Indian doctors join hands against practice of unwanted tests

Several doctors from all over India and across disciplines are joining hands to fight against the menace of unnecessary investigations, reports The Times of India.

The Society for Less Investigative Medicine (SLIM), which was initiated last year by a few cardiologists in the All India Institute of Medical Sciences (AIIMS) in Delhi, is now becoming a national society.

SLIM will start off by putting together a list of what investigations ought not to be done in normal circumstances in different fields of medicine accompanied by a detailed explanation of how over-diagnosis from such tests could lead to unnecessary treatment that would not only be a waste of resources but could also harm patients.

Such lists have been produced by doctors in several countries looking to cut down on over-investigation and consequent over-diagnosis. SLIM's objectives are similar to the Choosing Wisely movement in the US launched in 2012, which currently has 70 specialty society partners who have released recommendations for their respective specialties.

While SLIM mirrors this global movement now spanning 12 countries, one of its initiators, Dr Balram Bhargava of the AIIMS cardiology department, pointed out that SLIM would be rooted in the reality of medicine as practised in India and would look to tackle problems specific to the Indian context.

After the initial announcement in July last year, SLIM saw a revival in interest just last month as the movement for practising rational medicine gained strength in several countries. The website missionslim.org is still under construction. Doctors from across the country and non-medical professionals "frustrated by the sheer avarice on display in the entire field of medicine" have expressed their desire to be part of the SLIM initiative.

Dr Samiran Nundy, chairman of the department of surgical gastroenterology and organ transplantation at Delhi's Sir Ganga Ram Hospital, said that though many doctors justified over-investigation as necessary for a precise diagnosis and to prevent getting sued, the real reasons may often be to provide corporate hospitals, laboratories and imaging outfits with more profits to justify the astronomical doctors' salaries as well as to generate kickbacks.

"We need to get together in India to produce guidelines for investigation for patients with a vast variety of disorders. Our problems are different, our resources are scarce, patients are poor and these guidelines, if suggested by an authoritative organisation like SLIM, will do a lot to bring down corruption in healthcare," said Dr Nundy, adding that the committee for ethical practice in his hospital would be delighted to join SLIM in its efforts.

Eminent cardiologist and president of the Public Health Foundation of India Dr K Srinath Reddy said that he joined SLIM because he was fully convinced that inappropriate medical care was common, frequently involving unnecessary investigations and interventions. "This has both financial and health costs which are unacceptable. There are many doctors, in both public and private sectors, who share this view and would like to reverse this trend, restoring science and sanctity to patterns of medical practice," said Dr Reddy.

Asked about a private healthcare 'industry' looking for high growth in India, Dr Reddy said that while it was expected that the industry will push for profit maximisation, it was still unacceptable to practice scientifically and ethically bad, exploitative and dangerous medicine just to make more money.

"Growth of India's health care facilities should serve to fill healthcare gaps and respond to unmet needs, not to generate ill-gotten gains from a profligate use of technologies even when not needed. Growth is desirable, but it cannot be cancerous. The medical profession must return to its ethical moorings and restore purity to its practice," said Dr Reddy.

"We have unwittingly been complicit in creating an epidemic of misinformed doctors and misinformed patients contributing to considerable harm and great expense to our national economies. The root causes include biased funding of research, biased reporting in medical journals, commercial conflicts of interest and a lack of understanding amongst doctors and patients of health statistics and risk," said Dr Aseem Malhotra, consultant clinical associate to the Academy of Medical Royal Colleges in the UK, who is part of Choosing Wisely, UK.