Each medical graduate starts practising only after reading the hippocratic oath which states “I will practise my profession with conscience and dignity. The health of my patient will be my first consideration”. But the oath remains empty speech. Today healthcare is a business and patient a client. And the principle that drives business has crept into healthcare too. Patient care has become secondary and profits the prime motive. The industry has given birth to an ugly monster called “Cut Practise”, whom everyone knows but no one will dare to name  or stand up against it. What does “cut practise” mean? The practice in our health care system when the referee of a patient pays out to the referrer for sending him ‘business’, is known as ‘cut practice’, or simply ‘cut’ or ‘referral fee’. It occurs in many forms. Some of them are listed below:

• 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-speciality hospital so that procedural work is always referred by them to you.
• 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.

What usually happens is, the general practitioner gets a share of fees from the specialist or hospital to whom he/she has referred the patient. It's a win-win situation for the both the sides. But patients are the major losers. According to a report by OXFAM International, 63 million Indians are pushed into poverty because of healthcare costs every year - almost two people every second. Here “cut practise” seems to act as a catalyst. How much does the patient have to pay extra? According to Dr Kamal Kumar Mahawar in his book “The Ethical Doctor” he states that  “Personally, on the basis of my interactions with hundreds of doctors, I think one could safely assume the figure to be somewhere in the range of 20–40 per cent. Naturally, who suffers as a result of this extra cost is obvious, but if you are not sure, a report in the famous British journal, the Lancet, quoted Amar Jesani, editor of the Indian Journal of Medical Ethics as saying: ‘It’s the patient who ends up paying extra money to cover for the kickbacks.” He goes on to add about the prevalence of this practice that “Rather than arguing about the actual statistics of prevalence (which many people think is close to 100 per cent), to me this is one of those issues where perception matters, even if it is worse than the reality. Perception alone is enough to damage credibility. And for a profession like medicine, where credibility rests almost completely on trust, this perception is doing irreparable damage to the doctor–patient relationship in our country.”  

Let’s dig in a little deeper. Who are the major actors in this? Besides doctors and the touts, government and the regulatory authorities also have a role to play. According to NMC regulations: “7.19 A Physician shall not use touts or agents for procuring patients.” Even fee splitting is not allowed. But these regulations remain on paper and are never enforced. In addition to this is the crumbling government health infrastructure which allows the private sector to grow. The unregulated growth of private sector creates unhealthy competition, where in  order to survive they have resort to unethical means. The new doctors often look up-to their seniors, and when they find that even the integrity of seniors is compromised, they are left with no role models. The costs of medical education, hospital infrastructure put a huge financial burden on doctors. That makes them vulnerable to unethical practices as a source for quick money. But like foolish investors, they often fall for short term gains which leads to huge losses in the future. They lose dignity and self-respect. It leads to secret shame and guilt. The specialists in the long run end up losing a substantial income in giving cuts and at the same time have unhappy patients. The quality of healthcare provided also deteriorates. The cuts are usually black money, and gives sleepless nights for the fear of IT raids. 

Imagine what would happen if we put a stop to Cut Practise. The healthcare will be more affordable and the quality will improve. The trust in doctors will grow, which in-turn  will lead to reduction in cases of violence against doctors. We as citizens of India have a right to demand good quality, affordable and honest health care services. How can we do it? All the doctors should pledge never to do cut practise.  In 2017 Asian Heart Hospital had done  something similar by putting up a large hoarding stating “Honest Opinion. No Commission to Doctor.” Personal resolve is always stronger  than any legislation.  All doctors must pledge now and forever “I will never take cuts” and put an end to this corrupt practise.