May 30, 2016 03:36 PM
25962 Views
Your Site is a disgraceful site and so is Neha Suneja Kapoor. I have written a complete explanation for Nandini Sinha's false, baseless and biased report following which she has removed her face book post. Others are now scared enough to withdraw it. I suggest that you ask Ms Kapoor to read this and then top withdraw your post. SEnsationalism is not always good news.
Further atleast have a corresponding address on your CONTACT US PAGE. It just says coming soon.Amazing News and business ethics!
We as doctors in practice have decided to take legal action on every single false post. This is in response to Nandini Sinha’s post about her mother’s sad demise post Mitral Valve Replacement Surgery.
No words or no amount of commiseration can repair the loss or console the bereaved family but being a doctor myself and having faced the mudslinging on social media at least three times in my career spanning 40 years, I think that I must speak from a different perspective(probably unacceptable in the social media) and try and correct many misconceptions that creep into peoples’ minds because of anecdotal incidents.
I would like to clarify that I have nothing to do with Medanta, have never worked there and do not know the doctors involved in this case yet I feel grieved that such unfortunate accidents are used to tar the image of institutions and people just because the outcome was not as expected.
An analysis of the facts is therefore necessary.
That 6 months were spent in deciding about the surgery by the family is proof that adequate efforts had been made by the hospital and the family to establish the diagnosis and decide about the need for surgery. Presumably, second opinions would also have been sought. Therefore, I am sure that the surgery was medically indicated.
The contention that Valve surgeries are as simple as cataract surgery is grossly untrue. Even in the absence of any other associated medical illness eg diabetes, the 30 day mortality of mitral valve replacement surgery in females is 6.54%, even in the USA.(https://content.onlinejacc.org/article.aspx?articleid=1127024)
The patient went home in two weeks after due tests having been carried out and seems to have been recovering well for 6 weeks except incisional pain. There is therefore till this stage, no evidence of any problem with the surgery or that the surgeons at Medanta were negligent or callous or uncaring.
In this context, it is important to talk about theissue about the 4 lacs. Whenever a patient is admitted for surgery, a slip is for financial clearance is sent by the nurses to the Finance section. It is entirely possible that the nurses by mistake wrote CABG(Bypass for Coronary Artery Disease) instead of CAG. The only question that arises is whether a CAG, which is an angiogram, was required, done and whether the family was counseled about it. Sometimes, repeat angiograms may be required if one has not been done earlier or if a long time has elapsed between the angiogram and the proposed surgery. That 6 months were taken by the family to go for the surgery would suggest that this may be a possibility.
As I can see, the confusion was easily sorted out after discussion with the doctors. The fear that the patient would have undergone an unnecessary CABG is misplaced. Perhaps it is not known that before a patient goes into the theatre, a safety checklist is run which includes the surgery that is proposed. This is done for every single patient without exception. This is precisely so that such mistakes do not happen.
Further once the patient is on the table, before making the incision, there is a period known as “Time Out” where the entire staff introduce themselves to each other, discuss the plan of the proposed surgery, the giving of antibiotics etc, the anticipated blood loss and potential problems of the surgery and their solutions. Only then is the incision made. Every part of the surgery has to be consented and documented before surgery can begin. In fact if during surgery, there is a change of plan or should an additional procedure be required, the surgical team has to stop, talk to the relatives and counsel them and take their consent once again before proceeding with the operation. These are strict guidelines and I have no doubts at all that Medanta follows this protocol strictly as does every other hospital in this city. So the question of an unnecessary CABG being done by mistake is no longer a possibility.
As far as admission under Dr Chandra is concerned, there is no mischief involved. It is regular practice for Cardiologists to admit patients needing surgery(Dr Chandra is an extremely eminent Cardiologist, a Padma Shri and one of the doyens of Cardiology in Delhi) and to continue to care for them after surgery.
Further the law requires that every member of the operating team is an MCh or DNB in Cardiothoracic Surgery(the highest degree in our land that allows independent practice) and I am quite sure that Medanta and Dr Trehan would not compromise ever on quality or subject their patients to danger. It is also important to understand that hospitals which do 25-30 Cardiac Surgeries daily(each of which takes 3-4 hours) cannot have the Team Leader doing every step of the operation. But the team leader, in this case Dr Trehan, is always present during the critical steps of surgery because the primary responsibility is his. So the question of untrained junior doctors having a free run is untrue and has no basis. Incidentally, this happens to be the practice in every single famous institution of the world including Texas Heart Institute(where the world renowned Dr. Denton Cooley worked and lead the Cardiac Surgery Services). I am sure that the patient’s family can demand to see the case file and that they would find Dr Trehan’s name as the Principal Surgeon.
Now to get to point No 3.
The patient developed a thrombosis or clot in her valve. This was presumably large and lead to heart failure. Prosthetic valve thrombosis(PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. It is a potentially life-threatening complication associated with high morbidity and mortality. Guidelines differ on whether surgical treatment or fibrinolysis should be the treatment of choice for the management of left-sided prosthetic valve thrombosis and these uncertainties underline the need for further prospective randomized controlled trials. Thrombus size, New York Heart Association functional class of the patient, the possible contraindications, the availability of each therapeutic option and the clinician’s experience are important determinants for the management of prosthetic valve thrombosis.(https://ncbi.nlm.nih.gov/pmc/articles/PMC3760527/)
Traditional therapy is emergency surgery(valve replacement or thrombectomy), but thrombolysis has been proposed as an attractive first-line alternative.The optimal management remains unclear because there is lack of randomized controlled trials to compare the two methods. Additionally the published guidelines differ significantly on whether surgery or thrombolysis should be the treatment of choice, as well as on which is the main determinant for the treatment(functional class, thrombus size, obstructive, or nonobstructive thrombosis)(https://ncbi.nlm.nih.gov/pmc/articles/PMC3760527/)
Thrombolysis as first-line therapy in cases of critically ill patients whose operative risk is high or if surgery cannot be performed urgently(rescue fibrinolysis) as was done in this patient’s case.
Finally about the unnecessary ventilation to make more money. This is a sick allegation. Every ICU/CCU does counseling about prognosis every day and in the light of all these allegations, it is now standard practice to get the family’s signature on the counseling sheet each day. I am sure Medanta follows a similar practice. In my 10 years of practice with my corporate hospital group I have never been troubled about targets, NOT ONCE!
Also, it is we as doctors who have introduced the concept of End of Life Care wherein all escalation of treatment is stopped after due written consent from the family if the outcome is gloomy. Sometimes the family has internal conflicts or cannot decide. Under these circumstances, doctors have no choice but to continue ventilation and other ancillary treatment(this is a legal requirement) till the family decides one way or the other or till fate intervenes. Did this happen in this case?
I sincerely feel bad for this family. But I also know that the patient got state of the art care in a reputed hospital and that grief makes us imagine things which did not really happen.
I also know that every doctor worth his salt feels bad when patients don’t do well. But like everyone else we are also humans and subject to the diktats of destiny, fate and the Lord Above. I hope that the family is able to put their loss behind and move forward and is able to wash all rancor and bitterness from their hearts. Believe me, there are still good human beings in this world and good doctors…that is why this world is still surviving. I hope you will forgive me for this post. Of course, you are free to trash me as much as you like. All I request is that you think that there may be some truth in what I said. God Bless.
