Recently I chanced upon an article about an interventional cardiologist in the US,
who has been sent to jail for performing unnecessary coronary angioplasties.
I was sort of transported 18 years back when a senior
cardiologist in town had asked my dad to undergo cardiac surgery for a problem
with a cardiac valve. I had just started my graduate studies in medicine.
Therefore I had the privilege of getting in touch with friends who knew
cardiologists. We decided to take him to a public care facility which had a
cardiology department. The doctors there just put him on anti-failure medicines
and told us that dad need not undergo the surgeon’s blade as of now.
We continued to take him for his routine check-ups every
year. He had his last check up couple of months back and he is still on the
good old medicines. Not many medicines . . . furosemide tablets and digoxin.
And, it’s eighteen years.
The first cardiologist we saw had brought my mother to tears
saying that unless we did surgery there was not much hope.
Couple of months back when I was at home, one of my cousins
were telling about how interventional cardiology centres were sprouting all
around the state. It was quite a good investment and returns were quite
assured. There were stories about targets of the number of angiographies and
angioplasties being given to the interventional cardiologists being employed in
such centres.
Coming back to NJH, about 3 months back, I had 2 patients
who had undergone angioplasties. It is quite common for patients who have got
angioplasties to have compact discs of the images of the angiogram and the
procedure. However, I was surprised to find that they only had hand-drawn
images of the artery blocks. I could not resist thinking on how true were the
supposed artery blocks that both my patients had.
Regarding Dr. Mehmood Patel, he was convicted only because
this happened in the US. The major news item today in India is about the record
compensation that has been doled out for a case of medical negligence in
Kolkotta.
Unnecessary medical procedures are something very rampant in
the country. It starts with basic blood investigations. I’ve heard of
laboratories within hospitals that have specific codes from doctors for tests
which need not be done but are charged. The tests are charged, but not done and
normal values of the same are recorded. Then there are investigations such as
IgM/IgG for tuberculosis, serological tests done before the stipulated time
(e.g. Widal test done on 1-2 day fevers), Erythrocyte Sedimentation Rate (ESR)
etc. which are of no use to the patient.
There have quite a good number of uteri that are removed in
the country for no reason. We’ve had news about such hysterectomies which were
done under the Rashtriya Swasthya Bima Yojana. Then there are asymptomatic gall
stones, tonsils, appendices etc which are operated on for no obvious reasons. And
one should not forget the umpteen number of unnecessary Cesarian sections done.
News about Dr. Mehmood and Mr. Kunal Saha’s successful litigation should be a clear message for each of us in the healthcare profession to be
truthful to our patients. This has far reaching implications.
On the lighter view, I remembered a anecdote . . .
‘It is common for elderly men from well to do families in my
community in Kerala to unbutton the upper part of their shirt. It is usually
done to show off the gold chain on the neck. That used to be during the olden
days. Nowadays when they do the same . . . and it is done . . . to show off
their bypass scars’ . . . However, with interventional cardiology, those days
will also be gone soon.
I leave with a link to an article I read in The Hindu about Paul Dudley White,
who is known as the founder of Preventive Cardiology as well the father of American Cardiology.
I’m sure that there is much more for the heart in
terms of prevention of heart diseases than the sole choice of interventional
cardiology.
In the other post, you were talking about family medicine. I believe that the current level of regulation of health professionals is so inadequate that a robust family medicine system cannot survive in such an environment. A pity that we allow such an important profession to self-regulate. Indeed, if we as doctors would realise and at least put up minimum self-regulation standards through our medical councils, that will in fact be in our own self-interest even.
ReplyDelete