My last article on this series was written on 12th November 2011. The article was about how private hospitals are managed in this country and what is happening lately in private sector. Consultants in private hospitals are NOT employed by the hospital as many presume. You are self-employed and your income depends on your charges. Generally, a consultant fee is only about 20% of the total fee that you pay when you leave a private hospital as a patient. Out of this 20% that the consultant earns, the hospital will take 10-15% as their administrative fee. So, you work to make the hospital rich!
Towards the end of my last article, I mentioned that the incomes of many specialists in private hospital are gradually dropping due to stiff competition. That is the reality and you can see many consultants jumping from one hospital to another in Klang Valley. Same scenario will soon happen everywhere else.
When the competition gets tougher, unethical practises will become a norm. Some consultants want to maintain their income and thus indulge themselves in unethical practises by cheating patients. In fact, some go into private practise just to make money at whatever cost, making use of our ignorant society. Many may not like what I am going to write in this article but the truth has to be told. I received this interesting email quite some time ago:
“I would like to bring to the attention of the public the unethical practices of some doctors in private practice.
An 8-year-old boy was brought to see me by his father after suffering from fever, cough and vomiting for 1 day. He DID NOT HAVE ANY ABDOMINAL PAIN. He was initially seen by a general practitioner who insisted that the father bring him to see ‘Surgeon G’ at a specific private medical centre in Kuala Lumpur. The father at first refused and had wanted to bring his son to the medical centre where he was born but relented when the medical practitioner said that ‘Surgeon G’ will order some blood tests and will send his son home with some medications.
However, when he brought his son to see ‘Surgeon G’, the surgeon examined his son’s abdomen and pressed so hard that he elicited pain. Then the surgeon told the father that the son had a perforated appendix and insisted that he be operated the same night. The father was baffled because his son did not have any abdominal pain prior to that excruciating examination but he reluctantly agreed upon insistence by the surgeon. About 1 hour prior to the surgery, the father suspected that something was not right and he asked for his son to be discharged. He then brought his son to see me.
The first thing I noticed was that the boy had a slight cough but he was very active. His father told him to jump to prove that he did not have any abdominal pain, which he did with great enthusiasm. After a thorough examination, I was convinced that the boy did not have appendicitis and definitely not a perforated one. I treated him symptomatically for upper respiratory tract infection and sent him home with some medications. The father was outraged with what happened to his son earlier but he was relieved that his son was saved from an unnecessary surgery. Professionally, I could not tell him that ‘Surgeon G’ may have tried to cheat him but, in my heart, I knew that was the case because I knew ‘Surgeon G’ very well and had inherited a few of his patients whom he operated upon and had botched the surgeries.
The next day, ‘Surgeon G’ called me and asked what happened to the patient. I told him I was certain that the boy did not have a perforated appendix but he insisted that the boy was very sick and had rigors (severe shivering) when he first saw him. Surgeon G said the boy improved tremendously after one dose of antibiotics. In my years of practice, I have not come across one case where one dose of antibiotics can cure a case of perforated appendicitis. IT IS JUST NOT POSSIBLE! He also said that the boy’s father was a liar and had lied about his son not having any abdominal pain. Well, dear readers, I am a parent too. No father will lie about his son’s health because he would have wanted the best treatment for his son.
I suspect ‘Surgeon G’ is giving kickbacks to many general practitioners to send patients to him to operate. In return, he would pay these general practitioners for each patient referred to him. He would cooperate with the general practitioners to convince the patients that they need urgent surgery. I have personally worked with ‘Surgeon G’ and I know that his skills are questionable. He told me once that it is alright for a patient to have a recurrent disease as a result of his incomplete surgery because he would then refer the patient to another surgeon to tackle the problem. He had caused one death from a thyroid operation and at least 2 cases of complications after galbladder surgeries which he refused to admit fault. In his clinic he has medical books with pictures of dangerous diseases which he uses to scare his patients into accepting surgery.
I am writing this to alert the public that there are doctors who are out for money only and are unethical in their practices. It breaks my heart that there are such individuals practising freely and fleecing off unsuspecting and vulnerable patients and giving this noble profession a bad name. The only defence patients have is to be knowledgeable about their own illnesses and not be afraid to ask questions. All patients have to right to a second opinion and no doctors should coerce their patients to accept treatment against their will. The only consolation I have is that most doctors, both in public and private practice, are still ethical and are sincere in helping their patients.
Please circulate this article to your friends and loved ones and let’s hope no one will suffer in the hands of surgeons like ‘Surgeon G’. Also, beware of the general practitoner who insists that you see a particular specialist in a particular hospital because he could be working hand-in-hand with that doctor.”
Unfortunately, due to survival, many doctors are doing what is mentioned above. I even hear jokes at times that people around certain particular hospital got no appendix! This is because everyone who goes to this hospital with abdominal pain, vomiting or diarrhoea will have their appendix removed!! Few years ago I had a 16 year old girl who went to a private hospital for vomiting. She had an appendicectomy. She was still vomiting after discharge and was brought to government hospital 2 days later. When I asked her whether she had any abdominal pain, she clearly denied. It seems the consultant pressed her abdomen so hard that she had pain. It turns out to be that she was pregnant!! A simple history of LMP and a UPT would have given you the diagnosis. It’s all about money!
I have heard colonoscopy being done on a 16-year-old teenager who gets admitted for diarrhoea, which is just a simple acute gastroenteritis. Any patient with abdominal pain will have an Upper and Lower endoscopy done automatically if not an appendicectomy! Some doctors do not even examine the patient before ordering these investigations!!
It is very sad that the medical profession has gone so low just because everyone wants to make money. This is the reason why I keep saying that if you do medicine for money, eventually you will be carried away and unknowingly do unethical practices to sustain your income. Your motto of “saving lives” will remain a motto only. I will say this again : there is no money in medicine!! I have personally known specialist who are paying GPs to refer cases to them as mentioned in the email above. That could be the reason why certain GPs only refer their cases to a particular consultant in a particular hospital despite that consultant is not a sub-specialist in the field that is needed. That’s how desperate the consultants in private hospital have become.
I have had SLE patients with gross edema due to nephritis but the consultant in the hospital refuse to refer the patient to a nephrologist for a renal biopsy. Indeed, he was treating the patient with immunosuppressive agents without a renal biopsy (which is the standard practice)!! How unethical, but it happens. They rather take care of their pocket than the interest of the patient. Even though the specialist is not an expert in a particular field and the patient is still suffering from the illness, they still do not refer the patient to an expert! And they got no insight to the harm they have done to the patient. A good doctor will know his limit and would refer his patients out for the best level of care, whether to the government or another private hospital. He will not keep the patient to make money!
Also, don’t assume that all specialists in private hospitals are skilful. I have seen surgeons who can’t even do a simple hernia surgery but yet practicing in a private hospital. Most of the smaller private hospitals do not even have an ethics committee and what they want is just money. Whatever mistake or unethical practices that the specialist do, the hospital is not bothered as the hospital will just wash their hands off when the consultant gets sued (the hospital has already made the money!).
Do unethical practises occur in government hospitals? Rather unlikely but what I hated most when I was in the government service was when different and expedited treatment is given to VIPs! The VIPs were treated immediately and everything gets done fast. CT scans can be done the same day when general public have to wait for 3 months. I had always refused to entertain VIPs when I was in government service and my HOD was well aware of this.
I would say that partly the society is to be blamed for these unethical practices. Our society still has a lot of trust in doctors that they still feel that the doctor is doing the best for them. Fortunately, most still do but we are seeing more and more doctors who are cheating patients day by day. Unfortunately, our society believes that a doctor who says that nothing needs to be done as a useless doctor where as a doctor who removes an asymptomatic gallbladder is a good doctor! The public needs to be educated to do their own research and seek 2nd opinion when necessary before making a decision or they should ask for clear-cut evidence.
Sooner or later, the public will lose trust on doctors and the litigation rate will reach a very high level indeed. As you can see, the litigation rate is already going up day by day in major towns, especially in Klang Valley. Due to some bad apples, everyone will suffer one day………………….. and with the current quality of doctors being produced, the situation will only get worst………………
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