Indian surgeons call for end to unnecessary operations in private sectorBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1910 (Published 18 April 2017) Cite this as: BMJ 2017;357:j1910
A panel of surgeons in India has called on professional surgical societies to tackle the twin problems of unethical surgical practices in the private healthcare sector and the lack of services for vast numbers of the population.
The panel members, speaking at the release of The BMJ’s Health in South Asia supplement last week (www.bmj.com/health-in-south-asia), appealed to surgical societies to make efforts to reduce “healthcare corruption” in private hospitals, and to collaborate with the government to reduce inequitable access to surgical care.
Surveys of health facilities show a severe lack of surgical resources at referral hospitals. India’s community health centres, which serve rural populations across the country, have only 896 surgeons against a requirement of 5396. Many health centres have functional operation theatres, but lack anaesthetists. In the northern state of Uttar Pradesh, for example, 498 of the 920 community health centres have functional operation theatres, but 818 do not employ any anaesthetists.12
Samiran Nundy, a gastrointestinal surgeon formerly at the All India Institute of Medical Sciences in New Delhi and a member of the panel, told The BMJ: “Many people in the country are losing their lives because of a lack of access to basic surgical care, while others are subject to unnecessary surgeries simply because the government and doctors are not looking at this paradox seriously enough.”
He cited gall bladder removal surgeries, hysterectomies, and caesarean sections as examples of unnecessary procedures. “The practice is particularly rampant in corporate hospitals where doctors are given huge salaries that they then have to justify,” he added.
In February, Maneka Gandhi, India’s women and child development minister, backed a petition signed by more than 130 000 people calling on hospitals to declare their caesarean rates. India’s National Family Health Survey for 2015-16 showed that caesarean rates ranged from 20% to 58%, though in private hospitals rates were as high as 74%.3
Nundy and other panel members called for the government and professional associations of surgeons to establish mechanisms to audit and regulate operations.
Sanjay Nagral, a senior consultant surgeon at the Jaslok Hospital in Mumbai and panel member, said surgeons’ associations in India mainly serve as networking bodies rather than platforms to discuss ways to curb malpractice and improve the quality of and access to surgery.
Nagral told The BMJ: “It is dangerous that the government’s public health policies are centred around child and maternal health, while allowing the private sector to dominate tertiary and specialist healthcare without any monitoring or regulations. Cancer or trauma care should get as much attention in public health facilities.”
But representatives of surgeons’ associations said that the panel were “exaggerating” the situation.
Bhupinder Pathania, professor at Ascoms Medical College and Hospital in Jammu and president-elect of the Association of Minimal Access Surgeons of India, said: “I don’t accept what some are saying about needless surgery in private hospitals. Patients these days are way more intelligent and take multiple opinions before opting for surgery.”
Pathania added: “As far as equitable access to surgical care, it is the duty of the government to ensure that everybody who needs surgery can get it.”
Sanjay Jain, associate professor of surgery at the Gandhi Medical College in Bhopal and joint secretary of the Association of Surgeons of India, said allegations of unnecessary surgery should be examined on a case by case basis.
He added: “However, there should certainly be standard guidelines for elective surgery.”
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