 15,000, respectively”, he claimed in the book.

”Seeing this trend, doctors went a step further and started paying their referring doctors Rs 1 lakh advance and adjusting it as and when patients came in – an ingenious move,” writes Dr Kaul, who has been practising as a cardiologist in Delhi for around 40 years.

For the unversed, term cut practice refers to giving or receiving cash or gifts as professional fees or commissions to encourage or increase patient referrals.

The menace has spread its tentacles all over the medical field, including radiological diagnostics and biochemistry laboratories, according to Dr Kaul, who is currently serving as the chairman and dean, academics and research, at the Batra Hospital and Medical Research Center. So, for every medical test prescribed, 20 per cent of the bill is given back to the referring doctor, which has led to doctors recommending ”unnecessary tests and drugs” to patients, he wrote in the book.

”The pharmaceutical companies also saw burgeoning business. Acclaimed doctors and specialists were given freebies, such as fancy TV sets, refrigerators, air conditioners and cars depending upon the prescriptions. ”General practitioners would prescribe unnecessary drugs, multiple kinds of vitamin supplements and specific brands of drugs, and were given returns in cash,” claims the Padma Shri awardee in the book.

Very often, ”prescriptions were written in codes which could be deciphered only by specific chemists”, he adds.

Notably, these unnecessary and uncalled for procedures are not limited to diagnostic angiographies only, and also include ”angioplasties and putting stents” in non-critical cases.

For instance, one such case pointed out in the book is about a doctor advising his patient of immediate angioplasty and putting in a stent. Next, he took the money for the stent and seemingly did the procedure in the laboratory. However, soon the news leaked out of the lab that no stent was put in.

Dr Kaul, to whom the case was referred for verification by a state government, after conducting multiple tests on the patient confirmed the absence of any stent in his report.

But even after 20 years of the incident no action has been taken against the accused doctor, alleged the Kashmir-born cardiologist.

”These uncalled for procedures are not only ethically wrong but sometimes cost the life of the subjects because of clotting of stents . . . and lead to a lot of morbidity for these unfortunate subjects,” he cautions.

”When the Heart Speaks” is the life story of Dr Kaul – beginning from his ancestral village in Kashmir to becoming one of the top cardiologists in the country.