You can’t win in this job

A 60 year old lady waddled into my clinic.

“Doctor, I’m getting fat. I need some medicine to reduce my tummy and weight.”

“You’re in the wrong clinic, madam. I am a gynecologist, not a general physician.” 

“No doc, I was sent here by the physician doctor.”

I examined her. She had a grossly enlarged tummy, but the rest of her body was quite thin. A scan showed an enormous tumor.

We operated on her the next day. The tumor was 18 inches (45 cm) in diameter. With both my hands around the cyst I could not even budge it. The scrub nurse joined in and with double the biceps power we were able to remove the cyst. 

I cut the excess skin and tissues, located the muscles on either side and brought them together. The lady now had a flat tummy that any 20 year old model would be proud of.

Needless to say, m’lady was very happy with my cosmetic surgery. She did not care that she had an ovarian tumor. To her, I was the doctor who had made her slim again.

To this day, she sends all her overweight friends to me. All of them want a flat tummy like hers. 

Fleecing patients

The guy who cleans my car wanted to have a word with me this morning. He looked very worried.

” What is it?” I asked.

” Sir, can you tell me how much a CT scan costs?”

“Around 4000 to 5000 rupees,” I said. “Why, has someone asked you to get one done?”

” No Sir. My mother was admitted last night with vomiting and diarrhea. The doctors gave saline and medicines and told me to get a CT scan done. I got a bill today for 20000 rupees of which the scan alone is 15000 rupees.”

“15000 rupees for a scan!” I exclaimed. “That is three times the regular price! Why?”

” Don’t know Sir.”

” So did you pay the bill?”

” Yes Sir. Otherwise they were not going to discharge my mother today and would have charged me for an extra day in hospital.”

“So your mother is already discharged. Do you have the discharge card with you?”

The lady had received two bottles of intravenous glucose saline, antibiotic injections and an anti-emetic to stop the vomiting. Total cost would not have been more than 1000 rupees, inclusive of the overnight stay in the general ward.

This was shocking. The poor man earns no more than 8000 rupees in a month. His mother most probably had a mild form of gastroenteritis which responded to the medication. But why do a CT scan? 

It is obvious that the hospital wanted to make a fast buck from this man. To cheat any incoming patient by performing unnecessary costly  investigations has become the norm now and is assuming epidemic proportions. But to cheat a poor illiterate man not only by doing an unnecessary investigation but also charging three times the price is nothing short of criminal. This is what drives a third of Indians below the poverty line.

Unfortunately, hospitals and doctors have become so mercenary these days that medical ethics been thrown out of the window. You and I are helpless silent spectators to this grand looting and pillaging where men, women and children of all socioeconomic strata are plundered nationwide. 

When is surgery needed for back pain?

The first thing that we must do when we have severe back pain is to obtain a thorough evaluation by our local doctor or even better, an orthopedic surgeon. This will include a detailed medical history, clinical examination and possibly investigations such as a blood test, X-ray, CT or MRI scan. These investigations may show that the back pain:

  1. Is due to a serious spinal or other disorder that requires surgical management. These are known as “Red Flags.” Remember that ONLY 1% of all back pains come under this category
  2. Is due to a spinal or other disorder but can be managed with conservative treatments. It accounts for 10 – 15% of back pain cases.
  3. Does not have an identifiable spinal or other cause. Most back pains (85 – 90%) fall in this category.

Back pain does not mean surgery

Just because you see your physician or orthopedic surgeon does not mean surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back problems. In fact, surgery may do more harm than good.

This is why we need some strong indicators for surgery. These indicators are known as “Red Flags” and tell us that surgery must definitely be done if permanent damage is to be avoided and that the benefits of surgery far outweigh the complications that may arise due to the procedure.

Red Flags

So what are these Red Flags?

  1. Difficulty in urination or loss of bladder and/ or bowel control
  2. Saddle anesthesia – numbness around the genital area and buttocks
  3. Numbness/ tingling in one or both feet/ toes
  4. Difficulty in moving the ankle upward or downward or raising the great toe
  5. Gait disturbance – difficulty in walking
  6. Changes in reflexes in the legs (this can be detected by the physician).

If you have one or more of the above symptoms you definitely have a condition that may need surgery. The timing of surgery will depend on how severe the symptoms are.


  • Excerpt from “Say Goodbye to Back Pain” by Dr. V. Ranjan. Available at