Thursday, February 8, 2018

Medical malpractice fuelled by greed and unregulated system

Professor Zulfiqarali Premji

Professor Zulfiqarali Premji 

Close friends with medical problems still seek my advice – thanks to digitalisation. Recently, someone sent me the picture of an 18-year-old’s big toe: an infected in-growing toenail requiring a minor incision under local anaesthesia.

Their doctor had proposed an ultrasound, blood count, and a battery of biochemical tests that included renal function, liver enzymes, urine routine and stool – all costing about Sh400,000.

After the test results, minor surgery (not included in the testing fees) would be required.

They asked me whether all that was necessary. I counselled them to go to a government clinic; they went to Mnazi Moja Hospital in Dar es Salaam, where the toenail was removed – and the wound eventually healed. No highfalutin medical tests were needed, and Sh400,000 in costs was averted.

Another friend who saw a doctor for a sore throat and dry cough was also asked to undergo a battery of medical tests that included the Widal test. He was then told he had typhoid fever.

Doctors know that the Widal is an absolute test that is no longer required.

Tanzania is among developing countries struggling with widespread poverty; public health woes; scarcity of physicians; weak health care systems and regulatory deficits: pressing issues needing prioritisation.

It is sad there are no efforts to create workable systems for adjudicating physician negligence.

Patients don’t know where to go for justice in cases of malpractice. They are even less able to evaluate and challenge the care they receive – and medical malpractices are routinely swept under the carpet.

Yearly malpractice suits in the US account for about $55 billion.

We have an almost unregulated medical sub-sector – and, as the two examples herein above show, greed is a malignant cancer amongst poor patients.

After allowing stand-alone diagnostic centres (without clinical services) to operate, patients are being prescribed unnecessary tests by unscrupulous doctors in league with laboratories.

There are needless hospital procedures by mercenary doctors, from caesarean births to appendectomies, which harm people’s health and finances.

However, there are strong global practices and precedents to curb malpractices.

Six US hospitals were fined millions of dollars in 2017 for improper financial ties with diagnostic centres, and for recommending needless procedures. A Kentucky hospital was fined $41 million for prescribing unnecessary coronary stents.

Indeed, success of some corporate hospitals is no longer based on clinical outcomes, but on financial profits.

Patients are treated as revenue-generating clumps of tissue to be pricked, prodded and cut open on the slightest pretext. Why should a cough require an MRI (magnetic resonance imaging) or an ultrasound?

When goals shift from honest treatment to cold revenue targeting, intervention becomes necessary.

The net result – regardless of the financial condition of the patient – is that the treating physician and the hospital administration raise astronomical bills.

Monthly revenue-targets must be met. Incentives range from kickbacks for needless tests and longer hospital stays to vacations and luxury sedans for the best doctors. Anyone who has had the misfortune of going through the rigmarole at one of these branded hospitals will testify that even a short-stay can mean a massive financial hit.

The situation is worse for folk who cannot afford expensive medical insurance – and are, thus, at the hospital’s mercy.

If we are serious about malpractices, then there is an urgent need for clear legal procedures for patients ripped-off by professionals supposed to aid them in their hour of need. Governments must clamp down – through better regulation and serious enforcement of rules – on individuals and institutions that abuse the system.

In the midst of this mess, the only messiah – so to speak – is the Judiciary.

Gone are the days when you could blindly trust your doctor’s advice. With the advent of profiteering in medical treatment, it is now critical that patients know their rights.

There is a need to improve communications between patients and doctors, so that patients are aware of the risks that can occur despite a doctor’s best efforts.

Another important step is to institute programs that continue those communications even after mistakes have occurred.

Medical malpractice are mostly due to negligence arising from individual character flaws resulting in defective care received by patients, thus effectively denying patients their fundamental right to high-quality healthcare standards.

There must be regulations to checkmate it.

Zulfiqarali Premji is a retired MUHAS professor. His career spans over 40 years in academia, research and public health