The Surgery Debate: Not Collapse — But Cracks Widening
Rising C-sections, disputed hysterectomies, aggressive stenting, questionable knee replacements and insurance-fraud audits point to a deeper vulnerability in India’s healthcare system — a space where commercial pressures meet regulatory gaps, allowing unnecessary procedures to slip through
India has no national data on unwarranted surgeries, but evidence is mounting: private C-sections touching 50%, clusters of unjustified hysterectomies in several states, and lakhs of suspicious insurance claims. Doctors agree this isn’t a “collapse” — but a system strained by profit motives, weak oversight and rising patient expectations.
A Patchwork of Evidence
These scattered signals don’t indicate widespread malpractice — but they do expose pockets where financial incentives, lax regulation and patient pressure converge. Dr Nagendra Parvataneni, Surgical Oncology, KIMS Hospitals, cautions, “There is no credible evidence that 44% of surgeries are unnecessary.” But he acknowledges scrutiny across specific procedures. “India performs around 2.5 lakh TKRs a year. Insurance audits indicate up to 34% may be inappropriate, depending on the centre.” On oncology, he is unequivocal: “Cancer surgeries follow strict NCCN guidelines. The figures circulating online are impossible.”
Women’s health sits at the centre of the debate
Amid this debate, women’s health — especially hysterectomies — has become a flashpoint. Dr Manjula Anagani, Senior Obstetrician & Gynecological Surgeon, Care Hospitals, urges the public to differentiate misuse from evidence-based practice. “Yes, a few reports have flagged misuse in pockets where regulation and counselling were weak. But to generalise this and portray hysterectomy as largely ‘unnecessary’ is factually incorrect.”
Corporate Culture and Pressure to Perform
Doctors describe an environment where commercial targets can distort clinical judgement. “Corporate hospitals run on numbers,” says Dr Kesava Reddy Mannur, Metabolic & Bariatric Surgeon, Continental Hospitals. “Doctors who don’t order enough tests or surgeries are reprimanded — or removed.” On cardiology, he is blunt, says, “Many cardiac stents are unnecessary. Sometimes lifestyle modification is enough. I’ve advised patients against bypass surgery who then lived into their 90s.” Even obstetrics feels the strain. “Parents increasingly want auspicious birth timings. Obstetricians cannot always wait,” he adds.
For him, the root problem is structural, “Oversight is weak. Permissions for new hospitals come without assessing need. State hospitals lack staff and medicines. It’s a system problem.”
Profit-Driven Testing and Treatment Hype
Dr M.B.V. Prasad, GI and Laparoscopic Surgeon, KIMS, offers a blunt critique of how profit and corruption have seeped into healthcare. “Corruption begins the moment money or personal gain is valued more than virtue,” he says, recalling a moment that shaped him: a senior colleague once told him, “When people in all walks of life are corrupt, why shouldn’t we be?” He argues the cracks start long before a doctor enters the operating room — with capitation-based admissions, poor-quality medical colleges and compromised training that prioritises certificates over competence.”
Ethical Doctors Still Form the Majority
Despite structural failures, clinicians insist ethical practice dominates. Dr Praveen Mereddy, Orthopaedic Surgeon, Star Hospitals, says, “Like any profession, there are good, bad and ugly doctors. But 75–80% of those I’ve worked with are ethical.” Yet he warns of a broader drift. “Healthcare and education have become businesses. When conscience and accountability improve, so will the nation.”
Where Robotics Fits — and When It Doesn’t
With scrutiny around surgical choices rising, robotic hysterectomies are under the spotlight. Dr Manjula clarifies, “Laparoscopy is safe and cost-effective for many routine cases. Robotics isn’t a replacement — it’s for complex surgeries where added precision matters.”
Robotics doesn’t decide whether surgery is needed, but once indicated, it makes the procedure more precise and consistent, says says Dr Ajesh Raj Saksena, Consultant Surgical Oncologist Apollo Hospitals Hyderabad.
“Robotics lifts the technical baseline,” says Dr Ajesh. With 3D vision, tremor control and wristed instruments, it reduces dependence on individual skill and adds transparency by recording surgical steps and intraoperative video.Patients see the benefits — fewer complications, less blood loss and faster recovery. Costs remain a challenge, but competition is improving affordability.
As Dr Manjula notes, “For complex cases, robotics can mean safer surgery and quicker return to normal life.”
Greed, he notes, is not one-sided.
· Some patients buy insurance after diagnosis to exploit the system.
· Insurers reject legitimate claims on flimsy grounds.
· The same tests and drugs cost drastically different amounts across establishments. The outcome is a loop of distortion.
· Patients expect quick cures. Doctors face investor pressure. Hospitals chase revenue through unnecessary tests and procedures. Health itself becomes commodified.