Changing face of medicine





With the possibility of a lawsuit breathing down their necks, doctors nowadays recommend all kinds of tests, thereby making an otherwise simple consultation fairly expensive for patients

Back in the 70s, a single physician took care of you in the hospital. The hospital was only for serious problems and a sin gle consultant fit the bill. Occasional ly, when a difficult case was brought to the consultant, he would seek consultation with a senior physician and decide on a treatment plan. At a time when there were no ultrasound, 2D Echo, angiography, MRI and CT scans, treatment options were few. In today's world, the huge number of tests available for diagnosing a patient can burn deep holes in anybody's pocket. Thus, these tests should not be ordered without good reason by any physician. In many situations, I often find patients themselves asking for certain tests because they think that they are suffering from a certain ailment. Sometimes, they don't just ask for these useless tests but they demand them.The educated people today believe that these diagnostic tests are the bedrock of medical science, and are of utmost importance for any medical decision. I see people getting spinal scans done for no reason and undergoing disc surgeries at the drop of a hat.
A projected disc showing up on a scan result is just not enough reason for a surgery. One must first decide if it resulted in any symptoms and if traditional methods were first applied to tackle the situation. If the problem leads to wasting of muscles, weakness in the bladder and bowel movements, only then should a different course of treatment be taken up. The decision to send a patient for a surgery should be made only after exhausting all other options.
I often see logic being thrown to the wind and callous surgeries being done. An English patient of mine once asked me to accompany him to Germany for a back surgery. As his physician, I knew that there was nothing grossly wrong with his back. He had a little accentuated curve called scoliosis, but had no symptoms. He was advised surgery to set this right. When I evaluated him, I explained to him that only a lunatic would operate on him for something this trivial. Premature anatomical correction in the hope that this will not produce symptoms later in life is illogical.
It is strange how people treat their bodies as a car repair shop, carrying out surgeries like preventive measures, similar to changing spark plugs of old cars or the distributor cap to enhancer performance of the vehicle.
In the case of my English patient, I declined his offer to go to Germany with him and operate on him ­ not wanting to a part of such lunacy or worse still, tell the surgeon off.
Nowadays I see a number of physicians treating one patient -one for his diabetes, one for the kidneys and one for his blood pressure.All of this should be able to be handled by a talented internist, who is good at his job. I don't know whether the need to go to specialists arise out of the physician's fear of a legal suit being slapped on him in case of a mishap or because they want to master niche areas of medicine. I think such a practice is actually disastrous because in a given situation where the patient has heart malfunction and kidney failure, it now requires two different physicians instead of having one person treating him with efficiency.
Enter the cardiologist who, in order to improve heart function, orders a diuretics to increase urine flow. Then comes the kidney spe cialist, who to improve the kidney function of the patient stops the diuretic and orders fluid.Both are correct for their respective organs. But here is where the internist comes in handy as he knows exactly how to strike a balance between the two. But today, the Resident doctor coordinating all of this goes bananas.
Such is the case now that all doctors are scared of legal consequences and so nobody takes complete responsibility of the patient. Today, medical practice has been reduced to different specialists calling different shots, often ignoring what is best for the patient.
Ever since the practice of medicine entered the realms of courts and out of control of the medical councils, which were doing an excellent job in the first place, things have changed drastically.
Doctors have become so guarded that they fail to make decisions on their own, thus making the entire affair more costly and extensive for the patients. Doctors do not bat an eyelid before inviting special consultants, thereby making the process even more difficult for the patients. Alt the end of the day, it is the patient who is being bogged down by the complicity of things.