Physicians get 30-40pc of test costs from diagnostic centres
He is a schizophrenia patient for 30 years. As his physical and mental condition was deteriorating day by day, the helpless mother took him to a new psychiatrist but got disappointed just on the first day just seeing the list of pathological tests.
Mahmudul Haq, 47, was taken to Colonel (retd) Mohammad Nurul Azim, a behavioral scientist and consultant psychiatrist of Prescription Point at the city’s Banani, last June. The psychiatrist asked him to go for CT Scan, Electroencepalogram (EEG), Intelligence Quotient (IQ) test and blood test on the very first day.
“We had to pay Tk 3,500 for CT Scan and Tk 1,500 for EEG. They also charged Tk 5,000 for IQ test, which is only Tk 500 at Bangabandhu Sheikh Mujib Medical University (BSMMU),” said Halimunnessa, mother of the patient.
What is the point of testing IQ of a person who even cannot pass out his excreta properly, she questioned.
Not only Mahmudul but almost all the patients are to spend for such unnecessary tests suggested by the physicians. Doctors get 30-40 percent of the total cost paid for tests they refer, said sources from different diagnostic centres.
“We have been continuing his treatment for last 30 years and even taken him to India and USA. But no doctors ever asked us for IQ test before,” said Halimunnessa adding that they charged Tk 5,000 for the test taken at another chamber of the retired colonel.
When contacted, Dr Nurul Azim told The Daily Star that chronic schizophrenia sometimes creates brain atrophy and it is possible to identify the atrophy through CT Scan of brain.
“The treatment will be totally different if the patient suffers from brain atrophy. There are two types of atrophy and the treatment is different for these two types,” he said adding that if there is atrophy, IQ test is a must for proper treatment.
The psychiatrists of different hospitals said pathological tests depend on the doctors and the condition of the patients. But ethically it should be done following a discussion with patients or their relatives.
Considering Bangladesh’s socio-economic perspectives, ‘clinical diagnosis’ (diagnosis based on signs, symptoms, and laboratory findings during life) should be carried out first to avoid pathological tests, they said.
“As we cannot change the IQ of a chronic schizophrenic patient of 47 years, then asking for IQ test is quite useless and it is same for the CT Scan and EEG,” said a mental health researcher preferring anonymity.
Excessive or unnecessary tests thus grasp a huge amount of money from patients. Still trend of the doctors’ prescription for unnecessary pathological tests is increasing day by day, they added.
“When I went to a top private hospital following low pressure, vomiting etc., I was referred to the Cardiology department where the doctor asked for some immediate diagnostic tests that included Eco, ECG, TSH and routine tests of blood and urine,” said Arzu, 36, of the city’s Kathalbagan area.
“As the doctor asked me to show the reports of the tests on that particular day, I had no scope to think of going outside for those tests,” she said adding that she had to spent Tk 6,500 on that day before starting any kind of treatment.
“It bothered me and so I went to the Marie Stopes Clinic the next day. Hearing my symptoms they told me that I am pregnant and asked me just for only urine test,” said Arzu.
Some doctors at different public hospitals also refer patients to private pathological centres saying to prefer good one.
Abul Hashem who admitted to the Suhrawardi Hospital was found going to the Trauma Centre for blood test leaving his wife.
“As after 12:00 noon, no pathological test is carried out at the Suhrawardi pathology centre, so I am going to the Trauma Centre as per the recommendation of my doctor,” said Abul Hashem.
The man had to spend Tk 859 for hemoglobin, creatinine and blood sugar tests, which were possible to do from Suhrawardi Hospital by spending only Tk 170.
The technologists of the hospital pathology centre said more than 80 percent patients who come to the outdoor department for treatment, go to the private clinics for pathological tests as a significant number of doctors consider the diagnostic centres as a mode of earning some extra money.
“The hospital pathology centre runs 24 hour in two shifts. After 2:00pm, only the emergency tests take place at the laboratory,” said one of the technicians.
Though the hospital and clinic section of the Directorate General of Health Services (DGHS) is supposed to look into these matters, they just show excuse of lack of manpower for weak monitoring.
Deputy Director (hospital and clinics) of the DGHS ABM Lutful Kabir said that formulation of a policy is under process to control the private clinics and diagnostic centres.
“We don’t have to do much directly against commission business and [unnecessary] pathological tests. It is the doctors who can say best which test is needed for the patients,” he told The Daily Star.
