- Medical corruption has become systemic in India, with doctors taking and giving kickbacks and cuts for referrals, harming patients, doctors, and the reputation of the medical profession. - Doctors must stop the practice of giving and taking cuts and kickbacks, which increases costs for patients, results in overtreatment, and destroys trust in the doctor-patient relationship. - Doctors should invest in their own websites and digital presence to attract patients directly without middlemen and provide trusted medical information online in local languages. This establishes expertise, puts patients first, and avoids the need for cuts or referrals.

1. Cut out Cuts !
Dr. Aniruddha Malpani, MD
www.drmalpani.com

5. Conspiracy of silence
Makes a bad problem worse

6. The elephant in the room

7. Medical Corruption has become
embedded systemically today
Doctors take kickbacks (using euphemisms)
Pharmaceutical companies
Medical Device Manufacturers
Path Labs, Imaging and Scan Centers
Corporate Hospitals
Doctors give kickbacks
For referrals

8. Giving cuts for referrals
• Consultants and specialists give kickbacks for
referrals ( = fee-splitting or commission)
• Motive ? Earn more money
• Open secret. Pretending we don’t creates
resentment and suspicion in patients.
• This is why patients do not trust doctors
• The reputation of our profession has taken a
beating – both mentally and physically
• Violence against doctors is on the rise

9. Time to clean up the system
• Why now?
If not now, then when?
• No cuts were given 50 years ago
Why this greed to get rich quick ?
• A few bad apples started this.
Why did the rot spread so quickly ?
• Corruption as a cancer.
Has metastasized widely and caused Anorexia
Glad we are doing this in a Cancer hospital !

10. We are all on the same side !
• I am a Doctor - not a Doctor-Basher.
• Not trying to be holier than thou. Not a moral
policeman or a preacher
• The fact that cut practice has become so
rampant means it serves some purpose
• This is a “wicked problem” and will take time
to solve
• The Tata name is a model for Probity
• Let’s start by discussing this openly

12. Rationalisations and justification
• Family physicians are a bridge between the
specialist and the patient. They have earned
the referral fee for their services
• Doctors aren't Gods. Every other profession
does it, so why shouldn’t we ?
• If our seniors do it , what’s wrong if we follow
in their footsteps ?
• Medical college charge tuition fees and I have
to pay off my debt. I need a ROI

13. The change starts with us
• Choice we need to make for ourselves
• Emotional Income vs Financial Income
• Business vs profession
• Are you a missionary ? Or a mercenary ?
• Fiduciary responsibility
• Who is your role model ?

14. Cuts harm patients
• Increases the cost to the patient.
• Results in poor medical care. Promotes over-
testing and over-treatment
• Destroys the trust which should be the
foundation of the doctor-patient relationship.

15. Cuts harms doctors
• Cuts are given to earn more money, but you
end up losing money in the long run !
• Once you start giving kickbacks , you can’t
stop .
• You sign away 50 percent of your lifetime
income to the referring doctor.
• This is usually black money . IT raids and
sleepless nights

16. Giving Cuts Harms you
• The “top-line” is meaningless
• It’s only the “bottom-line” which counts – how
much money you take home, not how much
you earn
• Can do more with less if you stop giving cuts
• See fewer patients, to earn the same
• More spare time, to improve the quality of
your life
• Stronger spine

17. Loss of self-respect
• Today, family physicians do not respect
specialists any more.
• Order them around
• Make them do useless tests and unnecessary
surgery to maximise their cut
• After all, how can you respect anyone who is
willing to take a kickback ?
• Source of secret shame and guilt

18. Consultants become puppets
• The referring doctor keeps on squeezing you
• Kickbacks do not create any loyalty
• He is in control because he can create a
bidding war which you can never win.
• Race to the bottom
• Specialists have become a commodity, and
one specialist can easily be replaced by
another ( if the incentive is right).

19. The GP as a middleman
• Referrals from family physicians was
important in the past. The GP was the
gatekeeper. Trust was transferred from the GP
to the specialist
• Broken model today
• Cut out the middleman. Go to where the
patients are !
• They are all online ! Can you afford not be
there ?

20. Being a doctor today is not easy
• too much paperwork
• unhappy patients
• too much competition
• too much despair
• too little reimbursement

21. Doctor vs Patient

23. Why young doctors give cuts
• How do I get patients to come to me ?
I will starve if I don’t !
• Junior doctors are vulnerable
• My seniors give cuts , so why shouldn’t I ?
• I will stop giving cuts when I have more money
• Rationalisation and Justification = Hypocrisy

24. Back to basics –
What do patients want ?
• The right diagnosis and the right
treatment ( high quality medical care)
• Low cost ( affordable)
• Convenience ( available and accessible)
= A kind doctor who listens to them,
whom they can trust

25. Back to basics –
What do doctors want ?
• More money
• More fame
• Professional prestige
–Publications in medical journals and
Speaker slots at medical conferences
• Work-life balance
= More patients

26. Patients need doctors – and
doctors need patients
• How do patients find the best doctor ?
• Unethical options ( cuts for referrals) are
the norm today.
• Cut out the middleman
• We need to create healthier options
• Digital Telemedicine has become
mainstream now, thanks to COVID-19
• WhatsApp is not enough

27. Doctor-shopping

30. Dr. Google
• Unhappy patients
• Unhappy doctors
• It’s our fault that we force them to go to
Google !

31. Every doctor needs their own
website !
• You need to own your personal website
• Cannot afford to be a digital dinosaur !
• Get a professional webmaster – this is the
online face of your clinic ! Don’t skimp
• Very cost effective investment
• Digital startups like Practo are the new digital
middlemen and will skim off your profits

32. How do you showcase your
expertise ?
• Your patients are online
• That’s where you need to be as well !
• Become the trusted source for patient
education online
• Your website should be about their problems -
not about you !
• Generate fresh content – digital space is free !

33. Website benefits -
For doctors
Direct source of referrals. No cuts !
Create patient educational materials - spend
once, use often
Saves administrative hassles. No phone tag
Email has a much better signal to noise ratio
Makes doctors kinder. More transparent,
patient-centric, empathetic, accountable,
answerable and open

34. Your website should put patients
first
• Answer the patient’s queries
• Be conversational. Use local languages
• Show that you care and can be trusted
• Videos are very powerful !
• Patients want information about local facilities
– not about about US clinics
• By providing this information , you establish
yourself as a credible expert.

35. Website benefits –
for patients
• Doctor is available and accessible
• Can doctor shop from home
• Get second opinions
• Trusted voice
• Local language
• Transparency and openness creates trust

36. Play to our strengths
• Only we doctors can provide personalised
one-on-one care with compassion and
empathy.
• This personal bond creates trust, and this is
what patients want
• This is our USP
• No point in being a good doctor if you have no
patients to see.
• You will not have patients unless they are
aware of your services !

37. What to do
• Word of mouth marketing is best
• Your patients are your best brand
ambassadors !
• Is this ethical ?
• The “grey beard syndrome”
• Not educating patients is unethical !
• You can’t lie on your website – need to be
transparent, open and accountable

39. Google as frenemy
• Patients google you. What will they find ?
• Google needs you as much as you need
Google
• Teach your patients how to use the web
intelligently.
• Use educated patients as research assistants !

40. Doctors need to teach patients
• Instead of wasting time and money chasing
GPs, invest in building your website
• “Docere “ = teach
• Share your knowledge with patients online !
• Patients will respect and trust you more
• Quackery and misinformation flourish because
doctors keep quiet.

41. Medical Education
• Nip the problem in the bud ! Start with
medical students
• The National Medical Commission can
mandate medical students to create their own
website. Use it to share information with
patients in local medical languages
• Help with their professional and personal
growth
• Need to create digitally savvy doctors who are
future ready

42. The medical profession
• We need to take the bull by the horns
• We are not helpless , unless we assume we
are powerless – and we are not !
• Every medical association/ medical society
should have its own website
• Can provide trusted content for doctors to link
to and reuse

43. Health Insurers
• Need to prescribe Information Therapy
• Point of first contact for all customers with a
medical problem. Call center and website
• Collate data on how well each doctor treats
their patients – caring and competence
• Refer patients to the best doctors, based on
an objective data analysis of medical
outcomes and patient experience

44. Ayushman Bharat
• Huge opportunity to clean up a sick healthcare
system
• Government can create a fair, transparent and
trusted resource for all Indians, which Puts
Patients First
• 24/7 Call Center and website
• Doctor Rating System to help patients identify
ethical, competent and caring doctors

45. We need to be entrepreneurial
• Explore non-medical sources of income.
• You are talented and have many skills.
Reinvent yourself
• Be patient. Over time, this strategy yields
ever-increasing returns
• Traditional word of mouth still works. Give
lectures to Rotary Clubs and hold free medical
camps.
• Create a network of doctors who don't
demand cuts, or give them

46. The only place for cuts !

48. The joy of practising medicine –
how to be a happy doctor
• Put Patients First
• Lots of positive feedback daily
• A good doctor can have the best emotional
income in the world !
• Be thankful daily that you have the
opportunity for helping others
• Focus on quality, not quantity
• Stop comparing with your colleagues

49. www.thebestmedicalcare.com

51. Put Patients First !