In the modern days more and more super-specialists are entering private practice, and everybody wants work. The moment a patient enters the clinic of a gastro-enterologist, he is unlikely to get out without undergoing OGDoscopy examination.
Similarly, the moment a patient having chest pain enters the clinic of an Interventional Cardiologist, it is unlikely that he will not have undergone coronary angiography.
I see hundreds of patients who have undergone either one or both of these procedures. I found some similarities between the two which I am sharing. These are as follows:-
- The Cost : Both the procedures cost more or less the same. Many Gastro-enterologists are charging Rs. 5000/- for OGDoscopy examination which is a five minutes procedure.
Similarly, the cost of coronary angiography, which once upon a time cost the patient Rs. 25,000/- has come down to less than Rs. 12,000/- and now in the city of Chennai, it is being done for Rs. 5000/-!
- Both the investigations are being overdone.
- There is no doubt that some rich and fussy patients are proud to undergo either of these investigations - equivalent to an Income Tax Raid!
- Often, the abnormalities reported after OGDoscopy or coronary angiography, do not help the clinician to explain the patient's symptoms and may misguide the doctor.
- On other occasions, when the OGDoscopy or coronary angiography is reported as normal, the patient’s symptoms can still persist due to pathology in oesophagus or the coronary circulation.
- In both these procedures, the dynamic causes producing symptoms are missed, e.g. the motility disorders of the oesophagus are missed on OGDoscopy and patients having angina due to coronary spasm or small vessel disease are missed on coronary angiography.
- In elderly people, often oesophageal condition and coronary heart disease co-exist. The abnormalities found after OGDoscopy and coronary angiography should be analysed in such a way so as to find out if the patient’s symptoms are due to one or the other, or both the conditions.
- Finally, often both these procedures do not help the patients and continuous 24 hours monitoring of the pH in the oesophagus, or 24 hours ECG Holter Monitoring gives away the cause of chest pains for which the patient has seen the doctor.