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Many doctors working in India's "profit driven" private hospitals are under pressure to carry out unnecessary and "risky" tests and procedures to meet revenue targets, a report published in The BMJ journal has claimed."Doctors who face pressure from hospital management to over-prescribe surgeries or investigations fear for their livelihood," Dr Gautam Mistry, a cardiologist in Kolkata, told The BMJ."Also they need to practise for a certain number of years, and by complaining they would be jeopardising their career," he added.SATHI (Support for Advocacy and Training to Health Initiatives), a non-governmental organisation based in Pune, has for the first time documented the problem.Its recent report, Voices of Conscience from the Medical Profession, comprised interviews by the gynaecologist Arun Gardre with 78 doctors throughout India.Gadre told The BMJ that India has seen a rise in multi-speciality hospitals."Their main aim is to generate revenue and profits for their investors," he said."In the race to earn higher profits, conscience takes a back seat, and doctors are encouraged to indulge in unethical practice," Gadre added."Significant numbers of patients must be advised to be admitted for surgery or medical procedures that bring in real financial profit for the hospital," said Kunal Saha, adjunct professor and HIV/AIDS consultant in Ohio, US, and president of People for Better Treatment, a non-governmental organisation that promotes corruption free healthcare in India."Needless surgery, even simple procedures like tonsillectomy or appendectomy, may cause unexpected hazards for the patient," he said.However, some doctors disagree about the ubiquity of financial targets for doctors, including Dr Devi Shetty, chairman of the Narayana Health Group, which runs 32 hospitals for profit in 20 locations in India and abroad.He argues that setting financial goals for a doctor is not a common practice in India and told The BMJ that Narayana's hospitals do not set financial targets for doctors but do set performance targets to raise efficiency.The Medical Council of India (MCI) is responsible for institutional regulation of medical services, explained Bangalore-based journalist Meera Kay who wrote the BMJ report."But the MCI's reputation is in tatters; its inability to collect data on alleged medical negligence and general failure to bring prosecutions instill no confidence," she wrote."A radical change in the structure and functioning of the MCI is the need of the hour," Gadre told The BMJ."The elected members are all doctors, which could result in a biased outlook," she said.The BMJ said it contacted the MCI and the Association of Healthcare Providers, the trade body for private hospitals, but had not received responses by the time the report was published.