Matter of Opinions

Of course medicine is a noble profession.

Just one look at the teeming crowds outside a government run medical facility is enough to give you an idea of the role doctors, and as a whole, the medical establishment plays in the society. Private hospitals add to the comfort; for a price, you can access better wards and healthcare, and of course the prestigious tag that you can afford to be treated by the best in business.

But somewhere in the midst of all this, in our minds, there lurks a lingering mistrust in the profession. Most of the mistrust centers around two elementary pillars of medical practice. Diagnostics and surgeries. There aren't too many complaints about the quality of the prescription, unless the patient has suffered debility or death as a result of a prescribed medicine. It is the elaborate, and often excessive, diagnostics and needless surgeries that attract litigation. Let us try to dissect and analyse the problem objectively, from the standpoint of a client.

Say, for example, I am the patient. I smoke a packet of cigarettes daily, have a stressful job and love to chill on weekends with a couple of beers. One day I get a pain in my abdomen, near the pit of my stomach, that aggravates with meals. I recall a similar episode that struck me a couple of months back. I attribute the discomfort to 'gas', take a few over-the-counter pills and try to ignore the discomfort for a couple of days. My appetite deteriorates. Then one day I vomit, and decide to visit a doctor. The doc, a fairly busy practitioner, gives me a two minute hearing, and without as much as even a cursory glance at my tummy, hands me a prescription with a list of diagnostic tests that mandatorily includes an ultrasound examination. Of course the tacit instruction, as confided in me by his patronizing assistant, is that I get the tests done from a certain laboratory round the corner. I do as instructed. The tests leave me poorer by about Rs. 5000/-. The ultrasound examination reveals I have a gall bladder stone. I go to the doctor with the reports. He now focuses only on the ultrasound and conveniently chooses to ignore my other tests, which hint that I might be anaemic as well. I am given to understand that my gall bladder is on the verge of bursting open and that I might die if I do not get that offending appendage removed within the next 24 hours by a surgeon of his choosing. Since I can no more put up with the agony, I agree.

Key-hole Gall Bladder Surgery

The gall stone surgery costs me about Rs. 50,000/-. No one asks why I have anaemia.


I return home, quite weak after three days of fasting. They have extricated the gall bladder, along with the gall stone, and sent it for histopathology. They tell me it's cholecystitis, not cancer. I'm relaxed and hopeful that I'll never again have to endure the dizzying pain at the pit of my stomach. But I'm wrong. As soon as I swallow a few morsels, the pain returns. This time it strikes a little higher. The centre of my chest is on fire, and it spreads sideways to engulf the area where I suspect my poor quivering heart lies. I am rushed to the same neighbourhood doctor who now shakes his head in disbelief and pronounces that I might be having a heart attack. Such things are not uncommon after major surgeries, and particularly in stubborn smokers like me, he assures me. Without even an EGC, I am hurtled into a cardiac unit where a bevy of nurses hook me up to a dozen beeping monitors. Soon I am wheeled into the cath lab where I undergo what is called 'PTCA + stent to LAD' for a 70% blocked coronary. The cardiologists emerge from the OT with the unmistakable swagger of having saved another wretched soul from the jaws of certain death. They are mistaken. Seeing the bill of Rs. 2,25,000/-, I die from shock.

Putting a stent in a blocked coronary artery

I wriggle back to my home, shaken and stirred. My anemia has worsened. But I've beaten death by a whisker, I'm given to understand. The pain won't come back, I'm assured. I give up smoking. On the 5th day, in the middle of the night, I wake up in complete bewilderment, soaked in sweat. The pain at the pit of my stomach has returned to haunt me.


My cardiologist, thoroughly irritated at getting a call in the mid of the night, examines me cursorily and pronounces that nothing is wrong with either my heart, or with the stent they have placed in one of my coronary arteries. It's gastric pain, he hisses, and dismisses me from his presence.

Painful gastric erosions

I am on the verge of giving up when a friend of mine asks me to visit a gastroenterologist. So I fix an appointment and reach his office early in the morning. The gastroenterologist performs an endoscopy for Rs. 2000/- and finds my stomach full of nasty little erosions. I'm put on anti ulcer medication, which I continue for four weeks. My appetite returns. The pain vanishes. The anemia gets corrected by itself. I feel a lot healthier.




So one day, I sit back and think it over.

I had a nasty pain in the pit of the stomach that aggravated with meals, with nausea, vomiting, decrease in appetite and anemia. I had a gallstone. And I was a smoker.

Assumption 1: The gall stone was the culprit.
Then why did the pain recur after removal of the gallstone?

Assumption 2: It was cardiac pain. The physician had erred in judgement by linking it to the gallstone.
Was it? I had an elaborate procedure on my heart. Blockage clearing and all that stuff. Why did the pain come back?

Site-wise distribution of common abdominal pains

Assumption 3: It was ulcer pain.
Quite possibly. The gallstone and an 70% block in the coronary were red herrings.

Red herrings, or just incidental findings that should have compelled the physician to do a much closer scrutiny of the causes that lead to precordial and epigastric pain?

What did I lose?
Rs. 3 lacs.

What did I gain?
Wisdom.

What would have been the best treatment?
The doc I visited first should have taken care to assess my symptoms objectively against my lifestyle and history. Unless I had a really bad gallbladder (excruciating pain on the right side of abdomen that worsens on deep breathing, associated with shivering and high fever), the surgery could have been avoided for now. Also, a 70% block in the coronaries is fairly common and unless it precipitates an angina while walking on the treadmill, it doesn't need to be flushed open with a stent that costs a fortune.

What could have been worst?
I could have perished on the OT table. Or during angioplasty. Or suffered irreversible brain damage due to momentary failure of circulation when they tampered with my heart. Uncommon, but such things happen.

Question of attitude?
Yes. A doc who's overeager to push patients into surgical procedures is bound to willfully overlook simpler ways to treat the same thing at a fraction of the eventual cost.

In short...?
Carelessness at best. Greed at worst.

Was there a way I could have escaped the torment?
Yes. Had I cared to take a second opinion. At each step.

I rest my case.

(Based on a true story)