iRADiX

After going through the wonderful blog of Dr. Alok's "Cut practice" and the intelligent responses , I started wondering , about Medicine, Medical Profession and Professionalism, in context with present day of economics driven and economics controlled crazy world and its dominant living occupants known as Human beings and their 'Next only to God' physicians.

Profession

Webster’s Dictionary says "Profession is an occupational group of people who have learned specialized skills that allows them to serve the public need".

Examples given include Medicine, Law enforcement and Architecture.

Please note the definition. The skills acquired are to be used only for the purpose of serving the public need.

Medical profession

Free Dictionary says "Medical profession is a body of individual who are qualified to practice Medicine"

Now it is clear that anybody taking Medicine as a profession by virtue of definition of 'Profession" automatically allows himself/herself to serve the public need.

And one should remember that one is subject to obligations and values

The practice of fee-sharing or cut practice is regularly condemned by the medical fraternity and general public. Patients are waking up to this reality, making it one of the major reasons of declining doctor-patient relationship. Almost every discussion about cut practice results in loud cries of moral indignation. Despite this, such practices flourish and have now enveloped much of the modern medical practice.

Forms of Cut Practice

We radiologists tend to think that we are the most affected by this ‘affliction’ but it is much more diffuse and pervasive in the medical field. It takes many forms (1):

• Giving a share of fees to the referring doctor.
• Referring patients for unnecessary consultations or tests to ensure a kickback from the consultant or laboratory.
• Giving expensive gifts periodically to the referring doctor.
• Appointing junior specialists to a super specialty hospital so that procedural work is always referred by them to you.
• Unnecessary admissions in nursing homes/hospitals.
• Sponsoring of a conference or payment of travel expenses by a company in return for the use of its equipment or prescription of its drugs.

How independent can one be in a modern technology driven specialty branch dependent on referring physicians?

Systems and communities of practice

In the previous blog we had examined some practice options (Part Time?)

As Dr. Sridhar rightly pointed out that we are a referral dependent specialty and in his interact on Forum of Super specialty in Radiology has observed that one really does not often meet radiologists who are practicing as independent super specialists. We meet Neurologists, Cardiologists..but…super specialist radiologists?

In Blog End of Individual Goliaths we had examined how if one has to hold ground one has to be part of some system of practice.

Does the person who is working “For Himself” really work alone or are they part of several practices.

One surgeon friend did not want to initially invest on costly radiology equipment as he had invested in operation theatre and Intensive care units. He asked his radiology friend to invest and set up the radiology department.

“I am a man of limited means and you can use your real estate to become independent any time, once the initial loss making ‘teething’ period is over” the radiologist replied frankly.

Hippocratic Oath has lost relevance due to ever changing religious, political and social milieu. I faintly remember a line 'you can not advertise yourself, though you can advertise your hospital'. Taking into account a large number of physicians doesn't it sound absurd? In your daily life and during your practice have you not been asked by the public or a fellow doctor as to which hospital or doctor would be better for a particular patient. Do we not enquire where to send a patient for X-Ray, C.T. or MRI and do we not know whose report is reliable and whenever the report appears unsatisfactory do we not look for the name of the doctor signing it. Some institutions have developed a name for themselves, like AIIMS in Delhi, KEM, TATA memorial hospitals in Mumbai to name just a few. These hospitals are very large many with over 2000 beds and a large number of satisfied patients go home talking good about them. These hospitals need no further advertisement.