Tuesday, August 7, 2012

Private hospitals fuel C-section epidemic

Private hospitals fuel C-section epidemic

Do they really? I think I can answer this question better.

Let me talk about myself first.I have on an average 20 deliveries a month at a corporate hospital like Max.Less than 20% of them end up in a caesarean section.I do take pride in these figures.And yes MY  PATIENTS DO HAVE MAXIMUM NUMBER OF VAGINAL DELIVERIES IN COMPARISON TO OTHER CONSULTANTS.All of these are facts which can be verified from our hospital records......any media ,any SMJ team,anyone else who is interested can check the records.

Now why do I try for vaginal delivery?I do so because that is what has been trained as the optimal method of delivery unless there is a maternal and foetal indication for performing Caesarean.At my Hospital I am paid the same amount of money as my surgical fees which is around13 k in a single room patient,whether it is a simple 15 minutes caesarean section or 36 hours spent with a patient to help her have a vaginal delivery.Do you think this is fair?I strongly feel that surgical charge for vaginal delivery is very less in comparison to what it should be.It should be for sure one and a half times more than caesarean section,considering the hard work,patience and skills required for a safe vaginal delivery.It will be good for patient and doctor both.
For patients if they think ___ Money is the reason for caesarean section then if she is paying less for caesarean section in comparison to vaginal delivery she would know that the money wasn't the reason.If doctors work only for money then naturally they will start conducting more of vaginal delivery.

In my opinion money isn't the only reason for increased caesarean section rate.Some doctors and patients also feel that caesarean is the safest method and easiest method of child birth.So if they are paid less for a caesarean section,they also know that they wished the work done easy way out and thus less surgical fees.

Finally,if doctor earns money in correct way_________Don't be jealous.They have slogged hard to be where they are.
PS : When you make payment at private hospital for a caesarean do you think all goes to the doctor's kitty? You are mistaken.Of the total bill of 75 K + ,a Gynaecologist will not get  more than 13000.

If anyone of you have any question to ask me on this topic please leave your comments.


Parrish Medical Center said...

Great post. :)

Sakshi Agarwal said...

Very true doctor! I have following your blog for quite much time but writing for the first time. I must appreciate your will to steal time and be connected with the world so dedicatedly.

I would not argue on the reasons why C-sec deliveries are preferred by doctors, or hospitals or patients but certainly a beneficial reasons would have been there.

Why don't doctors take the patients in confidence by telling them every aspect of treatment going. why people feel cheated afterwards. And won't u agree that hospitals are money minded to get the fast return on their investments to make five star hospitals.

even a small thing is presented like hill and 9900 tests are being asked to perform knowing that none of them is actually required.

Dr Kaushiki Dwivedee said...

Thanks Ms Sakshi Agarwal for visiting my blog and your active participation is much appreciated.

Tell me who isn't 'money minded'?I don't know your profession but do you work without being 'money minded'?And I don't think there is anything wrong in it as long as that money is earned by lawful means without harming anyone.And yes hospitals wether 5 star hospitals or a smallest of nursing home...the owners have invested the money to earn money.There is no reason that I won't agree to it.But how does that make it wrong?Don't they tell the estimated expenses before hand?One can decide not to get treated at a particular place if the don't like the price.

A good doctor talks to her patient.Discusses the pros and cons of procedures.Explains if there is any complication etc.And takes corrective measures.Atleast I do so in my practice.......Majority of the time patients feel cheated if the communication hasn't been proper.At times doctors are actually at fault and many a time patients are also at fault.

:-)A doctors job is neither to present a small thing as hill or vice versa...her job is to tell the evidence based fact.And a clinically sound doctor won't ask you to get 9900 tests....but surely if there is a reason to get it done,which will be explained to the patient one needs to get tests done.Here also I give my patients an option...that you are advised xyz test...it is recommended..you can go for it or decline as long as you understand the downside of not getting it done.
Lastly I can't be responsible for the practices of other doctors.I can be responsible for my ethics.And I can say for sure that I love to earn money just like you but at the sametime I can tell you from a very clear heart that till date I haven't got a single unnecessary test done for my monitary gain.Neither have I done any operation or caesarean where it was not indicated.

Sakshi Agarwal said...

I agree Dr. with whatever u said, and obviously we are only responsible for our acts and not for others'.

I apologize if you felt offended with my post but mine was not the intention i was just sharing my experience with some of the doctors in gurgaon.

If you won't take me wrong then I would like to say that most of the people here are new and have migrated from different places, including me.

In your childhood you mother also would have been going to a simple dr. nearby to ur palce first for almost everything and in 80% of the cases the matter is finished then and there with some medications and precautions.

My worry is why can't a simple treatment be followed now. I agree that huge capitation fees is being paid by medical students for their admissions or etc. things and they have all rights to earn that money as well for the hard work they have put in.

But dr. pls answer a humble question that what a parent do if he does not have 1000 Rs. at the end of the month for a simple cough and fever of his child which is not eradicating by home medication.

And Dr. pls don't think I am talking about a BPL person a normal middle class person can also fall in this situtaion.

Thank you Dr. for reading my post humbly and patiently. I would stop discussing this here onwards so that it remains a pleasant talk with you only.


PS. Dr. by profession I am a chartered accountant but from last three years I am a home maker. We are a single earning member family of 4 including my in-laws.

We also like to grow in life and earn money but our profession does not deal with anybody's life so no comparison can be made, I guess.

Dr Kaushiki Dwivedee said...

Hi Mrs Sakshi,
Your comment was unrelated to C section but it was more on the lines of something like doctors overtreat to earn.
Now I have answered that only.
I am not at all offended and please feel free to express yourself.When there is disagreement of thoughts on a public forum one has to face it whether it is you or me and I don't have any issues if you disagree with me.Now good to know tha your CA who is a home maker now.Atleast you have the liberty to do so.I even don't have that liberty .If I stop earning there is no one to take care of my so

Now you talked of capitation fees.........well you are sadly mistaken .Just like 80 % of the doctors of India I have paid no capitation fees.It was all highly competetive entrance examination....and that is true for most of the doctors.Agree or not brain wise they are the cream of their batches.
Let me tell you my background.My dad was an honest Journalist and my mom a housemaker.They didn't have enough money to send me to a fancy english medium school and I studied in a kendriya Vidyalaya.They had not enough money for my tution or coaching.I passed a competetive exam to get my MBBS seat and didn't pay any capitation fees.It was at govt approved subsidized rates.Then I passed PG entrance examination to get a seat in MD OBGY.Again govt approved rates.And finally when i went to London my brother who is also a doctor loaned me money .I stayed in poorest of area of London where bed bugs bit me first time in life till I again passed my highly competetive examination with a 15% pass percentage to get my MRCOG degree and my job.
All this took me about 15 years....This is the story of most of us Indian doctors.I was lucky and I am just amongst the 10 to 15 % of successful doctors who you see today.there are many who despite so much of toil are just leading a very avg life.And when you talk of simple treatment at my mothers time then patients werent ready for a medicolegal case at the drop of the hat.Doctors could afford not to get many tests.I will give you an eg.2 years back i delivered a lady who had child with Downs syndrome(commonest cause of mental retardation)she had come under my care at 32 weeks.Before that she had changed 4 doctors.In between shifting the doctors one of the doctors forgot to prescribe tests for Downs syndrome screening.Post delivery this lady's husband had done all the research and was ready to sue this doctor for not prescribing the test.Ask your mom or your mom in law if they have even heard of any such test.So naturally things have changed.patients and their expectations have changed.And so have the doctors.I have a very humble background so I know what it is to be a middle class person.And what needs to change is the total healthcare system like NHS where quality healthcare is paid free while doctor isn't supposed to be the sacrificial goat.No point blaming the doctors.That is for the good of both patients and doctors.
Anyways that is not what the post was about.It was about C section...but none the less good that you shared what common people think of doctors and gave me a chance to answer.
BTW I hope you have a home of your own.I don't have one I live on rent:-))Can't afford the property price of Gurgaon.

Sakshi Agarwal said...

Nice to hear you Dr. and I am glad that i found a dr. in gurgaon with a heart.

I salute all the doctors for their tremendous hard work, i posses this thought since very early of my childhood.

Thanks dr. for opening another window on me, you are right patients' expectations have also changed manyfolds.

It feels great to express thoughts on your blog.

Shankarabarathi said...

Interesting and important information. It is really beneficial for us. Thanks
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