Surgical Strikes!

Sometime back, I came across a report that read:

"Is surgery necessary? A medical second opinion services center has found an uncomfortable answer to this question that traumatizes every family whose member have been advised surgery.

Almost 44% of the 12,500 patients for whom surgery was recommended were advised against it by their second opinion consultants."

On reading this, my thoughts ran like this.

I don't know how many people would have noticed the implied assumption in the report. The assumption is that the second opinions are right and the original suggestions advising surgery are wrong! How true this is can be found only through a scientific investigation. I have an experience in which the second opinion turned out to be wrong.

Around 1995, my wife was suffering from a Fibroid tumor in her uterus. The lady doctor (whom I will call LD, because this is also her initial) who attended to her two deliveries, after taking a scan, advised an early surgery. The date for the surgery was fixed.

A couple of days before the surgery, we received opinions from some of my well meaning friends and relatives that the surgery was unnecessary and that I should go for a second opinion. Though we were confused by these advices, we didn't cancel the surgery. But since the hemoglobin content in my wife's blood was quite low, the surgery was postponed by the doctor.

The doctor advised us to visit her to discuss improving the hemoglobin content by giving blood transfusion and then fixing another date for the surgery.

However, considering this development fortuitous, we went to another doctor (with a good reputation). She had a cursory look at the scan report and declared that surgery was not needed for fibroid tumor.

I was surprised that she didn't look at the scanned image but only read the typed report attached to it. She gave some herbal tablets (She is a Gynecologist alright!) and gave some advice about taking early dinner etc, attributing the bulging in my wife's stomach to gastric factors. We consulted her a few times periodically and she kept saying that everything was fine.

After a few years, my wife began to experience some problems. When we went to another doctor (we didn't go back to LD after she postponed the surgery), she said surgery was to be done immediately. It was done.

The operation took much longer than the time indicated earlier. After the surgery, the doctor said that the tumor had grown bigger and that removing it was not easy. (Mercifully, she didn't ask additional fees on account of this!) She also showed me the organ removed and said we had taken a big risk in not going for surgery earlier.

You can say this is an exception. But my point is: how can we assume that the second opinion is always right?

Now coming back to LD, she is perceived as being inclined towards cesarean deliveries. I believe that in both the deliveries of my wife, she tried to have normal deliveries and only when the normal delivery appeared problematic, she suggested cesarean.

There may be doctors who like to wield the surgical knife for making more money. But there are also doctors who advise surgery because they consider it to be a safer option. I think LD belonged to the latter category. She had delivered two children of my wife's elder sister, both through normal deliveries.

Let me cite another instance to highlight the risk factor.

There was (is) a doctor, who would seldom go for a cesarean surgery. She got a baby delivered of one of my relatives. The delivery turned out to be complicated and the doctor had to use forceps to pull out the baby. I have heard the baby's grandfather proudly narrating how this doctor had saved the baby's life by acting in the nick of the moment.

But unfortunately, the use of the forceps seems to have resulted in some brain injury and the baby has become physically and` mentally disabled. She is a girl. She is now 27, of the same age as my son.

Recently I saw her in a marriage, seated on a wheel chair with her entire body constantly shaking. I am sure if LD had been the doctor, she would have performed a Cesarean surgery and prevented the girl from going into the state she is.

There are good doctors and bad doctors (by bad, I mean both incompetent and dishonest) as there are good and bad types in all professions. Perhaps, the proportion of bad doctors is more. And so is the proportion of bad people in the human race!

Some decisions might have been based on dishonorable motives and some might have been due to bad judgements. Making generalizations, using numbers and percentages could be erroneous, apart from being unfair to the people concerned.

Many of you might have read Arthur Hailey's Final Diagnosis. In this novel, there is a pathologist by name Dr. Paterson (if I remember the name correctly!). He is old fashioned and doesn't get himself updated with the latest developments. At least, this is what his well educated assistant who has joined the hospital recently thinks.

There is a case of a young girl, about to be married. She develops a severe pain in her leg. The doctors find there is a tumor. But the biopsy doesn't clearly show whether the tumor is malignant or not. If it is malignant, her leg has to be amputated.

The young doctor is relieved that it is his senior who has to take the decision. Dr. Paterson, after pondering over the issue for some time, decides to amputate her leg. After her leg is amputated, they are able to examine the tumor and they find that it is malignant!

So, the senior doctor's judgement has proved to be right. But it was not easy for him to decide. Now, if the tumor was found to be benign, would it have been fair to blame the doctor for his judgement? I think, not!