We have a prestigious cancer institute
to which we send our patients with cncer for management. They used to
take all of them and treat them sooner or later – usually later if
they were free patients. Poor patients accepted the delay because
they knew beggars could not be choosers. We did not attempt to treat
the patients ourselves because they operated much better than us on
cancer patients (being superspecialists) and had facilities for
radiotherapy and chemotherapy under the same roof.
“Sir, this patient with ovarian
cancer has come back from the cancer institute” my Registrar told
me about a patient one day. “They have told her she does not have
cancer and she can be operated on by us here.”
I was surprised. I knew she had
undergone a hysterectomy in the past and now had an ovarian cancer.
Perhaps they had done a fine needle aspiration biopsy of the tumor
through the abdominal wall – something we did not recommend for
fear of spread of the disease. So I checked her reports.
“There is no report that shows that
your tumor is not malignant” I told the patient. “The doctors in
cancer institute have not written that it is benign anywhere.”
“They verbally told me so” she
said.
I did not want to be involved
medicolegally in something like that. I remembered a court case one
of the previous directors of that institute had lost recently.
“Please get them to write that report
on your paper. I will then operate on you at your insistence, though
I maintain that it is a malignant tumor and will not be responsible
for any deficiency in service. After all, I am not an oncosurgeon.”
She went back, only to come back again
the next day. “Doctor, here is a report from your hospital which
states I have no cancer” she said. She showed me the report of Pap
smear that we do on all patients, including those who have undergone
a hysterectomy in the past. It was normal.
“That one cannot show the tumor cells
you have inside your abdomen” I told her. “The top of your vagina
is closed after hysterectomy. A Pap smear very rarely shows ovarian
cancer cells, even when the uterus has not been removed. Please go
back to the cancer institute, get treated and get well soon.”
She went away and hopefully got
treated. When I mentioned this event in a meeting, another professor
told me that three of his patients had come back in a similar manner,
being told verbally they had no cancer when they actually had cancer.
A couple of days later, another patient came to me to get a second
opinion. She had been advised an operation at the cancer institute. I
checked her reports and found that she had ovarian cancer.
“They did not ask you to go back to
your doctor for an operation?” I asked.
“No. They asked me to get admitted
and operated at the earliest. I saw them yesterday and they are going
to operate tomorrow.”
“How much are they charging you?” I
asked.
“I don’t know. All my medical
expenses are covered by the company I work for” she said.
That looked like selective refusal of
referrals by the cancer institute – based on the inability of the
patient to pay much, though there were beds reserved for poor
patients as per government regulations.
