During those Chennai days, right after I was dropped from the group practice and I had to be on my own, I did not get cases, patients that came to me for surgery. I was running a clinic in the hospital and there were a few walk-in patients here and there.
The majority of the surgeries were for colleagues from other hospitals who called me to help them with their knee replacements, hip replacements, or even fracture fixation. I used to travel all along Chennai, from one end to the other, from south Chennai to north Chennai, and commuting used to take a long time. I was either travelling or doing surgery, but I was not seeing so many patients.
I was busy, but they were not my cases. They were not my patients, and some of them I never got to see. Some of them I never saw their faces. I just went in, did the surgery, and left.
The credit went to the doctor who had admitted the patient, and the money went to the person under whom the surgery was done. I got whatever professional fee he gave. There was no questioning, no asking. It was just given by them and received by me.
It was a busy practice that way. I was busy all the time, occupied all the time.
All these patients today don't know me. They will never come back to me if they had an issue or if they wanted the other side done. They will still go back to the surgeon who they think did their surgery.
So try the question I could not have answered then. If you left your hospital tomorrow, which of your patients would follow you?
Therefore that kind of business doesn't make sense at all.
I was a ghost surgeon at that point in time.
The profession has a name for it. A 2019 review in Surgical Neurology International calls it ghost surgery. Ghost surgery is for real, and we have to face the reality.
A particular episode happened that struck me very well.
It was a corporate referral. The husband came through a family friend of my dad. My dad was very anxious and called me up and told me about the patient. The patient arrived at our smaller branch hospital. I had finished my clinic, but I took the trouble of seeing her outside clinic hours in a small room, examined her, and told her and her husband that she needed a hip replacement.
He said, "Okay, can you make arrangements for us to go to the other hospital?" This is a private hospital, and I said, "You'll have to make your own arrangement."
Then he said, "Okay, can I just borrow your phone to make a call?" I said fine, and I gave him my phone. He called up someone, possibly an agent, and said, "This hospital is a smaller hospital and I don't like this hospital. We'd like to have the surgery done in the main hospital."
What really hurt me was the fact that he borrowed my own phone to criticise me.
At some level I didn't understand the mechanics of it: the way things worked between the hospital and the company, the way such patients are looked after so that they agree to the surgery. I did not make arrangements for him. It must have triggered this kind of response in him, whatever it is.
Ultimately the patient went to the main hospital, and there he saw a consultant who did not usually do hips. He called my boss to do the hip. My boss wanted me by his side when he did the case. We went there, we did the case, and it was a success.
The patient, her husband and her family never realised that it was me who ultimately did the case. How does it matter to him? For him it all worked well.