More Cesarean in Private and Less in Government

Let us start with debunking the common whatsapp forward that many people who were advised Cesarean in Private Had Normal Delivery in Government Hospitals

Around 10 Lakh Deliveries happen each year in Tamil Nadu
Of these
If No Cesarean is done, 50000 mothers will die
To save this 50000 mothers, just 50000 cesareans won’t be enough
This is a concept most non medicos and even many medicos don’t understand
This applies to almost all indications
Health care is a Non-Cartesian Science
We just cannot accurately predict the correct persons to do it
In Any Surgery
We need to “overdo” the numbers to make sure that we don’t miss those who need it
If we want to save more people –> There will always be some one who underwent the surgery, even though they would have been cured without surgery
If we want to make sure that only those who absolutely need surgery are operated –> There will be always some one who died because of non surgery
There will be always people who were recommended surgery
Who refused surgery and got well without surgery
This does not mean
That the initial recommendation was wrong
In case of Cesarean
We are doing surgery not only for the mother
But also for the baby
“Normal Delivery” means delivery through Vagina
Does not always “guarantee” a “normal” Child

The above data is wrong
Even then
What is the cesarean was indicated for fetal reasons
The delivery would still be normal
Child would be abnormal
So Where does the question of ethics even rise here
Most of our patients are greedy and stupid
Not all
But Most
If I place a foot wide and twenty feet long wooden plank on the floor and ask people to walk from one end to another without feet touching the floor everyone will accept the challenge immediately and 90 percent will even complete it successfully in first attempt
If I place the same wooden plank between two buildings, say DMS annex and DPH building and ask to walk very few will volunteer
This is difference between taking a decision “surgery or not” in the nick of the moment
That is like walking from one building to another
If we analyse the case sheets leisurely (walking with plank on the floor) we can always says that certain percentage of surgeries are not needed

This applies to any emergency surgery, not just cesarean
It applies to CABG, It applies to debridement, it applies to thrombectomy, it applies to SDH evacuation (yeah I am a Neurosurgeon)
Assume there is a Road Traffic Accident Patient with Acute SDH and GCS 4/15
If operated his chance of survival is 1 %
That means
If I Operate on 100 people like this
99 will die
1 will live
What will happen if I Operate these 100 patients in Private Hospital
They will pay a bill of Rs 5 lakhs
99 will still die and 1 will live
The relatives of the 99 patients will blame me – They will say that even though the doctor knew that it is 1 percent chance, he operated for sake of money
The stupid and greedy patients who lack ethics will blame me
Come to GH
If I do not operate, they will ask why I did not give a change
The stupid and greedy patients who lack ethics will blame me
For the same disease
The patients will blame the doctor for operating in GH
The patients will blame the doctor for not operating in Pvt
Who lacks ethics
It is patients
There is a big question mark on medical ethics
It is patients who lack ethics
Sorry to say
Even you lack ethics
Your post here shows you lack ethics
before questioning ethics
You could have at least known about fetal indications of cesarean
But you did not care
You mere started a blame game (in guise of questioning)
I know you will get angry on this comment
You will say that “I just questioned, I did not blame” or some vague excuses like “Can’t we even question” blah Blah
The fact is what you did is wrong
Taking decision sitting with coffee and vadai in AC room with just case sheets where the decision is not going to impact a life (is walking in a wooden plank placed in the floor)
Is different from
taking a decision at bedside where a life (in case of LSCS, two lives) is at stake
Along with fear of assualt, enquiry, hospital violence, court case etc (is walking in a wooden plank placed between two buildings)
Doctors will of course lean to the side of caution and there will be more surgeries done
This is to be expected and to be accepted
I would be surprised and intrigued only if the post-discharge-analysis of case sheets found out that all surgeries are needed. In that case there is something wrong . . That would be a case of the Dog which did not bark…/The_Adventure_of_Silver_Blaze
// If someone posts such data we should know what is the truth//
Let me explain
1. This data is false
2. Even if there is a case of a woman who was asked to do cesarean, but she delivered normally –> The cesarean could have been because of fetal reasons
3. Even if there is a case of a woman who was asked to do cesarean for maternal reasons in one hosptial, but she delivered normally in others hospitals –> It was because the first hospital did not have facilities like Vaccuum or Forceps and the second hospital had
Just because
a surgery was advised first
It was not needed later
Does not mean the first decision is unethical
There are lots of factors sir
In RGGGH, we can take a patient to surgery in 30 minutes – The anaesthesiologist is on duty, the staff is on duty, the theatre technician is on duty, there are 4 tables in emergency OT
If I am working in say, Ambur GH, I won’t have this luxury
The number of surgeries I do in Ambur will be more than those of RGGGH because I will be more cautious in Ambur
Can you label this as a question of ethics Murthykarunanithi Bhuvaragha Sir
First and foremost you need to come out of the notion that doing surgery is unethical
In most cases
Not doing surgery is unethical and doing it is ethical