Mediangels a second opinion centre in Navi Mumbai recently studied 20,000 consultations over the past two years and found several people were advised unnecessary surgeries by their primary doctors. Almost 44% of the 12,500 patients for whom surgery was recommended were advised against it by their second opinion consultants. In one case a Kandivli man was advised urgent cardiac surgery so his family contacted MediAngel's cardiac surgeon who looked at the ECG and said the patient only had an orthopaedic problem. Eventually the man consulted a shoulder specialist in the US who diagnosed unaligned shoulder and arm bones and showed the man exercises on an online chat, which reduced the man's pain considerably. Surgeon Dr Debraj Shome who owns MediAngels said the discrepancy in opinions was highest in heart problems at 55%. Knee replacements and hysterectomies were second at 48%, while infertility was third with 45% discrepancy in opinions. Another surgeon said doctors are like daily wage earners in India and are paid on the basis of the business they bring to a hospital, thus a surgeon is tempted to recommend surgery. Some specialists say at present there are many non-medical ways that compete with surgery as a form of treatment, so in India it is more a case of who the patients consult first, a surgeon or a medical specialist. A deliberation organised by the World Bank in 2014 concluded that 'medical overuse' is emerging as a serious issue in India, especially as more people can afford to pay for medical interventions due to access to insurance cover. Consequently individuals in India with private voluntary health insurance are more likely to be hospitalised than the national average. Many of these interventions deliver only marginal benefits and can actually harm the patients, leading to unnecessary suffering, especially among the frail and elderly.