KOCHI: Cardiovascular disease is the leading cause of death in India, with Keralam reporting a high prevalence of the coronary artery disease (CAD) and risk factors such as obesity, diabetes and hypertension. Against this backdrop, Chief Minister V D Satheesan’s recent remarks on angioplasty have triggered a debate on medical ethics, patient care and the commercial interests of hospitals.
Satheesan urged doctors to avoid unnecessary angioplasty procedures, alleging that financial incentives could influence clinical decisions. “If 10 angioplasties are performed, the doctor will get (commission) for two. Even if the patient asks permission to go home and think about it, some never allow it,” the chief minister said.
The remarks drew strong opposition from the medical community, though some doctors supported the need to scrutinise potentially unnecessary procedures. The state chapter of the Indian Medical Association (IMA) said the remarks had undermined the trust between doctors and patients.
“Every profession has a few black sheep who bring disrepute to others, and medicine is no exception. However, making a generalised statement about all practising professionals cannot be encouraged,”IMA state president Dr M N Menon said.
While disagreeing with Satheesan’s generalisation, doctors acknowledged that commercial interests could influence healthcare decisions,particularly amid growing concerns about the corporatisation of the sector.“Ideally, the cardiologist should decide the course of treatment based on the patient’s condition.The chief minister may have made the remark based on the inputs he received, but it should not spread a misleading message among the public,” Dr Menon said.
A senior cardiovascular surgeon said that the distinction between emergency and elective angioplasty was crucial. While the procedure can be lifesaving during a heart attack,patients advised to undergo planned angioplasty during routine check-ups may seek a second or third opinion. “In cases of cardiac arrest or other emergencies, treatment must not be delayed.
However, if an otherwise healthy person is advised to undergo angioplasty during an annual check-up, seeking another opinion is reasonable,” the surgeon said, adding that the need for intervention should be carefully assessed, particularly among older patients with a relatively healthy lifestyle.
Backing the statement made by the chief minister, Dr Rajesh Gopalan Nair, head of the department of cardiology, Government Medical College Hospital, Kozhikode, noted that in the medical college, where 500 to 600 patients come to the out-patient wing every day, fewer than 15 cases of angioplasty were done.
“If it is a heart attack, go straight to the cath lab and do primary angioplasty as quickly as possible. You have no significant symptoms, but there are changes in ECG, and if someone recommends angiogram, get a second and even a third opinion. If cases like ECG taken before a hernia operation shows abnormality, again, get a second opinion,” Dr Rajesh said, congratulating the CM for speaking the truth out loud.
Indian College of Cardiology Kerala (ICCK) president Dr Rajesh T also stressed the need to distinguish emergency procedures from planned interventions. “In cases such as ST-elevation myocardial infarction (STEMI), a severe form of heart attack, time is critical. Restoring blood flow at the earliest can save heart muscle and, in many cases, the patient’s life,” he said.
In contrast, chronic stable angina, which causes brief chest pain during physical exertion or stress, may initially be managed with medication, depending on the patient’s condition.
Cath lab access expands
Keralam has significantly expanded access to advanced cardiac care through government hospitals. Official data showed that the number of hospitals capable of performing percutaneous coronary intervention (PCI), including angioplasty, rose from 18 to 103 over a decade. “Having these facilities in public hospitals, where anyone can access them, is undoubtedly a blessing. In some countries, patients have to wait six months for angioplasty, if not urgent,” Dr Menon said.
Doctors have called for stronger government oversight of the corporatisation of healthcare, arguing that the interests of hospitals also warrant scrutiny.