Fees

Doctor’s Fees: A Taboo Topic
© Dr. Rajas Deshpande

A famous industrialist from Pune recently visited my OPD. My Boss called me on phone and told me to waive off the fees, as he was a close friend of my Boss. The industrialist was not only well behaved, but well-read too. He had a complicated problem, had seen Neurologists etc. in India and UK. He asked many questions, and I was happy to have been able to reply to most. The consultation lasted over 45 minutes. He went out, and was told by the receptionist that his fees was waived off. He knocked my door, came back in, and placed three thousand rupees on my table. My usual fees is half that.
“Doc, I don’t believe in taking advantage. You gave me all the time I needed, and I have paid far more to the foreign doctors for a fraction of that time” he said.

Just a few days prior, a European patient from Mumbai had visited with her Indian in-laws, and after a detailed consultation, when they went out and paid the usual fees of 1500 INR, she messaged me: that this was far lower for the service they received. © Dr. Rajas Deshpande

Two days ago, on Saturday night at 9 PM, one lady rushed in without appointment, an engineer now working in Pune. Quite lavish in her get up and paraphernalia, she told me she had recently delivered a baby in the USA and then returned to India. After we finished the consultation that lasted over 30 minutes, and included many questions and explanations about her “minor” neurological problem, about justification of diagnosis, every medicine, about lactation, and about her prior medical consultations, I was happy that I had answered all her questions, and was able to treat her without any tests. Then she said: “And yes, doc, your fees is too high. Most doctors in my area charge less than that. I want concession”.

Earlier it was quite embarrassing for me to discuss money with patients. I felt it was below my dignity to have to talk about money, and humiliating to have to explain my fees. When I decided what I charged, it was after a prolonged thought process, and awareness of Indian healthcare scenario and socioeconomic conditions. While being available for genuinely poor patients, I did not want to resort to any backdoor incomes, and also wanted to give every patient the best of my skill acquired over 15 years of education, and enough time. There are clean doctors, far more senior than me, in my branch, who know this well and charge a lot more as consultation fees than I do (some over 5000 INR for a single consult), for they know their own worth. But there also are few who for their own reasons continue to charge far lesser, some with a noble intention (usually at the fag end of their career), some with alternative plans. It is a personal preference of the doctor, especially specialist. A correct diagnosis and honest /right advise is becoming rare and rare, what with the quality of medical education and an admixture of streams, which aim at the fast, cheap, objective and basic rather than specialized, subjective and accurate. © Dr. Rajas Deshpande

In absence of any comparable example, (medical service is not comparable to any other, but to quote an example that most should understand), I have to mention this: when one buys land, home, good food or technology, one pays differently at different places, for different brands. No one argues about the rates of foreign cellphones or jewelry, even about cinema tickets, but the most important service of all: health, is considered a bargainable, perpetually low cost charity. Basic and emergency healthcare doesn’t mean attached super-technology, five star rooms and washrooms and air conditioning, best qualified staff and ancillary services. © Dr. Rajas Deshpande

Used to this question very frequently, I told this lady that my fees was the same as that of most super-specialists in larger cities, that it was based upon qualification, experience, skill and time spent. She wouldn’t listen, and refused to pay. I told her she could avail of the free OPD meant for poor patients if she had a BPL card or if she was a farmer. “I can afford, I am not poor. But I want concession, because some doctors in my area charge only XXX”she said. © Dr. Rajas Deshpande

A senior doctor had advised me during the beginning of my practice: “Concentrate on the affordability of the middle class. Manage your time with the patient according to their affordability, people are rarely willing to pay the doctor. If your consultation fees is high, you will turn off many patients, because even the rich opt for the cheapest possible healthcare, including the doctor”. © Dr. Rajas Deshpande

Of course I did not want to discriminate. But over a period of time I realized that most of the forced free categories keep on repeatedly visiting various specialists / hospitals (a free category patient visits over three consultants for every medical issue) because it is free/ low cost, this is a frustrating scenario. Even the affording class visits many specialists for the same problem because the doctor’s fees is too 'affordable'.

A doctor must always be kind and compassionate, but in India, he / she also needs to be practical to avoid being exploited. Compare to the availability of a free food service at your home for the poor. Check out for yourself how many misuse it, and how often. © Dr. Rajas Deshpande

Various pathies and specialties have a different fees structure, and people must be educated that all doctors cannot charge the same. A surgeon or physician with more skill, experience, expertise and good outcomes is definitely entitled to charge more than his peers. After all, what is a few thousand rupees when one’s health is concerned? When filing suits against doctors who commit mistakes, people claim in crores, a fact that must be accounted for when the doctor charges his / her fees.

“Your fees has increased” said a patient, who has paid the same fees for last 8 years. When I asked him to name any commodity whose price hasn’t increased in last eight years, he said “But you are a doctor”. © Dr. Rajas Deshpande

Among all the inflations happening everywhere, it is only the doctor’s fees that mostly remains unchanged for years. There are excellent charity institutes with great healthcare services , also many government hospitals, but most people want a “Premium / Priority” healthcare service at their lowest rates, refusing to stand in a queue at such hospitals. © Dr. Rajas Deshpande

The cut throat competition among hospitals to match society's low cost healthcare expectations has resulted in a nightmare: most of the permanent staff being hired is low-salary, low qualification overworked, and exploited, many of the consumables used are of a questionable quality. This reflects worst in most critical care units and some surgical units. Very few will understand the true depth of this horrible tragedy.

While all cut-practice and other malpractices must end, while every doctor must compassionately aim at resolving the health problem that the patient trusts him / her with, and satisfy the patient as much as possible, it is also necessary that people understand that good healthcare will come at a higher cost. No doctor should refuse emergency /basic treatment to a patient who really cannot afford. Other than this, “Cheaper Doctors are the kindest and the best” is a devastating superstition we must eradicate.

© Dr. Rajas Deshpande

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