Society for Ethical Medical Practice

This is an appeal to all healthcare professionals in India to join hands to bring compassion, integrity and ethical standards to the practice of medicine in India. While the norms that we dream of should be the same across the world, the promoters of the idea here aim to advocate and fervently endeavour to bring about changes in India that would ensure ethical standards of practice with social conscience.

This is our first appeal to all our practitioners to come forward and bring, or actively participate in bringing, changes where needed. We have, I believe, a treasure trove of knowledge, talent and expertise in our midst. We can compare in that arena with the best in the world. Our medical education is second to none. Our men and women are scattered across this planet earning accolades. So you might wonder “what is it that we lack?” What we are talking about is elevating the standards of practice. We have to admit that there are many areas in the delivery of healthcare in this country that need to be addressed. We do not wish to burden the readers enumerating all that need to be fixed or improved upon, therefore we chose to address the issue of remuneration earned by physicians for referring patients to labs or imaging centers. This practice is not unique to our country. It has been practiced elsewhere but antiquated by rather strong regulatory legislation making such a practice unethical and criminal, punishable by loss of the license to practice medicine. This practice of kick-backs for referral has the singular byproduct of over utilization or unnecessary utilization of such diagnostic modalities and thus adding to the misery of the already overburdened patient. Out of pocket expenses borne by our patients is a staggering 86% compared to 13.8% in South Africa (among BRICS nations - Brazil, Russia, India, China and South Africa). We cannot be naive to believe that this monetary windfall comes from the vendor. It certainly is passed on to the patient. With the advent of these high tech diagnostic tools, that have revolutionized our diagnostic abilities, has come the unfortunate belief of the patient that no doctor visit is complete without a "scan". We as healthcare providers have the added responsibility to educate our patients and avoid unnecessary and burdensome testing. And on the other side of the equation, the referring physician can certainly survive without this ill-advised remuneration for referring patients.

All of us physicians need to show compassion at the outset. Private practice of medicine is a business and not a philanthropy and has to be operated as a business. But we are also subject to the Hippocratic Oath and therefore must be controlled by certain ethical boundaries. Being physicians ourselves we have our best interests at heart besides the interest of our patients. It is in our best interest to police ourselves. If we are short sighted and do not attend to such self- improvements, outside influences, consumer demands, political forces and governmental regulations will force us to do even more. So my friends, it is time for us to take stock. As we write this, please understand that this is a work in progress and all of us can together take it where it needs to go. We urge you to get involved because it concerns all of us healthcare professionals.

Our purpose in this appeal is merely this referral remuneration. Our long term aim is to point out whatever areas in the healthcare system are amiss or need to be changed. To this end we have called ourselves:

"THE SOCIETY for ETHICAL MEDICAL PRACTICE or "SEMP"

SEMP is an open forum with the freedom to discuss or criticize. There is no hierarchy and certainly no financial interest. We have merely taken one subject for discussion and implementation - a subject that is entirely in the purview of the physician to change. There are so many other subjects that need review and which would need co-operation between healthcare professionals, hospitals, the pharmaceutical industry, the public, and the government, to name a few. The opening discussion above is meant to stimulate and create a platform for discussion of ethical medical practice with social conscience.

We welcome your thoughts and ideas.  Please join our discussion forum linked below.

M.K.M. Zawahir, M.D., F.A.C.S