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There is an oath sworn by all those who practice medicine, laid down at the dawn of history by the father of medicine himself, Hippocrates, The oath? Primum nil nocere : In English, "First, do no harm". In that regard, it is implied that the duty of a physician is to prescribe treatment that best benefits the patient. Unfortunately, this age old cornerstone of medicine is being increasingly eroded by the seductive call of profit to the point that, patients apparently have to invoke another age old adage when seeking such a fundamental need as medical treatment : Caveat emptor; more widely known as "Buyer Beware".

Despite living in a world where information is literally at the tip of one's fingertip. People still do not approach aspects of their health in as exhaustive a manner as they bid for the next geegaw on e-Bay. Nine times out of ten, people will not have the same level of enthusiasm when conducting research about their medical problems or the pros and cons about any particular procedure or treatment they wish or need to undergo.

Being in the medical profession is an awesome responsibility: lives are literally at stake. One misdiagnosis could mean disastrous results for a patient. Part of the extensive medical training is a course on ethnics, in particular the sacred covenant between patient and doctor. A doctor will always hold a patient's interest over others. In an ideal world, such a view would be sacrosanct. This once sacred covenant is now fraying with the arrival of big business into the medical profession. Unlike a second hand car, or a collectible toy, which you can get a refund, the consequences of a misdiagnosis or inappropriate treatment, are permanent.


In the field of medicine, one of the most sought after procedures by patients is LASIK - a quick elective procedure that can potentially correct shortsightedness. Since its debut in the 90's, thousands of people worldwide have undergone the procedure with industry experts forecasting that demand will only grow. Since its inception, LASIK has experienced a number of technological improvements that reduce the number of potential complications and increase the range of patients capable of undergoing the operation. To meet this growing demand, some surgeon team up with investors to form a mutual joint venture. The surgeon provides the technical skills, while the investors provide the cash to acquire LASIK equipment and other logistics.

In smaller private practices, the surgeon who will conduct the operation is often the one who provides consultation to the patient. In larger ones, a non-medical consultant may be the first point of call for a patient before they get to see a surgeon due to the volume of patients. Large business setups are under massive economic pressure to generate volume production to recoup their investment costs. When consultants in such large firms are given pay schemes that are based on the volume of patients they can get to undergo LASIK, this can lead to potential complications. Without a qualified doctor at every stage of the assessment process, minor details that could mean future problems can go unseen. The public often perceive such elective procedures as being risk free. They're not. Trained doctors must properly assess potential patients to ensure that they are viable candidates for the procedure. The same goes for other optional medical and refractive procedures such as cataract surgery. Such procedures are only justifiable when a patient's lifestyle and quality of life are reduced and can be improved through surgical intervention. It's paramount that a doctor prescribes treatment, be it LASIK, cataract lens replacement surgery, or something else based on how suitable it is for the patient rather than the almighty bottom line. The danger is that patient may be prescribed treatment they don't need, but rather, what the balance sheet needs.

Nowhere else does this bizarre setup appear in medicine: even the largest hospitals have you seeing a doctor or a surgeon to directly state your medical problems be it for a cold, a weak heart or a nose job. Only at the last stages of a consultation do many patients in these large setups ever get to see the surgeon that they are placing their lives and trust in, and even then, only for short minutes.

As many businessmen say, 'time is money'. The more patients seen, the more profits can be made. While it makes perfect business sense, it may not make perfect sense for the patients interests. A key aspect of delivering proper healthcare is first establishing a good doctor/patient relationship. Without a certain level of understanding and trust, a doctor is often unable to render an effective diagnosis for the patient and the patient not as willing to disclose potential or actual problems for fear of embarrasment or being slapped with unnecessary, painful or risky treatment. In a situation like this, kindness and compassion inevitably fall by the wayside. How can these two values be calculated if a patient only sees the doctor for all the span of five minutes?

Doctors are already unjustly accused of being uncaring, dishonest and unethical by certain parties. If nothing is done soon, one of the unfortunate result for both patient and doctor will be an insidious decline in what is accepted, appropriated and right. The decline has already started. To implement change without acceptance will be difficult in an industry dominated by large concerns. The main person losing out there, will be the patient themselves.

For now, the best solution is to be forewarned. Patients, always seek a second opinion. Cost is not necessarily the ultimate deciding factor when undergoing a life changing procedure like cataract removal or LASIK. You do, after all, get what you pay for. The following are some hard, appropriate questions to ask should a patient ever consider the option to undergo a refractive procedure.


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Interested in undergoing LASIK or other refractive procedures? Watch out for the following:
  • When seeking treatment options are you consulting a qualified doctor as opposed to a sales rep?

    A doctor spends many years, often half their lives in training, housemanship and in actual practice in preparing themselves for their role. A salesperson may simple be on the job for a few months, armed with a few brochures and no medical background.

  • Are you being communicated the pros and cons of your prospective treatment as well as alternatives should you not be willing to undergo it or are not able to for other reasons?

    Part of a doctor's obligation is to offer treatment options for the patient that offer the best potential outcome, not based on the best potential profit for the surgeon.

  • Are you being given the hard sell and asked to get the 'most expensive' treatment options on the premise that it offers the best treatment outcome?

    This is not necessarily true - advancements in LASIK or cataract surgical technology are incremental improvements that reduce potential complications during the recovery process or during the procedure itself; a large part of obtaining a favourable outcome is still based on the skill of the surgeon. A trained surgeon who has experience with their existing hardware can offer potentially better results than one who is using the latest technology off-the-shelf where a learning curve is still necessary.
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