Private doctors refrain from prescribing tests, cite BMC pressure

Since two days, several private doctors are refusing prescription to eligible candidates for the Covid-19 test fearing backlash from the BMC.

Lack of clarity in the testing protocol continues for patients and doctors on the ground. Families of Covid-19 patients – who are considered high-risk contacts, especially those who are elderly and with co-morbidities – are finding it hard to get a prescription from private doctors to get tested symptoms, leading to a delay in treatment.

Since two days, several private doctors are refusing prescription to eligible candidates for the Covid-19 test fearing backlash from the BMC. At the same time, people under home quarantine are refraining from accessing BMC’s testing services because they don’t want to get admitted at Covid Care Centres to undergo a test.

The Indian Medical Association (IMA) said at least 20 doctors have received notices from BMC for prescribing Covid-19 tests. Most doctors are from L-ward (Kurla). BMC has observed that these doctors prescribed tests for asymptomatic patients and have been asked “why your licence should not be cancelled” for violating Indian Council of Medical Research guidelines. The notices were withdrawn Sunday after IMA reached out to the government. The IMA is creating a new form for prescribing test for Covid-19, stating earlier forms were confusing. Meanwhile, several private doctors have decided not to prescribe tests for patients.

Fear of BMC notices

“These notices are intimidating. Doctors are working under fear and stress. Several are refraining from prescribing tests now,” said Dr Avinash Bhondwe, president, IMA Maharashtra.

The current testing guidelines of BMC allow both public or private doctors to prescribe Covid-19 test. But there are conditions. While protocol allows asymptomatic people to be tested based on medical examination after fifth day, on ground, private doctors are discouraged from prescribing these tests. BMC is encouraging only symptomatic patients to be tested apart from health workers, pregnant woman, cancer or renal failure patients.

Dr Chetan Velani, who has received a BMC notice, said he has been prescribing tests for only high-risk people who need treatment and a test report for confirmation. “There are patients under home quarantine who need online consultation. But BMC insist on physical examination to prescribe a test. How can they step out? How is that possible? Government needs to resolve these issues,” Velani said.

In several cases, senior citizens with diabetes or hypertension and have a close family member who is Covid-19 positive are finding it hard to get tested because they cannot physically reach a clinic. Dr Nikhil Kulkarni, general physician, said he visits several patients’ buildings and waits for them to come down to take physical copy of prescription if they are under home quarantine. “Till now I am trying to avoid online prescription,” he said.

“Government needs to understand if a patient is ill and a doctor is prescribing the test, then it must be important. All doctors are following protocol,” said Dr Shahid Barmare, general physician. He said while online consultation is allowed, issuing prescription is not.

Dr Daksha Shah, deputy executive health officer, BMC, said if a private doctor is sure a person needs a test he can prescribe it. “But we came across cases where unnecessary tests were being carried out,” she said. She agreed online consultation is not being allowed and BMC is insisting on physical evaluation before a test.

A meeting was held of private doctors with additional municipal commissioner on Sunday to put forth these issues.

Issues with forms, tests

The current government form that a doctor has to fill before a Covid-19 test has compulsory sections like symptoms, which laboratory to undergo the test, and patient details. If that particular laboratory has a waiting period for a day or two, the patient cannot take the same form to another laboratory. He has to return to doctor to get another prescription.

Physician Dr Barmare said one of his patients required urgent testing. “He was breathless and had fever. I wrote SRL’s name in the form, but SRL online appointment had waiting period. The patient went to Metropolis but they refused to test since the lab’s name was different. All this adds to testing delay,” he said.

After receiving a doctor’s prescription, a patient has to apply online and get a time slot. On an average, it takes two to three days to get results. “After 7-10 days of developing fever a patient can get breathless and start deteriorating. If treatment is provided at right time, lives can be saved,” he said.