About 44% of the 12,500 patients for whom surgery was recommended, were advised against it by their second opinion consultants, say a Mumbai medical second opinion services centre. Unnecessary surgery is not something new in medicine. Doctors in Andhra Pradesh rampantly performed hysterectomies in 2010 to get a higher compensation from government medical insurance schemes.
MediAngels studied its first 20,000 consultations and found that several people were advised "unnecessary surgeries" by their primary doctors. Take Kandivli resident Gaurav Sharma whose uncle was advised cardiac surgery. He was told to undergo surgery the next day itself. The entire family went into a tizzy wondering what to do. He logged into MediAngel's online chat with a cardiac surgeon who looked at the ECG and said the patient only had an orthopaedic problem. He then sought an opinion from a shoulder specialist in the US, who told him that his uncle's shoulder and arm bones were not aligned properly and showed some shoulder exercises.
Dr Debraj Shome, who owns MediAngels, said his centre's data showed poor adherence to surgery guidelines in all specialties. It was found that the discrepancy in opinions (between the patient's doctors and the second opinion-giver) was the highest in heart problems at 55%. Knee replacements and hysterectomies stood second at 48% while infertility had 45% discrepancy in opinions. Interestingly, many doctors seek second opinions if they themselves are asked to undergo surgery, whivch is a big eye-opener. It shows that there are reason to feel concerned as everything in Indian healthcare is increasingly getting monetized.
In many hopitals, doctors are treated like daily wage earners and are paid on the basis of the 'business' they bring to it. Obviously, a surgeon will be tempted to recommend surgery. Some specialists, though, say there is a logical reason behind the discrepancy in the MediAngel data. "There are many non-medical ways that compete with surgery as a form of treatment. So, in India, it is more a case of whom the patient goes first for consultation—whether a surgeon or a medicine specialist" they opine. In the USA, where healthcare is mainly paid for by insurance companies, some states require two opinions on the need for a surgery.
Incidentally, at a World Bank meeting in July 2014, it was concluded that 'medical overuse' has emerged as a serious issue in India as more people can afford to pay for medical interventions due to better access to insurance cover. "Individuals in India with private voluntary health insurance are two to three times more likely to be hospitalized than the national average. Many of these interventions provider only marginal benefits and can actually harm the patients, causing unnecessary suffering, especially among the frail and elderly," says the World Bank document.