Thursday, June 12, 2014

Disappearing skill of clinical diagnosis

We had the subject of general medicine and surgery in the third year of BDS. To train us to do the clinical diagnosis for the exam, we had some good teachers. When any of us fell sick, they would diagnose by clinical examination, give appropriate medicine and that was it! The health was restored.

In that period of time, one day my aunt who stayed next door, frantically called me home. Her daughter, about 4 years old, was having deep purplish color inside her oral cavity. My cousin who was doing MBBS, was already there, checking her with his stethoscope. I looked at the girl, she seemed to be completely normal, the breathing rate, pulse and all. I called her aside and asked,’ Tell me, where is the thing that you put in your mouth?’  She took me to the place where potassium permanganate was kept!

When I joined my job and started working, I developed a pain in the neck and shoulder region. The pain was a bit more and we went for consultation. He diagnosed some problem in the neck area and told to go to the physiotherapy department to get traction done daily for a number of days, apart from taking some tablets. Well, I am not a lover of tablets, but went for traction for a few days. Then I got the intuition that something was not right. I didn’t want to continue with the traction. I started thinking deeply what must have gone wrong.

While doing post graduation, my friends had talked me into buying a very high heeled chappal, and I was continuing to use it.  I thought of discontinuing its use and see the result. Well, that was it! Within a week, I was totally free from the pain.

I had a maid whose mother used to fall sick often. She would be admitted to the hospital for saline infusion, for at least two days. Now I have another maid, who absented one day and told that her mother was having abdominal pain. She took some pain killers herself, the pain got worsened. So they took her to the doctor.
I was experienced now, so asked her, ’They admitted her for saline infusion?’

‘Yes,’ she answered with a look of admiration.

I was surprised that her mother took pain killers. I asked her, ’Don’t you people have any home remedies (gharelu davai)?’

‘No’, she told with an expression, ’What are you talking about?’

‘The bill came to Rs. 7000. The doctor told that there may be problem with the heart also, it is very necessary to get a check up done (of course another fat bill).All of us are worried and are thinking about it.’

On further questioning her I came to know that her mother had a hernia operation last year. The day prior to getting pain she had carried big vessels of water to store in the house. Mostly the pain must have started due to the strain and then her self medication must have created acidity or something like that.

From our friend circle and others, we come to know that doctors who can make a correct clinical diagnosis are very rare now. They will write for investigations and even repeat investigations again and again! Doctors are proving to be ‘karmic police of the kaliyuga’ (my daughter’s words). The sins are increasing and doctors are here to mete out punishment by misdiagnosis, draining people of their money by repeated investigations, unnecessary hospitalization and surgeries.

To one of my colleagues’ mother, immediate heart surgery was advised, with a warning that she might not last even for 3 months without the surgery. The lady was very courageous and decided, ‘ I have spent a life time and had a good life. I am ready to die any time now.’ She didn't get the surgery done and was alive even three years afterwards. I lost contact with her after that.

I have reliable information from a hospital that there is standing instruction to the ICU unit that any patients that came with chest or abdominal pain have to be kept in the ICU for at least one week. The cost of doing an MBBS course is almost one crore now. If they do post graduation also, spending a fortune, they are in a hurry to make money after starting the practice. Then cuts from the drug companies and pathology labs are very lucrative. Even some dentists are routinely writing tonics for every patient for their cuts from the drug company. Is there any comparison to the earning if one does correct clinical diagnosis and cure the patients with minimum medicines? 

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