Wednesday, November 10, 2010

Doctors vs Businessmen

From a recent conversation I had with mom over the phone, the doctors found a cyst in one of her ovaries. Unfortunately, mom is not born with a keen sense for details, so there's not much use to try to find out more information from her about her condition. To her, the doctors found something there, and it needs to come out—plain and simple. She probably thinks that she'd be given something so that she'd fall asleep for a few hours while the doctors cut the thing off. And then she'll be up and running again the next day, perhaps in good time for her favourite bingo games on Monday and Thursday.

Later on, I obtained a bit more info from my half sister who told me that both her ovaries and her entire uterus will have to go. So I suppose the doctors are not taking any chances. Apparently, the cyst in her ovary is not cancerous, but after all, I suppose a woman in her mid-sixties would no longer need her uterus and ovaries.

As a matter of habit, I have since done a bit of reading about ovarian cancer and related topics. I don't claim to know a lot—certainly I have only fathomed perhaps 5% of the subject. One of the related topics I found interesting is the CA-125, which is commonly referred to as the tumour marker.

The Sports & Recreational Club of our company conducts an annual comprehensive blood test for all the staff at a "discounted rate" by one of those labs in KK. I think it's a good annual project of our sports club. I remember that amongst the available tests in the blood screening package, was the test to detect elevated levels of CA-125 for the ladies. But that was an optional add-on test which cost a bit more for the ladies. The CA-125 test was promoted as a screening test for early detection of mainly ovarian cancer, although not limited to that type of cancer.

However, I have since read up a bit on the topic, and then had the opportunity to verify some points of the CA-125 test with my friend, Dr Peter, during one of our recent long runs.

It may be surprising to some of you, but the CA-125 test offered by the labs is not even suitable to be used as a screening test for ovarian cancer, especially for pre-menopausal women, simply because there are just too many other factors that can cause an elevated level of CA-125 in the body. But what's worse is that there are cases where ovarian cancer is present, yet the test of CA-125 may be negative, thus resulting in a false security! This may lead to delayed treatment, and we all know that when it comes to cancer, precious time lost usually means death!

The recommended use of the CA-125 test is as a follow up of treatment of ovarian cancer to monitor progress, not so much for detection of the disease.

Yet the labs have been promoting the CA-125 test as a screening test. What's even more disturbing is that even some of the specialist medical centres are offering such tests. I think only doctors should be authorised to order such tests as the CA-125.

The only trouble is that when doctors wear the physician's cap as well as the businessman's cap, ethics may become a secondary consideration in the equation.


Unsettled Soul said...

"The only trouble is that when doctors wear the physician's cap as well as the businessman's cap, ethics may become a secondary consideration in the equation."

So very true. We are seeing a problem forming here because doctors get paid by insurance companies based on how many tests and surgeries they do. Surgeries pay the most. It has been found that doctors will advise a person to get surgeries, medications, and even go to the ER, when it is actually unnecessary. Our doctors are losing their ethics in their greed.

Socrates29 said...

Medical centres earned most of their revenue from their Pathology (Lab.) and X Ray departments so it is no surprise whenever a patient goes to see their consultants with all their mri and blood tests taken earlier from another source,will be asked to do all the tests and mri scans again.

The same applies when one, after seeing a private medical centre or government hospital here in Sabah goes to Kuala Lumpur,goes to see another private one in Kuala Lumpur.He or she will be required to do the tests and scan all over again.

It is also a known fact in the insurance sector that if a medical case requiring surgery is subject to an insurance claim,the surgery costs more.

Insurance companies know about such business practice so in most cases where there has been a medical insurance claim,they do not renew the policy after it lapsed.

Cornelius said...


I don't know about recommending unnecessary surgeries, but as far as conducting tests, that seems to be quite obvious I guess. But the trouble is that when it comes to a matter of life and death, most people would willingly obey the doctor's recommendations. So if a test is ordered, that's exactly what the patient will have to do.

Recommending surgeries when they are not needed is another level further, because unlike tests, surgeries are very intrusive in nature. It may cause a lot of harm to the patients!

Cornelius said...


Perhaps a possible excuse the doctors could use in carrying out their own tests is that they can't rely on tests conducted by other doctors or labs.

Unsettled Soul said...

The way they found out about it was by studying how much money was paid to certain hospitals over others. The hospitals that spent the most money were found to recommend surgery, scans, bloodwork, and meds, when it was not needed. The doctors do it to cover their own asses. They don't want any malpractice lawsuits. They also do it because surgery pays $800 just for one procedure. They found doctors recommending knee surgery for people who could have just had physical therapy. It is scary! Fee for service doctors have nothing keeping their greed in check.

My Dad was in the hospital for a blood clot in his intestine. They cut his stomach open and looked around, and closed him back up. They did not remove the blood clot, they did not perform any surgery, except the act of cutting him open and closing him up.

To this day I think about that and wonder if it really was necessary to cut my Dad open and look around.

It is becoming a concern in America.

Unsettled Soul said...


My Dad was in the hospital for 2 weeks recovering.

He had two doctors working on him. My mom received the insurance bill, just for those two doctors services it cost $18,000. She has not received the bills for the room or equipment usage or for the nurses. They assume it will end up totaling $200,000.

That is for 2 weeks.

Unsettled Soul said...

In American hospitals, everything you touch, use or have in your room has a bar code on it. The nurses come in everyday and scan the bar codes into a computer. Anytime they put a cathater in you, iv, you name it, the barcode is scanned. If the cathater comes out they replace it with a new one and scan the new bar code.

Everything they are scanning is a charge. Even our wristbands with our personal info is scanned so they know who the charges are going to. And we don't have a public option, so it is our only choice.

Cornelius said...

Wow! $200,000 is a hell lot of money! I think any American without medical insurance is living life like a time bomb, huh? Once he's sick with a life-threatening disease, he will just have to wait to die!

I think people like doctors in the USA simply have to earn a lot because the society is just too adversarial in nature. One mistake, the doctors can be sued into bankruptcy. Not only that, they may lose their licence to practise; they may have to start a new career! Therefore even doctors have to insure themselves sufficiently. And of course who's gonna bear the cost of that professional insurance if not the public at large?

I think in Malaysia, doctors get sued too, but to a much lesser extent. However, as the patients are becoming increasingly aware of their rights, it's just a matter of time before we, too, become something like the USA.

Just my thought, but I can't support it with evidence, of course.

Unsettled Soul said...

If one is sick in America, like cancer, any long term or chronic illness, one faces the very real prospect of bankruptcy, even if they have insurance sometimes there is a limit, we call them caps. For most the cap is 2 million. If one goes past 2 million in one year their insurance will no longer cover additional charges. This is easy to go past if one has cancer.

Our system is so flawed, it truly is survival of the fittest. We are the only developed nation without a public option.

Cornelius said...

In this case, I must say that I'm lucky to be in Malaysia, because treatment cost very rarely go up to RM2 million (notice that I'm talking about Ringgit, not US Dollar).

Major surgeries organ transplant may cost quite a bit, but hardly ever reach anywhere near the "million" mark in Malaysia. I think it is quite believable that follow up treatments for cancer cases can cost a lot, but still not generally up to millions.

But again, things are gradually becoming increasingly expensive in Malaysia. So perhaps it is possible that by the time we achieve the "developed nation" status in 2020, medical cost may also reach the levels of those seen in the USA.

And talking about Malaysia achieving the "developed nation" status in 2020, we all know that that just a BIG DREAM of our politicians, but I suppose we have always been a nation of dreamers.

Unsettled Soul said...

In order for Malaysia to be considered developed, the government would have to focus on towns and cities like Sandakan, where people are still living on the water and without any sanitation, sewage system, water or electricity.

I don't think the gov't is focusing on that though, they are focused on building bigger towers in KL. KL is already developed, it is the status of the poor that will decide if Malaysia is a developed country.

As far as hospitals are concerned, American medical companies are selling their products to developing nations with the mandate that these nations also set up private, fee for service hospitals. So yes, we are systematically making health care everywhere horrible! There is too much money to be made, you know, who cares about people's quality of life?

Cornelius said...

Tell me about it, Sarah. Always the emphasis is on the surface - the towers in the big cities; that we have sent our boy into space etc, but hardly ever sufficient focus on the smaller towns and villages. The government is giving out free laptops to the villages who are still living in houses villages without proper roads and electricity and water supplies. We believe that we can compete with the developed nations, you see. Go figure. So yes, the focus is all wrong.

Unsettled Soul said...

I'm actually glad the gov't did that. It can inspire self-taught education for poor kids. There is a lot of power with the internet, kids who aren't able to go to school can teach themselves. Or at least that is what everyone is hoping. But how would they know what to learn, or what is credible or not? There are just as many propaganda and scam and misinformed sites as reliable, credible sites.

How can we know what they are learning?

Anyway, there is an initiative taking place by an American man who wants every single poor household to have a laptop.