The second side of the story of “Unnecessary surgeries and stenting”:

Stop “Doctor Bashing”!!
The said firm in this news is said to have conducted research about this. What is its standing in medical research? Has it obtained permission for such research from ICMR/MCI/local medical councils? Has it obtained permission also to publish such studies in the general press/media? Who has verified the statistical/medical authenticity of the study and the various opinions therein? Who has sponsored the study? (Because medical insurance companies will always prefer non-surgical/non-procedure oriented doctors that save them money). Were all the advising consultants equally qualified in the specialty they were advising about?
Finally, who takes the responsibility of damage to life/limb in case the patient chooses a non-surgical/non-stenting option, and suffers because of this decision?

Many times there are contradictory advices given by doctors, and the most intriguing situation is when both of them have medical / legal justification for their own conclusions. While there is some truth in the “over prescription ” of surgeries and procedures like stenting by some doctors , here are some facts that may misguide our patients and society:
A patient is justifiably/naturally scared of any surgery/procedure like stenting, primarily for his own life and threat to it, secondarily for its future implications and finally for the costs involved. Hence, he/ she naturally finds a doctor with ‘non-surgical/invasive’ options more alluring, attractive. Some doctors, especially the ‘non-specialists’ (by which I mean they may still be qualified doctors but from a different speciality: this malpractice is quite rampant in India) may advice about griveous medical conditions very light heartedly without having in-depth knowledge of advances in the treatment of that condition. This not only puts a frightened patient at ease, but gives them a false sense of well-being and hope. The doctor advising so also becomes more popular and generates his follow-up by such populist practices. There are a thousands of such advertisements by quacks running in the same newspaper as this news, claiming miracle cures. Who takes the responsibility of death in these cases?? How come the courts of law and medical councils are silent about these??
While the medical world advances by leaps and bounds and hundreds of sub-specialities/ super specialities now exist, it is pathetic that the social awareness about such advances is near zero, except in the elite class. The poor and the illiterate are still charmed by the notions of a good doctor always being cheap and good medical care being available for free and if not so, the medical profession is looting them. It is idiotic for anyone to imagine that advanced medical care, equipment, procedures and skill will all be available for free, that has never worked anywhere in the world, unless the government or some charity specifically concentrates on this. But this will never be ubiquitous unless existing policies are widely changed. The above study mentioned in the news is done by some online firm. It readily presumes that the doctors not advising surgery or those whose second opinion was no surgery or procedure were correct. This presumption may be fatally dangerous. The doctor advising no surgery should then be able to carry the responsibility of any complications that may arise because surgery/stenting was not done in time. One of my own relatives, who was advised CABG (bypass surgery for triple vessel disease), went for a second opinion from an old cardiologist, who laughed away the suggestion of surgery and said only medicines were required. That relative is no more today, passed away due to cardiac arrest in a few months (unfortunately, that cardiologist is also no more).
I have personally known many knee-replacement surgeons/spinal surgeons, even some cardiac surgeons who have gone a painstakingly long way to avoid surgical intervention unless they were themselves convinced there was no other choice. Many people do not realise that someone with a dependent knee (knee problem that impairs the patient’s ability to walk) needs a family member/attendant to continually attend to the patient, thus affecting the productivity, quality of life, work, and finances, and time of two people. Needless to mention the excruciating pain that the patient suffers, the addiction to pain killers and the well known side effects. This can be solved by a good surgery in many cases where the knee replacement surgeon thinks the patient will benefit.
Stenting, joint replacement surgeries and most surgeries / endoscopic procedures have become far safer and advanced now. One must also try and analyse that there may be “mala fide” intention / lack of knowledge behind such “pseudosafe” pleasant advice.
(C) Rajas Deshpande

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