Saturday, April 07, 2018

Mucous Cyst Rx

"Its just a local trauma..."
"No, its a bacterial wart! be careful, it infectious...certainly needs a surgery and biopsy..."
"Oh, just a simple mucous cyst!"

Two months, four doctors and three hospitals and many thousand rupees later, we have gained a few insights into the way in which our medical system works. It give you a glimpse of how private medical care is designed to make a mountain out of a molehill, to scare and fleece the gullible.

Two months ago, our son Aki got a cut on his upper lip which, instead of healing, developed into an eruption. Flesh etruded out of the cut which bled profusely from time to time. One day it would seem to be healing with a black scab but return to a a fleshy, bleeding nodule the very next. About 10 days after it showed no signs of healing, we took him to a doctor at the nearby Jaypee Hosptital. The pediatrician said it was just a "local trauma" and prescribed a  an anti-inflamatory syrup.

Aki found the syrup tasty but it nothing to reduce the eruption, or the bleeding. So off we went for a second opinion, to pediatrician at Patparganj, one strongly recommended by doctor-friends. The clinic was crowded and, from the number of vaccine adverts on the walls, quite popular with pharma companies as well. The doctor here came through a fair, honest, consciencious physician. "This looks like a wart", he said, "It needs to be surgically is just an Out Patient (OP) procedure in any government hospital, but given the crowds, you won't be seen unless you know somebody personally. If you go to any private hosptial, make sure you get the estimates clearly, in writing, before you get the child admitted". He also graciously returned - to our amazement - his consultancy fees (INR500) because, in his words, "I only advised you to go elsewhere." 

Next stop, Max Hospital. Here we got to meet our first pediatric surgeon. One look at Aki's lip, and he declared that it was "mucous cyst". Pulling our a couple of blank sheets, he explained in detail how it developed. "Sometimes, the process of healing ends up blocking the flow of mucus cells...and instead of keeping the lip surface moist, they end up discharging mucus under the skin. This develops into a cyst which ruptures and bleeds easily." Surgery, apparently, was the only way to get the cyst removed.

How much would surgery cost? Well, the answer depends on whether or not you have a mediclaim insurance cover. If you do, then it would cost about INR 25,000 if you got it done at Max Hospital. The cost of booking an operation theatre, anaesthesia specialists and a days' stay at the hospital, we were told, made a relatively simple procedure expensive. 

Would this be defenitely covered under mediclaim? Guys at the billing office were not so sure. "Lets see", they said, "We will submit all the papers and then know in a couple of days". Not quite reassuring.

So now we went for fourth opinion with a surgeon at Kailash Hospital, Noida. The diagnosis at Max was reconfirmed. This certainly was a mucus cyst that needed to be 'surgically excised, or cauterized'. The cost was a couple of thousands less but, given the crowds at this hospital, nobody wanted to an operation date, or the insurance coverage.

Back at Jaypee Hospital, the feedback from the billing office was the same. The procedure would cost not less than INR 25,000, which included no less than INR 8000 for 'micellaneous consumables'! The cost of the biopsy, of course, would be extra.

Since none of the pediatric surgeons said that it was emergency procedure, we thought about it for a couple of days, checked with other hospital, and settled for a surgery at Felix Hospital. This was the only place were we met a pediatric surgeon who inspired confidence in us with his surgery-as-last-resort approach. This was the also only hospital that had an OT readily available, did not insist on conning insurance companies and came up with surgery cost estimates at INR 5500. The only down side at this hospital was that they charged thrice the amount for consultancy fees for pediatric surgeons, compared to far more reputed hospitals. 

Anyway, sometimes when all is not so well also ends well. A supposedly common medical condition was misdiagnosed, received inflated cost estimates for the surgery, and was finally sorted out for one-fifth the estimates. One thing is clear, the nexus between private private, medical insurance companies, and TPAs is designed to fleece patients - especially those who may not have the luxury of time to seek a fair deal.

After the final follow-up visit, our doctor requested that we evaluate him online. I received three sites on WhatsApp -- Practo, Lybrate and JustDial. This is an interesting new trend - doctors want to create a reputation that is independent of the hospitals in which they serve. I am not sure if this is good for the patients because we now have one more broker in between, and the additional costs are built into the doctor's fees :(

* Practo: Verifies feedback with an OTP sent to mobile number, collects proof of visit (bill/prescription), and creates a login for you, on the sly. 
* Lybrate: Does not have a clear section for doctor feedback. Verified using OTP. No need to login.
* JustDial: Badly designed site. The doctor's review page forces you to post your comments on FaceBook and Twitter (default option). Crazy.


- Oral mucocele -