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Apr 23, 2019

It's not about your health; it's about your wealth, Damn it!

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By Dr. B. M. Hegde, India [ Published Date: April 28, 2011 ]

"Give all thou canst; high Heaven rejects the lore of nicely-calculated less or more."-- William Wordsworth. (1770-1850)

I was at a college day function three days ago when an agitated young medico was in a great hurry to see me immediately. He looked very agitated and I did not want him to suffer any more. He had come there with one of his very senior professors who had pacified him a lot already. I excused myself from the dais and went down to meet him in the green room. He had called my house first and then he came to the venue directly. He could not speak properly as he was still agitated. I tried to put him at ease and asked him as to who he was and what was the immediate provocation for his acute anxiety state?

With tears of joy in his eyes as he got someone to soothe him, he slowly opened up. He was a bright student of a government (Bangalore) medical college and had secured a merit seat for doing MD in general medicine. As he had a few months time to join his course, he took a temporary job in a teaching hospital in Mangalore as a casualty medical officer. That morning he was on duty. A middle aged man had come to the casualty with atypical chest pain since morning. This good bed side doctor had come to the conclusion that the pain was not due to myocardial ischaemia (angina pain) and was in the process of allaying the patient's anxiety. The latter felt better and he was about to go when one of the senior cardiac surgeons happened to walk in. I was pleased with the expertise of this young medico as he was following the best scientific tradition of diagnosing cardiac ischaemic pain on the bedside. The cardiac surgeon saw this young doctor about to send the patient away.

The cardiac surgeon took the young medico to the adjoining room and told him that this is not the method of disposing off any one with any kind of chest pain. He told: "first find out about the patient's personal details like, his financial status, whether he has medical insurance or a Govt. or corporate job that reimburses his medical bills etc. In case the patient comes from the poor strata of society what the young medico was about to do was right but NOT for a rich man or for the one that has a God father to pay for him. The young doctor was advised to reinvestigate the patient using all the available tests in the hospital (if the patient can afford) and then ask for a coronary angiogram as he might have some blocks in the coronary arteries needing a bypass graft! The young man was told that is how corporate hospitals work these days!

The cultural shock was too much for the young man to bear. He was so confused that he wanted to quit the medical profession if it is this inhuman. To take a final decision on what to do, he went to see one of his teachers. Looking at this young man's state of mind his teacher, who happened to be an old friend of mine, directed him to see me and gave my address etc. That is how he landed with me! He was caught in an ethical dilemma. Little did he realise that the medical fraternity today, especially in the fee-for-service system has become a corporate monstrosity. He was innocent and believed in all the nice things about medical ethics and was keen to do service to the less fortunate after becoming a doctor. All those dreams and the castles in the air he was building about his future seemed to come down and collapse suddenly. It took me nearly half an hour to get the medico to reality of this world and convince him that it is not good to run away from a problem but to stand and fight it. It is the minority like him that can change the set up. People like him are the hope of the suffering humanity.

He agreed with me and was quite composed when he left. He promised me that he will study for his MD with greater vigour with a resolve to stand up to be counted in the fight against falling moral standards in the profession. May his tribe increase?
I didn't forget to ask this young man as to how he was so sure that his patient did not need bypass surgery? He was up-to-date, even though he was only a fresh MBBS. He told me: "the only study, large enough to give an opinion on Bypass surgery, not funded by vested interests, the CASS study, showed that 84% patients did not get even a day's extension of life expectancy while the remaining 16% got some relief. There are only TWO scientific indications for Bypass surgery-intractable chest pain despite the best medical management and severely compromised left ventricular function. Neither of them was present in this man. In all other cases Bypass surgery could increase the risk of a future heart attack, quadruple the risk of acute stroke, have 47% long term resultant cognitive defects, some of them quite incapacitating. Bypass does not even reduce the risk of sudden death due to malignant arrhythmias. He concluded by saying that he has saved one human life by sending the man away. I was speechless!

The moral of this true story is what Professor Harlan Krumholz of Yale University wrote something like this in the New England Journal of Medicine (NEJM 1997; 336: 1523) about cardiac interventions: "cardiac procedures bring in billions of dollars in cash for doctors, hospitals and the instrument manufacturers, in addition to television interviews. The procedures are done mainly to get those benefits and not to help patients in the USA." This is the long and short of the present day medical economics. It is not about doing good, damn it! In the year 1823, James Wakely, a young MD and member of the House of Commons, thought that the London doctors at that time were a bunch of "incompetent, corrupt, and nepotistic" humans that looked like an abscess on the body of the profession. Wakeley started a new journal, The Lancet, named after the scalpel that surgeons use to drain the pus, to clean up the mess in the medical profession. Today in 2011, the medical profession, in the words of Hillary Butler, a medical journalist, has become "a corporate monstrosity"! Very sad, indeed!

"Experience is a comb which nature gives us when we are bald."-- Anon.

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Dr vijay Atole , India :
I read the book what docter's don't get study in medical school by Prof. b m hegde and i was shocked how the consultant super consultant 'so called' misusing their nobel profession and robed the people through out the world without giving good heath.it is necessary by law audit of medical intervention of surgery like bypass , angioplasty and to ban of such procedure for mankind.
B H Giridhar Shetty, India :
After reading several articles of Prof.B M Hegde I request medical fraternity and regular readers of Mr.Hegde can think of nominating Mr Hegde for Jindal Prize instituted by Sitaram jindal Foundation for the year 2011 before 30th June For HEALTH INCLUDING DRUGLESS HEALING. Kindly go through www.Jindalprize.org for nomination form. I am not a Doctor or medical student and hence the request with Medical Persons. or readers of this column.
B H Giridhar Shetty, India :
I endorse the view expressed by Mr.Alfred Vincent Monis,Bahrain.
Balakrishna Shenoy, USA :
I am inclined to agree with the learned Doctor B.M.Hegde. Professors question the Interns and House Surgeons about her pescribing a medicine for a poor patient without a " Recommendation" from a Politician or Bureaucrat!
Still the problem raised by the Student is universal.
When I go to see a Physician in the U.S., the first thing I am asked for is my Insurance Status and my or my people's ability to pay and then pass me on to a Specialist for further diagnosis and other expensive Proceedures.
Once I had to tell a Specialist that when my time comes, I prefer the Highway and not the byepass! Reckless exploitation of Health Insurance has made Insurance no longer affordable and reckless Litigation with Millions in damages awarded by Jurors has made Health Care a big ? not! It is just Health Scare to squeeze out the maximum money from the Patient's Insurance and other financial resources and there is a big set of people to share the loot! The late respected Dr.A.L.Mudaliar, Vice Cancellor of Madras University has proved right. Oversupply of Physicians, Surgeons and Specialists from a proliferation of Medical Schools and Hi Tech Hospitals has made Health Scare a really big business without scruples!However, the Economy grows by this exploitation of Healyh Scare. Let us hope that things will correct themselves!
Rudolf Rodrigues, India :
We would be hypocrites if we say we too are not in the same mentality of earning fast money. Also we have to accept the fact that medicine is no more a nobel profession. It has been totally commercialized and is big business with the entire chain right from the GP to the specialist, pathologist and pharmacist involved in fleecing the patients. We should not be much suprised at this as doctors also need to live a lavish life with certain status like all other professionals. The added problem here is the high capitation fees one has to shell out to get into good super speciality courses which needs to be recoverred as early as possible.

Everything looks fair in today's world of gross consumerism and loss of values. Only dangerous thing would be someone resorting to organ trade or killing for monetary gains!!
Alfred Vincent Monis, Bahrain :
Hats off to you Dr. Hegde for the article. We need many many Dr.Hegde's in this world.
Leeladhar Puthran Baikampady, India :
As per an insider of a very famous south Mumbai hospital (you can make out), an internationally acclaimed cardiologist and medical educationist of India, who has been conferred with Padma Shri, the Padma Bhushan and the Padma Vibhushan, as a matter of routine advises angiography, angieoplastry and bypass surgery to the patients who consult him in this hospital. The idea is to get into the Guinness book records and to collect as much money as fast as possible! Where this noble profession is heading.
Prashant Rao, Saudi Arabia:
Indeed so heartening to see doctors with a conscience, we need many more of these in our country...
Drona, India :
he is God... but some times he thinks he is a Surgeon !!!-Probhu

That was a nice joke Porbhu. Thanks for sharing it with us here. I don't think Prof Hegde will have any objection to that.

A very famous ophthalmologist was being honoured. They had kept thee cut out of a large eye with the face of the ophthalmologist in the centre of the eye as a back drop and lights illuminating it. One of his friends was jealous watching all the importance given to him. Thank God, he said. Thank God they do not do this to us.

PS: He was a Gynecologist.
vas, New Zealand:
Excellent comment. This is the problem with modernization and privatization. In my opinion, private practice should be separate from public as there going to be "conflict of interest". I have not done private practice, and used investigations only when required. I fully agree with Dr BM Hegde, who was my professor, 30 years ago that medical profession is different today. I am happy with my generation
Porbhu, India :
Thanks for pointing out my error.

However what I witnessed in that hospital is my first hand experience and I stand by that statement.

At this juncture I would like to narrate a joke: )

One politician dies and goes to heaven ( that in itself is hard to believe) .

Its lunch time and there is a long Que. The politician tries to cut the line and others stop him .

Hey .... hold on a second ... we are all equal here . Politicians do not get preferential treatment.

The poor guy falls in line. After some time he sees one guy running ahead .. cutting the line( que) .. whoa ..exclaims the politician ... who's that guy ....? why is he cutting the line?

Others shrug off.... Oh him ... don't mind him.. he is God... but some times he thinks he is a Surgeon !!!
Drona, India :
I know exactly who the cardiologist is -Porbhu

If you read the article again, you will find that Dr Hegde mentioned cardiac surgeon as opposed to cardiologist.

I think he has delivered the message and the concerned would have taken note. It is not nice to point fingers in a public forum. After all, the person may have changed for the better since you saw him last.
V Prabhu, India :
A very nice eye opener from Dr. Hegde. Thank you Sir.

I am in complete agreement with your views. Every patient needs a very good doctor (primary health care provider). Based on the doctors advise the patient may be asked to undergo further tests and procedures- the doctor has to asses the benefit to risk to the patient without monetary considerations.

Judicious use of health care technology is needed. Patient awareness and health education will go a long way.

One example of the same hospital: One of the partners (Surathkal) was talking to the BD distributor (a MD ) -Ortho business is down! We have to wait for pre- monsoon showers to start. There will be more Ortho cases!! with more accidents and broken bones to mend!!

Medicine is indeed a business these days.
A.S. Mathew, USA :
Great article exposing the greedy and unethical side of the medical industry.

New medical devices are being invented by the industry and to sell them at very high price, they need the help of the doctors.

When the Doctors get a patients, they are simply pushed to the hospital bed and conduct all kinds of unnecessary and highly expensive tests using the most modern machines. It is very sad to say that the medical profession is downgraded as a legal rip off business.

Mr. Puttur Dinesh, U.S.A. I do agree with you 101% that India is blindly following the American medical industry practice. Thousands of unnecessary highly expensive tests are being done in India every day.

Recently I heard in the ABC news that the U.S. population, which is only 5%of the world population is consuming 80% of the world consumption of pain killers. The medical Doctors in the U.S. are ready to prescribe strong pain killers and they get the commission from the pharmaceutical companies. But the number of deaths caused by the overdose of pain killers are greater than the number of people died in the road accidents.
Porbhu, India :
I know exactly who the cardiologist is , The hospital was started in 2002 and is near pumpwell.

This cardiologist was the same man even then. He was using healthy patients to do angiographies to cover the cost of his Siemens Equipment.

He is one of the partners there. He was initially not experienced to do even these procedures and was using healthy patients mostly from Kasaragod and Kerala.
Kadengodlu Shankara Bhat, Kazakhstan:
Namaskara, Prof. Hegde-yavare.

I really liked this article like all your previous articles on medical ethics & attemopt of Doctors to increase the quantity of longevity rather than the living quality for the years a person can live without unwanted surgical intervention.

Awaiting more & more such articles from the real great HUMAN doctors like you.
Puttur Dinesh, USA :
Few days ago when I commented on bariatric surgery someone said I was being mean. India is surely headed the american way, very soon insurance companies will start case management and many doctors who defraud the system in India many go to jail.
Drona, India :
I am glad Prof Hegde has penned this article which was long over due. Many unnecessary surgeries are also done apart from CABG.The American way of practicing medicine is corrupt to the core. They believe that the man is immortal. Strange enough we see them dying like any body else. Don't we? Obama may bring some balance to the stupidity which is rampant in America and copied by our people.
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