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A: He had heart attack and was sent to the hospital. The doctor says that he needs surgery urgently to stop it happening again.

Question 1. Shouldn't it be said? because the doctor said something in the past.

Question 2. Can I replace the sentence with " The doctor said that he needed surgery urgently to stop it happening again," or "The doctor said that he needs surgery urgently to stop it happening again?"

Thanks for answering my questions.
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Comments  
A. : It should be a heart attack. If you add "a few days ago", he must still be in hospital, and the doctor may still say it today.

B. : If the story is set in the past (long time ago), then " The doctor said that he needed surgery urgently to stop it happening again," is correct. If the story happened a short time ago, then the second possibility is correct.
says is OK too, say if the doctor is still of the same opinion (today)
both your other versions are OK too
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A. Are there any differences between the other two versions of mine?

B. So if someone who expressed his thought ? in the past still holds the same opinion, can I say, "he says ...," or "he said...?"
if you're using "say" for "holding an opinion," yes, you can use the present in this context, because the doctor still thinks that way

if "say" means "speaking out that opinion," no, you should use the past, IMO, because it took place in the past

IMO, your first alternative is more rigorous in terms of tenses involved:
The doctor said that he needed surgery urgently to stop it happening again
A.: "the doctor said at the time when he had his heart attack". "The doctors says now".
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Question 1. Shouldn't it be said? because the doctor said something in the past.

Thought-provoking questions: In what case can we ever report that we heard someone say something when they did not say it in the past? (I never hear anyone say anything in the future, for example!) Even if you said something two seconds ago, haven't you said it in the past by the time I tell someone else what you said?

Now does this mean that we must never use "says" because it is not a past tense form??? Is "says" just a useless verb-form of English? If not, then what does "says" actually mean?

Emotion: smile

CJ
I'm getting confused now...by the way, can you say someone expresses this thought instead of opinion?
I made a search at Yahoo with all these:
"had a heart attack" "doctor says" "needs surgery"
(the quotation marks are important)

I got several relevant samples which seem to prove the viability of "says" in
such context:

........
Jimmy had stopped by to tell them that Perry White, editor-in-
chief of the Planet, and their boss, had just crumpled over and
had a heart attack.

When Lois heard what happened, she said, "Is he all right?"

"He's resting at Metropolis General and the doctor says he
needs surgery."

http://www.lcfanfic.com/stories/2000/lastson2.txt
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My husband has had several surgery's on his knees, and they seem to be
getting worse. His job requires him to stand on his knees quite
abit. The doctor says that if he does not change jobs he will have to
have knee replacements in a couple of years.

http://www.churcheshosting.com/ccprayer_archive05.htm
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