Super specialists sans humility

GUT: The stomach and the abdomen are the biggest problem areas. It is the intestines, pancreas and other parts of the gastro intestinal system which ensures that you are able to digest what you eat and remain in good health. The picture above shows a lump in the throat caused by reverse flow of deadly gastric fluids

BY RAJAN NARAYAN

Even the best super specialists in the world are reduced to becoming arrogant extortionists if they do not have good infrastructure, MBBS or MD qualified resident doctors and trained and experienced nursing staff. It is the resident doctors and the nurses who are the backbone of any hospital

On January 23, 2019, I went to Mumbai to consult a super specialist in GERD, more popularly known as acid reflux. As long-time readers will know, I have been having severe acid reflux — to the extent that very toxic gastric juices flow in reverse gear. This has resulted in a lump in my throat suspected to be malignant. I had visited several gastroenterologists in Goa and Bengaluru but they could not solve the problem. I even held consultations with neurologists and ENT specialists. Many of my doctor friends very strongly recommended a super specialist in Mumbai who had exclusively specialized in acid reflux. So off I went to Mumbai.

DAY 1

Thanks to traffic jams at the Zuari junction and a delayed flight, I reached the hospital in a suburb of Mumbai around 6 pm. I then had my first consultation with the super specialist for which I was charged 1,500. I had no problems paying the fees as it is the standard amount charged for consultation with any super specialist, as they invest a lot of time and money to achieve their status, but I did ask for a receipt. The specialist seemed very upset over my request for a receipt for the consultancy fee. I told him that I did not have any black money and there was no reason why doctors should refuse to issue receipts for consultancy fees. Unfortunately, the super specialist is not the exception but the rule, as I have never come across doctors who give receipts for consultation fees they collect. After discussing my symptoms with the super specialist and showing him my file, which contained the entire reports of tests I had already undergone, it was decided that I would be admitted to the hospital he owned. Considering he was a super specialist with an international reputation, I thought the hospital would be well equipped to handle a serious patient like me. I opted for a twin bedded room which cost me3,000 per day. I had expected a comfortable bed with all the amenities which you are entitled to if you are paying 3,000 for half a room, but I was disappointed. And then came the blood tests. Even if you have reports from blood tests in the best pathological laboratory the previous day, hospitals and nursing homes will insist on doing the blood tests again. Perhaps they get a kickback from the pathologist! In the case of this particular hospital, the Pathology Department has been outsourced and was not part of the hospital officially. I received a further shock when the nurse came to collect blood for the mandatory blood test. It took the nurses more than 30 minutes and several pricks to find a vein! Admittedly my veins have collapsed and it is difficult to locate a vein. However, most corporate hospitals, unlike privately run small hospitals or nursing homes, have a laser lens which helps you to locate a vein. I subsequently learnt that the nurses in this hospital were either not trained or had just passed out with diplomas and were being paid9,000 per month. If you pay peanuts you can only get monkeys — not the best qualified and experienced nurses.
But day 1 was not over yet. To my surprise around 8 pm when my better three-quarters had gone out to get some essential items like mineral water, I was told that I would be taken for my MRI.
For those who may not be familiar with medicine, MRI stands for Magnetic Resonance Imaging, which is supposed to generate less radiation than CT scans. I suggested that the MRI be done next morning and not so late at night. The hospital staff insisted on doing not only the MRI, but also an ultrasound right away.
I was taken to the MRI room where there was what appeared to be a second- or third-hand MRI machine. After checking that there were no metal parts on and in my body I was told to lie down on the MRI bed.
MRI machines have a very narrow space and the distance between the face/body and the top of the machine is less than a metre. It can be very claustrophobic if you have to stay within the MRI machine for a long time. On an average an MRI nowadays takes 15 minutes to 30 minutes, or a maximum of 45 minutes. In my case it went on and on and when it finally ended I discovered that I had been in the MRI machine for one and a half hour!
Apparently, apart from an MRI of the brain, a cardiac MRI for angina (heart) was also done, though there is no relationship between the heart and the acid reflux condition I was suffering from. I was not informed that it would take so much time and I discovered that the technician was badly trained and paid a very low wage. The MRI, like the Pathology Department, had been outsourced to a third-party, operating from the same premises as the hospital.
Immediately after the MRI, I was taken for an ultrasound where at least there was a trained doctor. The MRI and the ultrasound confirmed that I had no major problems except for some fatty liver in my abdomen. My brain MRI was totally normal.

DAY 2

The next day, Thursday, started off badly. Since I have severe acid reflux I cannot sleep and wake up as early as 6 am. I was told by the ward boys that the canteen for patients opened only at 8 am and so I would have to wait for breakfast. An enterprising ward boy told me that nurses and doctors could get their machine tea any time they wanted and got me two plastic cups of tea-flavoured sugar syrup. I thought I would have a wash, if not a bath, before the doctors came for their rounds. Though there was hot water in the bathroom the previous night I was told that geyser would be put on only at 8 am. I must in fairness note that some ward boy woke me up in the morning and wanted to give me a sponge bath which I declined.
Normally the super specialist under whom you are admitted comes for his rounds in the morning. In my case while various junior assistants came on behalf of the super specialist, he himself turned up only in the evening. Instead of sending me one of his assistants qualified to treat my condition, he sent me his young administrative head. She was not a doctor as I was expecting, but a newly passed management graduate in hospital administration. When I asked her what she did in the hospital she said she was in charge of process controll. Which in simpler words means that she keeps track on how many bed sheets, pillows, blankets and cotton rolls were used for patients, and if the staff were doing their jobs. Understandably she could not answer any question about what tests or procedures had been prescribed for Thursday, the second day of my hospital stay.
Much later in the afternoon, one of the doctor’s assistants — who claimed he had a master’s degree in surgery — brought a list of tests to be done. The test included a repetition of the manometry test which I had done at least four times in various hospitals within the previous two months — including at specialised gastro centres under very senior gastro physicians. The list also included getting me checked by a neurologist and an ENT specialist who were attached to the hospital. On the list I crossed out the repetition of the manometry tests. I also cut out the fresh references to the neurologist and ENT specialist attached to the hospital.
When the super specialist finally came to see me with all his assistants around 5 pm in the evening I told him that since I’d done the nanometry test half a dozen times I did not want it to be repeated. I also told him that I had consulted the HOD of neurology in Goa and she had confirmed that my acid reflux had nothing to do with my brain or any nerves in the brain. The MRI that had been conducted the previous night had also confirmed that there was nothing wrong with the nerve which could have triggered off acid reflux. Under the circumstances I strongly objected to the references and his insistence that I should be examined by the neurologist attached to his hospital. As far as ENT was confirmed I showed him the report of the HOD of ENT in the GMC, as well as that off a very senior private ENT specialist in the Manipal hospital in Goa, who had both assured me that there were no blockages in my oesophageal tract.
The super specialist obviously did not believe that patients had the right to ask questions. He obviously believed that patients should treat the super specialist as god and follow his orders blindly.
There was another complication as the TPA of Oriental Insurance, Medi Assist, had already approved a cashless budget of 49,000 as had been told to them by the hospital. The hospital insisted on telling the insurance agency that the budget was no longer relevant and that they did not know how much the cost of the treatment would be. Since I was carrying limited funds, expecting cashless treatment under my5 lakhs insurance cover from Oriental Insurance Company, I asked him how much the entire treatment would cost. At which stage the suave smooth super specialist insulted and humiliated me.
A good friend of mine who has been covering the medical and health area for over 30 years for a leading national newspaper in Mumbai, had spoken to the super specialist and had asked him to pay extra attention to me as I was a colleague in journalism whom she respected. She had not asked him for any discount or rebate. The super specialist in a most arrogant and insensitive manner asked me to tell my media friend to arrange a charity bed for me in the Lilavati or Hinduja hospital. I was furious. The super specialist was insulting my friend who is a most ethical journalist and has never misused her position to seek favours for anyone. In fact, it amounted to defamation. I was also very angry that he should suggest that I should get a charity bed at the Lilavati. If I wanted to be treated at the Lilavati I would have gone there directly and not gone all the way to meet the super specialist.
I insisted that since he did not seem to know what was wrong with me and had insulted me and my friend, I was moving out of his hospital immediately. He insisted that I should pay 28,000 for the treatment given to me, in addition to the15,000 he had taken at the time of admission. I refused because he had not treated me at all and only made me to do tests which were unnecessary and with substandard equipment. We were of course not allowed to leave the hospital without making the payment. My inclination was to walk out without paying even if the super specialist called the police. I could have complained to the police of wrongful confinement and humiliating a senior citizen under the Human Rights Act. Unfortunately, the better half had already paid the 28,000 in addition to the advance of15,000.

BACK HOME!

When I went home I send a message to the super specialist demanding an apology to my media friend and me for his insulting words and the return of the 43,000 he had extorted from me without giving me any treatment. His reply added insult to injury. I informed all my doctor friends in Goa and Bombay that the super specialist was an overrated arrogant extortionist and that nobody should refer patients to him. I was surprised to receive a call from veteran gastro surgeon Dr Datta Gaitonde, who is now in his 90’s, under whom the super specialist had apparently worked for 10 years. When I explained the situation to Dr Gaitonde, he agreed that however good a doctor may be, he had no right to insult and humiliate a patient. The super specialist must have called several other doctors in Goa and Bombay but did not get any sympathy or support as they knew my reputation for integrity. Or perhaps they were afraid of getting into a panga with me. Although some doctor friends cautioned me saying that if I wrote nasty things about the super specialist no doctor would treat me, I was not concerned. I knew that my doctor friends would not let me down. The day I arrive back in Goa on Sunday, January 27, 2019, I got a call from a leading gastro specialist who said that he would be happy to treat me and that I need not have gone to Bombay at all. I posted on Facebook asking readers, including doctors, to watch out for my cover story in the Goan Observer on the arrogant extortionist from a Mumbai hospital. The post went viral and got more than 10,000 hits suggesting that the arrogant super specialist was not very popular with patients or doctors. The super specialist finally realized he was not dealing with an illiterate poor bakra whom he could exploit. For the first time since I walked out from hishospital he offered to explain the situation to my media friend and return part of my money that I had paid. Unfortunately, though he did speak to my media friend he did it in an insulting way which has left my media friend furious. I insisted that I want a written apology to my media friend and the entire43,000 I had paid him returned to me through bank transfer.
On Sunday, January 27, 2019, I received a message from the super specialist which said “Thank you sir if I hurt you in any way I apologies unreservedly. I shall send you a full refund tomorrow by RTGS, regards”. As of 12 noon I had not received any information from my bank about the return of the money, though when I reminded him of the money he promised “will do sir” at 10:47 am.
I can understand why the super specialist has become so arrogant. I can understand why he has become so greedy. The super specialist used to work for many corporate hospitals and used to get huge fees. But he was not satisfied with the golden eggs he got and thought that if he had his own goose he could get many more golden eggs. I explained to him this logic did not work, as I myself had discovered. When you leave a large organisation and set up your own shop or hospital you do not have the funds or the organisational support to deliver the quality of medical care you could when you had access to the up-to-date, well maintained infrastructure of a rich corporate hospital.
When he was working for a corporate hospital previously, the super specialist presumably had senior trained nurses whom he could depend on. He had senior interns who were MBBS at least, if not MDs. But at a small nursing home he does not have any of the facilities he needs to sustain his reputation as a super specialist. Many doctors quit corporate hospitals and try to start their own hospital on an individual or a cooperative basis, like Healthway in Goa. Most have failed because banks are not willing to lend to small people and even professionals, and they cannot afford the equipment necessary for diagnosis and treatment.
In this case, I do not know how many corners the super specialist has cut. Whether he has illegally extended his building by two floors. Whether he is using the terrace as a canteen for patients without permission. Whether equipment, like the MRI he also outsourced, consists of new, tested and tried, or reconditioned second-hand machines.
The backbone of any hospital are nurses and resident doctors. If you are running a nursing home you cannot afford to pay MBBS doctors or trained nurses, since the government pays nurses over `40,000 at the minimum end of the scale. So it is much better to stay with a corporate hospital or limit your goose only to the super speciality you are reputed for, and not make more money by also offering everything from knee replacements to dialysis to dentistry.

(PS. Names withheld to give the good doctor an opportunity to learn humility and respect patients)

NOT SO UNCOMMON AFTER ALL…
The super specialist of whom I was a victim recently is unfortunately not a stray exception. I recall that when I was beaten up allegedly by the hired goons of the than speaker of the Goa Assembly, the Head of the Department of Medicine of the GMC pumped me with steroids. While his intention may have been to relieve me of pain, he kept increasing the dose until severe side effects set in as the symptoms were masked.
When the then leader of the Opposition Dr Wilfred D’Souza urged me to shift to Mumbai for better medical facilities, the HOD abruptly terminated the very high steroid dosage leaving me in a coma. Subsequently, the various super specialists in neurology whom I consulted kept passing the buck or rather cutting my pocket — which kept me in and out of hospitals for five years.
The endocrinologist in Bengaluru who insisted that I did not need steroids and had developed Addison’s because of the high level of steroids prescribed, insisted that I detox. By than my weight had gone up to 180 kgs!
After I successfully detoxed over a period of five months my weight dropped to 30 kg, which destroyed my gut. When I pointed out this to the endocrinologist he washed his hands off me and told me to consult a gastroenterologist.
The worst part of the bias and arrogance of super specialists is that the senior most gastro expert in Bangalore, and perhaps in the country, insisted that I must be a bevda because I lived in Goa! This deprived me off reimbursement of my medical claim from the Oriental Insurance Medi Claim.
Talking of insurance companies we warned against any insurance company which is represented by Medi Assist as the TPA. On several occasions they have refused to re-reimburse my legitimate claims, forcing me to approach the insurance regulatory authorities.
However I must acknowledge that the majority of doctors are sincere, ethical, and treat patients with great respect and concern. This includes the gastro consultant of Amitabh Bachchan, one of the most polite and gentle gastro experts I’ve met. The problem starts with the super specialists becoming greedy and trying to kill the golden goose so that they can get all the golden eggs immediately.
Check on the infrastructure of doctors and resident medical officers even if you are convinced the consultant is the best among the country or the world for your medical condition.

EXIT: The anal sphincter is the valve at the bottom of the rectum which opens to permit waste to exit the body and then closes. If the sphincter muscle is weak or damaged, as in my case, the process of evacuation becomes difficult
ANDHER KI BAAT: The status of the inner part of the gut can be seen only through a ‘scopy’. There are both gastroscopies and endoscopies by which a tube, through which a camera is passed, is inserted through the bottom to check the state of the colon

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