Why is Indian Medical Association defending unnecessary surgeries?

The Indian Medical Association (IMA) claims to be the largest body of doctors in India that is supposed to work for health promotion and patient welfare. But its reaction to a recent survey on unnecessary surgeries shows that it is a mere trade union of doctors engaged in protecting interests of private and corporate hospitals.

The doctors' body has reacted angrily to the survey which showed that a bulk of surgeries being conducted may be unnecessary. Of the 12,500 patients who sought surgery-related second opinion, the second opinion provided in 44 per cent of these cases suggested surgery was unnecessary and there were more relevant, less invasive treatment options available. The survey was conducted by an online second opinion platform called MediAngels.com.

Instead of addressing the core issue raised by the survey - unnecessary surgeries - IMA has shot off a letter to the Medical Council of India (MCI) to gag such surveys. The association has suggested that such surveys with likely national impact should not be made public and they should be first discussed in a medical conference. Not just this, IMA wants the medical regulator to proceed against the company which has done the survey.

Whatever may be the motive of the online second opinion firm behind the survey, it has brought out an important issue that concerns patients in this country. This survey only adds to growing evidence - both scientific and anecdotal - about unnecessary surgeries.

A large study called "Delhi Delivery Care" sponsored by the Indian Council of Medical Research (ICMR) recently revealed that a substantial section of women in private hospitals are forced to undergo significantly higher number of ultrasounds and caesarean deliveries. The caesarean rate is as high as 53.8 per cent in private hospitals and 41.4 per cent in nursing homes. This is much above 10 to 15 per cent limit suggested by the World Health Organisation (WHO). C-section is a major - and costly - surgery and should be carried out only if medically required.

Thousands of women in villages and towns across India are forced to have their wombs removed by private doctors, taking advantage of the fact that these women are covered under government insurance schemes. Scores of such cases have been exposed by health activists and data presented to relevant authorities.  

Family planning operations conducted by private surgeons in government-sponsored camps often don't follow basic guidelines such as taking informed consent of women and adhering to quality norms. This results in young women being subjected to surgeries and many a times under dangerous conditions, like it happened in Bilaspur in Chattisgarh.

What does IMA do in all such cases? It defends doctors who botch up operations. After the Bilaspur tragedy, it defended Dr RK Gupta, who conducted the surgeries in the sterilisation camp, demanding his release and revocation of his suspension. IMA lobbied for the release of Gupta with the health ministry in New Delhi. When Aamir Khan presented evidence and case studies of unnecessary surgeries, falsified diagnostic tests and the system of commission payment in Satyamev Jayate, officials of IMA called it an attack on doctor-patient relationship.

In fact, the association has consistently opposed any regulation and quality standard setting for private sector healthcare. The world over, medical associations support evidence-based treatment guidelines and protocols and their adherence by members. Medical regulatory authorities include non-doctors too as members. Instead of lobbying for such patient-friendly reforms in the system, medical bodies like IMA are acting as vested interest groups.