Sunday, May 13, 2012


Medicine in India has evolved tremendously in the past few years. Advancement in technical knowledge and skill of doctors, infrastructure of hospitals, technology and management has made the country famous for good medical care. The large number of international patients flocking to the country adequately substantiates this claim. However just as every coin has two sides, so it is with medicine in India! Something somewhere is wrong. The picture is not as rosy as it seems. I know it, you know it. Everyone knows it. So what is wrong with the medical field in India?

Is it that medicine has become too commercial?
If that means it has become expensive then that's due to inflation. Even I wish I could get petrol for Rs 20 per litre like in my school days!
If becoming commercial means that hospitals and doctors are marketing themselves, then that too is necessary. It's a survival tactic for the hospital/doctor and useful for patients. Useful as it helps the patient become aware of a service or expertise.
If commercial means cut practice, then that's an evil we all would like to avoid. But that occurs because of a problem in the system. So corruption flourishes in medicine like it does in almost any other field in India.
From a patients’ perspective, I don't think commercialisation of medicine is the real problem.

So then is it that surgeries are unsuccessful and complications are more?
Actually the situation is the exact opposite. Complications are a part of surgery. They always were and they always will be. Nobody wants a complication. The doctor wants it even less than the patient. But when a complication does happen the patient finds it all too easy to blame the doctor. I think we as patients need to stop being all emotional about this. A little maturity and rational thinking is the need of the hour. Just as the fear of an accident doesn't stop us from using a car, so it must be with surgery and complications.
And though road accidents are on the rise, medical complications are decreasing due to advancements in technology, infrastructure and medical knowledge and skill.

So then is it that doctors aren't as good as they used to be?
 Again the opposite is actually true. Today's doctors have the advantage of better training. They also have the advantage of learning from the mistakes of the past. Add to this the beauty of specialisation. A specialist basically means a better result and fewer complications.

So then what is wrong with medicine in India today?
The main problem is unindicated surgeries, procedures and investigations. To understand this we have to understand the meaning of the word indication. The dictionary meaning is "a special symptom or the like that points out a suitable remedy or treatment or shows the presence of a disease" Simply put an indication is a criteria that helps a doctor decide if a certain procedure is suitable for that patient. An indicated procedure means that the patient will benefit from the procedure. An unindicated procedure means either the patient will not benefit or the patient will benefit from a simpler, less invasive procedure as well. It is important to understand the last part of the previous sentence.
Some doctors do more invasive, aggressive procedures or investigations to make more money. The procedure generally gives the desired result but it was unnecessary and simpler things would have worked just as well. This is a shameful practise and must be condemned.
A classic example is MRI. Many times doctors prescribe MRI's when it is not indicated at all. Another example is in cardiology. Some cardiologists advice angioplasty even though the patient needs a bypass! The reason for doing this is obvious.

Another problem is a doctor attempting something he is not adequately trained for. A classic example is knee replacement. It seems nowadays that every orthopaedic surgeon is a specialist in knee replacement. An untrained, inexperienced surgeon attempting a complicated surgery is a recipe for failure. And if the surgery is unindicated, it is a recipe for disaster!
So how does a patient deal with this problem?
The first most obvious thing to do when one is advised an expensive procedure or surgery is to take a second opinion. There are 2 types of second opinions and both are important. The first is an opinion of another doctor, preferably a well known specialist in the field. Many times a second opinion increases the confusion. In that event take a third or even a fourth opinion. The other type of second opinion is a second opinion of another patient of that doctor. Please ask your neighbours, friends and relatives about the doctor. You may be surprised!
The second thing to do is to ask your doctor the right questions. Most patients end up asking stupid questions like ‘Doctor, is there a guarantee of the result?’ You are not buying a washing machine. This is medicine! There are no guarantees.  A more sensible question is ‘Doctor, what are the indications of this surgery?’ or ‘what are the potential complications and the percentage?’ or ‘is there a simpler procedure which can do the same job?’ or ‘what is the percentage of success?’ or ‘can this procedure be delayed?’ or ‘what is the risk/benefit analysis for this procedure for a patient like me?’. It is your right as a patient to know everything about a procedure from your doctor before you agree to it. If he is not willing to answer, ditch him immediately. Another advantage of asking many questions is that it will blow his cover if he is lying.
The next is research. Just like we research the market before buying a cell phone, all patients should research the internet about a procedure before agreeing to it. If your doctor doesn’t tell you the complications of a procedure, the internet surely will. Just type ‘indications of angioplasty’ in Google and your question will be answered.
Many of us have a close friend or relative who is in the medical field. He/she may be a doctor or a nurse or a technician etc. It doesn’t matter what they do in the hospital. The point is they are part of the system. They know the inside story! They know which doctor is really good and which one only shows that he is good! They know the complications and results of commonly done procedures like knee replacement, etc. Always consult them before taking a major decision.

Almost all Doctors are good people. They deserve your trust and faith. They will do what’s best for you whether you ask the right questions or not. They will not cheat you even if they can. Doctors in India are also amongst the best in the world. Sheer experience and volumes have made them better than their western counterparts. A successful result from a procedure or surgery is far more likely now than ever before. The whole world is coming to India for medical care and we are lucky to have it at our doorstep. My purpose is not to scare you away from doctors and hospitals. Your trusted doctor still deserves your trust!   
My purpose is to make you aware that there are a few rotten tomatoes out there. If we keep our eyes open we can avoid them!