Patient education, or doctor regulation?

Dr Aniruddha Malpani, Medical doctor and venture capitalist, objects to new angioplasty regulation, saying that patients should be educated instead.

In a post titled “Big Brother wants to monitor doctors” Dr Malpani writes that “Sadly, the government does not respect the intelligence of patients, and thinks Indians are too stupid to be able to make decisions for themselves.”

The government of India is putting limits on expensive services like Angioplasty and stenting.

According to the Times of India, angioplasty and stenting are often administered when unnecessary, and can be 100 times more expensive than drug treatment.

Angioplasty is the use of a balloon like tool to expand blocked arteries, used when the blood isn’t flowing properly.  Stenting is angioplasty with the use of a stent, or a wire mesh, inserted into the artery during the surgery.

It seems that “big brother” is an MCI committee headed by three doctors, including New Delhi based cardiologist Ashok Seth and Dr CV Bhirmanadam.

Dr Seth says:

“The procedure should be done when appropriate. In situations where it is possibly or rarely appropriate, a doctor must be able to justify it with necessary documents. Even a diagnostic procedure like an angiogram should not be done without adequate reasons.  There should be adequate space between angiogram and angioplasty unless it is an emergency situation. Patients should be told about the risk and cost in each procedure. This will help patients take a second opinion and make informed decisions.”

So, unless it is an emergency, the doctor should inform the patient and give them time to consider the consequences of procedures such as stenting and angioplasty.

Dr Bhirmanandam added that,  “Not all cardiologists should be allowed to do this procedure. It’s too risky. They should be trained for at least two years in interventional cardiology either by a senior or through structured fellowships. Countries like the US insist that doctors should have assisted at least 75 cases as assistants before doing the procedure on patients.”

While Dr Malpani seems to agree that agioplasty is overused, and patients should be educated, he is worried that with regulation “the remedy may be worse than the disease.”  He contends that educated patients “can ask intelligent questions, before consenting to any medical intervention!”

Comenting on Dr Malpani’s post, Dr Somena Mitra seems to agree with the MCI rather than Dr Malpani:

“A good move. Most of the medical doctors and hospitals are running on a pure business model too hurried to make profits at any cost! There are hundreds and thousands of cases everyday [of] innocent patients being cheated in and out by doctors and hospitals! Doctors & Hospitals need to be monitored closely or get ready to wear compulsory helmets in the near future.”

Side note: riders of two wheeled vehicles in the Kolhapur region of India must wear helmets since the 15th of July this year.  Vehicles are being confiscated, but some people are still buying fuel without a helmet.  Compulsory helmets is therefore big news, and the analogy would be topical to readers.

A few lay commentators also took the side of the MCI after reading the article.

However, as usual, Dr Malpani does have his supporters.  In addition to the silent likes, Frederick Wenger says, “It has been the same in the US for decades […]  Wenger suggests that “maybe the people are now too stupid to know how to ask questions,” because of government controlled education.

Vivek Yadav suggests, “Isn’t MCI itself deeply mired in all the corruption?”  His allegation seems to be founded on the high level of security around the MCI.  Apparently, the only reason you’d need that much protection was if you had something to hide.

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