Sunita Kaushik knows everything that she needs to know — and some more — about blood tests. The normal levels for thyroid tests, cholesterol, uric acid and sugar are on her finger tips. But Kaushik is not a physician — she describes herself as an “informed patient”. And she gets these tests done regularly — even before being asked to do so by a doctor.

“The first thing a doctor asks for when I complain of knee pain is a litany of medical tests,” she says. “So I do it beforehand,” she adds smugly. The 52-year-old Delhi resident suffers from osteoarthritis, because of which she has to maintain her calcium and Vitamin D levels. But when she goes for an investigation, she routinely undergoes every test that she can think of.

Kaushik is only preempting her doctor’s orders. Across the country, thanks to patients like her and cautious or trigger-happy doctors, unnecessary tests are being conducted every day. The patients end up wasting time and money.

But doctors maintain it is a small price to pay for early detection of diseases. “Often I ask for medical tests even when there are no visible symptoms. Mostly they include sugar tests, thyroid, lipid profile, cholesterol, etc,” says Dr Anil Varma, a Delhi physician. “I would rather have my patients do a few extra tests than miss out on an important diagnosis,” he adds.

Currently there are around 60,000 laboratories in the country which mainly offer routine and specialised testing. Health experts fear that the demand for tests is also driven by a nexus between such testing centres and physicians. The number of private hospitals in India has been growing by leaps and bounds to take care of growing health demands. But they come with a downside, health experts say. “Corporate hospitals have to make a profit. To make a profit you have to bill the patient higher. One of the ways is to do all the tests that are available in the hospital on every patient,” says B.M. Hegde, cardiologist and former vice-chancellor, Manipal University. Compounding this are unethical medical practices. Health experts stress that doctors get heavy commissions from each test conducted at a centre.

Independent diagnostic centres have worked out commissions for referrals by physicians. The commission formula no longer seems to be a secret. “Doctors who prescribe expensive diagnostic tests such as an MRI or a CT-scan get 30-50 per cent as commission,” says Chandra M. Gulhati, editor of Monthly Index of Medical Specialties, an independent research journal.

A physician in Delhi who wishes to remain anonymous explains the arithmetic. An MRI could cost a patient Rs 5,000 and a complete blood test Rs 1,500-3,500. “I get Rs 1,500 for every MRI that I prescribe and Rs 500 for blood tests,” the physician admits.

Consultant pathologist Veena Singhal has struggled to stay away from the greedy nexus. “Doctors have often asked me for commissions for their referrals. However, I opted out and have lost many patients in the bargain,” says Singhal who runs Veena Medical Laboratory in Delhi.

The head of a diagnostic chain holds that certain doctors prescribe tests without “proper education or awareness” of their utility. “There is near universal agreement that laboratory tests are over-utilised, though the degree of over-utilisation is difficult to monitor,” says Sanjeev Vashishta, CEO, SRL Diagnostics. The chain with 241 laboratories across India does on an average 65,000 tests at all locations every day.

Opening a diagnostic centre isn’t too tough either. At present, any registered medical practitioner can open a testing centre. All that they need to do is register under the Shops and Establishment Act. The National Accreditation Board for Testing and Calibration Laboratories is the sole accreditation body and at present accreditation is not compulsory. “Accreditation is not mandatory so there is no overseeing mechanism,” says Deepak Kumar Mishra, head, department of laboratory haematology and laboratory sciences, Tata Medical Center, Calcutta.

All this doesn’t bother Sunita Kaushik. As far as she is concerned, tests keep her going. Last year, she spent Rs 20,000 on laboratory tests. And she’s not complaining.