Why does the neurologist end up ordering a CT scan for a simple headache? Or why does a surgeon order an ultrasound scan for a minor abdominal pain?

As you ponder these, also analyse how the numerous diagnostic imaging centres that have mushroomed in your area survive?

One sentence holds the key to all these queries: the bribes paid to doctors by diagnostic centres.

Here is an elaboration of how this unethical practice flourishes. Representatives from these centres  offer doctors kickbacks for the tests they direct to their clinics. The amount paid depends on the doctor’s seniority, the number of patients he or she sends to the clinic and the bargaining skills of the doctor. 

Unfortunately, even very senior and reputed doctors indulge in this kind of shady business.  Doctors obviously feel that they are entitled to this kickback as they are bringing business to the imaging centres. To draw a parallel with another sector, bus drivers and conductors get a decent amount of extra cash when they halt at certain restaurants, for the passengers to order refreshments.

The real issue between this sphere and other sectors is that a doctor is professionally bound to do the right thing for a patient without any conflict of interest.  Kickbacks will ensure a doctor prescribes a particular test to a patient that is not needed or will be tempted to suggest a more expensive procedure to a patient since the doctor’s monetary benefit is at stake here.

This helps explain why a doctor suggests an MRI scan instead of a CT scan.  Doctors are usually given 20%- 40% of what the patient pays to a diagnostic centre. A CT scan costs Rs.3,000 and the doctor stands to gain Rs.600- Rs 1,200 for ordering the test. An MRI costs Rs.7,000 and, hence, the doctor gets between 1,400 and Rs 2,800 as his or her share. It does not take a genius to figure out which test the doctor would suggest.

A clever way doctors make the patient do what they want is to gain his or her confidence by charging very low consultation fees.  This makes the patient unconditionally trust a doctor and assume the medical professional is not greedy for money. The doctor compensates the minor loss incurred by ordering expensive tests at a certain diagnostic centre!

The shocker is that some doctors earn anything between Rs 2 lakhs and Rs 4 lakhs through these kickbacks/bribes.  However, this is not meant to suggest that all doctors indulge in it.

On the other hand, there are doctors who try to get their patients a discount at these centres or help needy patients in other ways. 

This practice is not only restricted to private imaging centers but also extends to some corporate hospitals.  In fact, a few hospitals pressure their doctors to order extra tests that are not necessary.  Doctors who refuse to comply are shown the door.

The government must insist that hospitals and imaging centers have displays that clearly mention that they do not give kickbacks to doctors.

Patients should also ask the imaging centers if their doctor gets kickbacks from them.  A mechanism to penalise or prosecute hospitals, imaging centres and doctors, who collude in this malpractice, needs to be evolved by the Central government and the Medical Council of India.