Friday, October 25, 2013

Doctor: Between the devil and the deep sea

I’ve seen many “positive” reactions to the Supreme Court verdict that many news channels termed historic and landmark. While the case might be historic, extrapolating it to any and all other medical cases is, however, not good for the profession in particular – and general public at large.
  • Disclaimer 1: I belong to a family with a few doctors.
  • Disclaimer 2: I’m not a medical practitioner. I’ve not consulted with one before writing this. I’m not in any way related to AMRI or any other hospital for that matter.
  • Disclaimer 3: I’ve nothing to say about this particular case but a lot against generalizing this case.
Here’s why:
Have you gone to a car mechanic with a complaint of a weird noise in your engine? How does he repair that? He doesn’t take it to an automotive lab. He doesn’t contact the car manufacturer for the engine specifications and schematics. He puts his ear to your gas guzzler and asks you to turn the ignition ON. He keeps his ear close while making those faces that make you feel insecure about your 10-yr new possession. He suddenly rises from the hood of the car and pronounces to no one in particular – “There is a jam in the valve”. Now he is not talking to anyone. His brain is however working to repair your car. He then calculates and tells you, “It will be done. Do you want a company valve or just any will do? It will cost you Rs.4000. You can collect your car tomorrow.” You haggle about the valve price without having any clue whether 4000 or 1000 is the right price. And finally, a number decided, you entrust him with the vehicle. He repairs it, or if else while trying to repair, finds some other fault, calls you up to tell you that his initial diagnosis is wrong and a separate procedure might be required.

A doctor does the exact same thing with your body!

He has two options:
  1. Go the detailed way:
    1. Conduct thorough diagnostics – You never know if a scratch on the outside is actually deep rust from the inside! So better do a x-ray scan of the complete car
    2. Prescribe the best medicines. Why go with a Rs.10 rubber strip when you can go for Rs.200 guaranteed puncture fixers from Dunelope!
    3. Treat it with intense care till it becomes alright. Even if its just puncture, better get the car to a workshop where a team of specialized mechanical engineers from IIT-KGP will work on it for 4 days and fix the puncture.
    4. And at the end, give you a bill of Rs. 1,20,000 (+taxes)
  2. Go the trusted way:
    1. Conduct brief diagnostics – just feel inside the tire to see if there is a nail.
    2. Prescribe the most effective known medicine – you know the crowbar is enough to open up the tyre and a hydraulic press is not really required.
    3. Treat it with care – you know its not your car but you have an intent to do good for two reasons – i) you do not want the brickbats ii) You want a repeat customer. Hence, give it chhotu who knows how to repair the puncture and has a workshop record of doing it under 4mins 39secs.
    4. Give you a bill of Rs. 200 (the tube has to be purchased from the market by you)
Agreed, a car is far more dispensable than a human body, even then, does the doctor prescribe ELISA the moment you go to him with a second instance of a running nose! Ideally, he should – recurring diseases is a sign of AIDS. And if he does that, Aamir Khan will be knocking his doors with a court notice of unjustified expenses on the treatment of a “poor hapless customer”. And then he’ll be accused of being a stooge of the pharma and medical instrumentation companies.

This, btw is very likely what happened in the west where the cost of medical treatment is high. So high that healthcare alone could shut down the government controlling the biggest pot of money in the world.

Not all doctors are unscrupulous thugs. In fact most aren’t. Medicine is a profession built on trust and fame. Infamy is a death knell in the profession. More often than not, a doctor intends well. More often than not, a doctor will practice his profession well (almost like a case of a SW Engineer coding – the ‘default’ is the right way). In a few cases where he doesn’t, action needs to be taken. But to say that all hospitals are 5-star hotels and thugs is a gross misstatement and, imho, a disservice to the nation. Continue this tirade against the doctors and very soon we’ll be shutting down the Indian Govt too asking for a cheaper healthcare system.

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