This is my fourth decade as a doctor. When I started my PG at AIIMS in 1980, we used to look down upon doctors who offered commissions for referrals.

When I returned to India in 1993, after my fellowship at Cleveland Clinic, I saw that offering commissions had become much more commonplace, and with it, the increasing incidence of unnecessary treatment. Private hospitals were mushrooming, and they gave away commissions to get patients rather than establishing their reputation through the quality of their care.

I was determined to establish a heart hospital that upheld the strictest standards of ethics. But the long line of scared patients who came to us didn’t stop. “I have been told that if I don’t undergo surgery or angioplasty within a week, I will drop dead,” is the refrain of many patients, who were virtually in tears out of fear of sudden death. I have spent much time convincing people they do not need surgery or angioplasty, and that they can in fact be treated with medical management. In the past few years, I have spent more time asking patients not to undergo surgery or angioplasty.

As physicians, we are expected to heal a patient, give relief from suffering and save lives. However, with kickback or commissions as the motive, hospitals and doctors have forgotten that golden rule. It is safe to say that at least 25 per cent of costly treatment, be it angioplasty or bypass surgery or knee replacement or other procedures currently being performed, are not needed and much cheaper alternatives can be offered to patients.

But doctors alone cannot be blamed for this sad state of affairs. And the ‘cut practice’ is not a standalone issue either. If we take a stand with one issue, we will have to initiate reform across multiple issues. It emanates from other evils like capitation fees for medical education. A doctor from a middle-class family (as most doctors are) would have incurred an expense of a crore of rupees (for an MBBS degree) or ₹2-5 crore (for post-graduate degrees), and is 30 years of age when he starts practice.

Young doctors face also face competition from fake doctors who operate without legitimate degrees and perpetuate the ‘cut practice’.

That is why we decided to put up hoardings to draw public attention to this highly unethical practice. All the senior doctors I spoke to — Dr Vijay D’Silva, Dr Pradyoth Kumar Rath and Dr Sunil Vanzara from the Asian Heart Institute, and other highly respected doctors, Dr V Mohan, Dr Sanjay Nagral, Dr Samiran Nundy, Dr Soma Raju, Dr GN Rao, Dr Srinath Reddy, Dr Shiv Sarin, Dr Gautam Sen, Dr Devi Shetty, Dr KK Talwar — have supported our stand and have joined hands to fight this evil.

Young doctors from across the country are sending us congratulatory messages. One doctor wrote to urge us not to stop our campaign against.

The Maharashtra Government has taken this up on a war footing. From 1980 to 2017, ‘cut practice’ has become the norm rather than the exception. The practice is universal and applies to all healthcare providers, radiology centres, pathology labs and hospitals across Unani, Ayurveda and homeopathic practice, and even for physiotherapy.

But July and August will be crucial months as the Committee for the prevention of cut practice works out the penalty for those who are caught indulging in it.

Mischief-mongers and agents are actively trying everything possible to break our resolve and deter us from continuing our campaign. But in both the doctors’ and the patients’ interest, we are determined to see this campaign through.

The writer is Vice Chairman & Managing Director, Asian Heart Institute. Views expressed are personal.

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