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Sadly, it is like that in private healthcare where doctors profit from the fear and misery of patients. If a surgeon does not recommend a surgery for a patient, the fear is that he will go to a competitor for a 2nd opinion, and if that surgeon recommends the procedure be done, the first doc will lose that patient for life. Not only will his competitor profit from the surgery, but also all post operative care thereafter. That patient is also likely to refer his spouse, relatives and friends to the competitor if the op goes well.