Clinical Medicine vs Innumerable Costly Tests
I learnt my medicine at the feet of some of the great teachers in India, the UK and USA. Time was when every patient went through a detailed interview to record the history of his/her ailment and then a thorough clinical examination. Tests were done only when indicated to either confirm or refute the bedside diagnosis and it was not all tests for all patients. What I see today baffles me. Doctors rarely examine patients but rely on all tests to base their judgement. The very act of examining a patient could act as placebo therapy.
 
I get emails daily enclosing all kinds of test reports for advice. I get confused. This trend is bad for patients, even though it is good for business—if medical practice were to be a business. This has to stop and we should get back to clinical medicine. Even senior doctors have got acclimatised to this new environment. A doctor in Chennai came to see me; I wanted him to get on to the examination couch. He was surprised! He told me that all his reports are in his file and why should he be examined. To the surprise of both of us, his diagnosis was totally different at the end of the day. He was elated and went on to tell his students that he is changing his teaching style. 
 
Hippocrates said that if a doctor listens to his/her patients long enough s/he will know what is wrong with her/him. How very true! When the first corporate hospital came up in a metropolis in India, my former teacher, the late professor CRR Pillai, admitted one of his private patients there with clear-cut instructions. To his dismay, the next morning his patient had been put through all the tests the hospital was offering. He got his patient discharged forthwith and never entered that hospital, during his life time again. The hospital has grown from then to becoming one of the biggest corporate monstrosities, making huge profits at patient’s misery!
 
Re-emergence of clinical medicine is going to make medical-care very inexpensive from the patient’s point of view and will make for better diagnosis and cheaper treatment also. Many times, it might make major risky surgeries unnecessary. Even the NHS (National Health Service) in the UK has come to the conclusion that intervention is not only a bane but is also prohibitively expensive. It has taken a bold decision to cut down on unnecessary and doubtful interventions for NHS patients by tightening the criteria for treatments where the risks outweigh the benefits. The proposals will ensure that procedures, such as those for carpal tunnel, haemorrhoids and varicose veins, will take place only where there is good reason to do so. Alternative treatments, such as injections, changes of diet or physiotherapy, will be effective in the majority of cases, NHS England said. 
 
National medical director, professor Stephen Powis, said: "If we want the very best clinical care for our patients, we need to stop putting them through treatments where risks and harms outweigh the benefits. By reducing unnecessary or risky procedures for some patients, we can get better outcomes while reducing waste and targeting resources to where they are most needed.” Speaking to the media, he added that this would be the first stage in looking at situations where surgery is better avoided. He said: "We shouldn't, at best, inconvenience or disappoint patients by offering treatments that are not effective and, at worst, harming patients.” In consultation with the National Institute for Health and Care Excellence (NICE), four of 17 procedures will be offered only when a patient makes a specific request, with the other 13 being offered only when specific criteria are met.
 
If this is the state of affairs in the NHS, one could imagine the status in corporate hospitals, especially in India, which are built to amass wealth from human misery. I am sure, readers will be convinced that if we resurrect clinical medicine, as described above, mankind will be happy. One actual case history will reinforce this point. 
 
A middle-aged gentleman had some unusually spicy food one afternoon and had stomach upset with a vomit. His dinner gave him the same feeling. He slept well. The next morning, the stomach-ache returned with one more vomit. A good doctor in Mangalore, an old student of mine who practises good clinical medicine, arrived at the right diagnosis of acute gastritis and prescribed correctly. The patient was a very rich man who was not impressed by this. He went to a corporate hospital where a cardiologist heard two words, vomiting and upper gastro-intestinal pain.
 
The patient was admitted to the intensive care unit with a provisional diagnosis of acute coronary syndrome. A good history alone would have given away the secret. He had to go through the usual drill and ended up with coronary angiogram. Lo and behold! There was a block which was angio-plastied. Now, this man gets two blood thinners both of which are gastric irritants. The angry stomach reacted violently. The stomach-ache and the vomiting promptly returned with a vengeance. This is today’s corporate medical practice which netted a few lakhs of rupees to the hospital and the doctor. May clinical bedside medicine return for human good!
 
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    COMMENTS

    Balraj Amaravadi

    12 months ago

    So, what one has to do- Doctor and/or patient ( may not be patient at all) ? We have some checklist in financial domain. Is there any for a doctor/ Patient to avoid ( not to fall into this trap of human misery , where possible) this corporate business clinic?

    Dharmendra Kesaria

    1 year ago

    Absolutely correct. Pray to God that you will get good clinician when you are ill. The art of clinical diagnosis is becoming illusive.

    Rajesh

    1 year ago

    Very true.

    Gurudutt Mundkur

    1 year ago

    What Dr. Hegde says is true. I was "examined" and "treated" by a Consultant Physician without his getting up from his chair, based only on the pathological and x-ray reports.

    Anand Vaidya

    1 year ago

    Very true. Many (most) doctors nowadays don't even try to gather facts (food, allergies, excessive stress, any bad habits, even current prescriptions etc) before diagnosing. They know a pill for everything. 3 minutes and they are done.
    It is essential for patients to try to understand why they are suffering in the first place and not depend too much on prescription meds. Better look at lifestyle & other factors first.

    Ankita Shah

    1 year ago

    Good article!!

    JatinRB

    1 year ago

    Nice article

    REPLY

    JatinRB

    In Reply to JatinRB 1 year ago

    Hiii this article is good

    Ankita

    In Reply to JatinRB 1 year ago

    Great one!! Seems to be helpful

    The Wonder Greens—Coriander and Curry Leaves
    Curry leaves (the humble kadi patta or mitha neem) and coriander leaves are the two most underrated greens in a world where customers are aware of super-foods and super-veggies, thanks to the proliferation of digital media. In this article, we are going to look at the health benefits of these leaves.
     
    Curry Leaves: No Indian menu in south India and a few other states is complete without a dash of sautéd curry leaves. Whether it is plain dal or dal makhani or curries or rasam or sambar, curry leaves add that unique flavour to food. Curry leaves are rich in antioxidants and chlorophyll. They also contain minerals and essential nutrients needed for our physical well-being. Consumption of curry leaves regularly can improve eyesight, control the level of sugar in blood and reduce cholesterol levels. Curry leaves are rich in fibre and this is what makes these leaves unique. Consumption of a few twigs of curry leaves early in the morning on an empty stomach can also lead to health benefits like improved metabolism and digestion.
     
    Curry leaves can also be dried, powdered along with a few proteins (like udad dal) and used as a side-dish for rotis or curd-rice. The curry leaf powder available in supermarkets is often loaded with too much of chilli or salt. So, it is better to make curry leaf powder at home. South Indian homes generally prepare buttermilk adding a dash of curry leaves, lemon and a bit of ginger. This is really a wonder drink. 
     
    It is simple to make. Churn the curd with sufficient quantity of boiled and cooled water to make about 10 glasses of buttermilk. Sprinkle asafoetida and a pinch of salt. Shred the curry leaves into small pieces using your hands. Scrape ginger so that the skin is peeled off so that you can cut the ginger into minute pieces. Stir the contents well and top it up with a spoon of freshly squeezed lemon juice. Your herbal buttermilk is now ready to drink. It is not uncommon to add finely shredded coriander leaves to this buttermilk. Coriander leaves are rich in iron.
     
    So, the next time you make sambar or daal or a vegetable curry, add loads of curry leaves so that your dishes are flavourful and appetising. What is more—as you keep consuming curry leaves, you will realise a number of health benefits as a collateral benefit. Dried or processed curry leaves are not as useful as they contain an excess of oil/ salt and, sometimes, preservatives. It is also advisable to buy a stock of curry leaves that will last for two or three days and then replenish the stock. If you stock them in the refrigerator, they will soon dry up. Curry leaves can be washed, dried and boiled along with coconut oil. Cool this oil and this can be used as hair oil for growing black, long and shiny hair. You can apply the oil at night and wash it off in the morning. 
     
    Coriander: Coriander leaves and dried coriander seeds are commonly used in Indian cooking. These leaves are rich in Vitamin C, Vitamin K and proteins. They also contain small amounts of calcium, phosphorous, potassium, thiamine, niacin and carotene. Coriander is used for digestion problems including upset stomach, loss of appetite, nausea, diarrhoea, bowel spasms and intestinal gas. It is also used to treat measles, haemorrhoids, toothaches, worms, and joint pain, as well as bacterial and fungal infections.
     
     
    Regular consumption of fresh coriander leaves lowers blood sugar, eases digestion, decreases blood pressure and reduces cholesterol levels and helps address urinary tract infections. A small quantity of coriander seeds boiled in water can act as a good diuretic. It is important that you buy stock of coriander leaves that will last only for two or three days so that you get the benefit of all the nutrients that the leaves contain. Coriander increases the levels of HDL cholesterol. It also has anti-inflammatory properties. Coriander seeds are especially good for the menstrual flow and also best to treat anaemia.
     
    It is wise to include curry leaves and coriander leaves as part of your regulardiet. Mix equal quantities of cumin and coriander seeds and grind them well into a finely textured powder. Consumption of one spoon of this powder daily can help control triglyceride levels in blood.
     
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    COMMENTS

    Anand Vaidya

    1 year ago

    Thank you for highlighting the health (& taste) benefits of these two wonderful herbs...Hope this series will continue

    Amit Phatak

    1 year ago

    That's good "health investment" advise.. and since, as they say, "health is wealth", this automatically becomes sound wealth advise!

    Protect Your Teeth: Cut Out Refined Grains and Sugar
    Increasingly, in the face of mounting evidence, doctors are reluctantly coming to the view that what is really bad in a diet are carbohydrates and sugar. Interestingly, this was known all along; but a combination of interests from food companies, zealous researchers and politicians had suppressed this insight. Consider this study which is over half a century old. 
     
    One of the best places to measure the impact of carbohydrates and sugar was Greenland, where the traditional Alaskan Inuit lived semi-nomadic life hunting and catching fish, marine mammals and birds. They had minimal sugar and carbohydrates—all in the natural form. However, beginning around 1920, a group of Alaskan Inuit slowly developed permanent settlement in the mountains, in a pass called Anaktuvuk Pass. In 1953, a post-office was established as well as a ‘white trader’ store. Their diet started changing with the addition of more carbohydrates and sugar.
     
    Shortly thereafter, Gisle Bang and Tore Kristoffersen, of the Gade Institute from the department of pathology and school of dentistry in Norway, conducted two studies, over two different periods, on the diet and dental health of the Inuit. They first analysed the diet in 1955–1957 by weighing all the food eaten by each person for two consecutive days once a month. They recorded the content of fat, protein and carbohydrates, as well as the total caloric intake of each individual.
     
    In 1965, they conducted a second dietary intake study by the ‘interview method’ plus personal observations by visiting the families during meal times. The interview included questions on what, and how much of each item of food, each person ate during the year. There was a sharp increase in carbohydrates intake of ‘nearly 50%’ and a decrease in the intake of protein ‘by about 50%’ over these two periods. Increased carbohydrates intake was paralleled by an almost 90% increase in decayed, missing and filled permanent teeth for primary teeth and a fourfold increase in those more than six years old, the percentage of caries-free persons had decreased from 74.5% to zero in eight years. 
     
    In 1955-1957, 50% of the children had caries-free teeth; whereas in 1965, all the children had decayed teeth. The most dramatic change occurred in those who were in the 30+ age group. This group had no caries; all had developed caries by 1965. All this while, consumption of carbohydrates had increased by 50%. Much earlier, Dr Weston Price and Dr Melvin Page, pioneering dentists, had found that eating the wrong kind of sugar and carbohydrates (grains) causes tooth decay (though not by ‘decay-causing bacteria’) but by changing the blood chemistry.  
     
    Dr JD Boyd accidentally healed diabetic children’s decayed teeth by designing a grain-free diet, writes Rami Nagel in his book Cure Tooth Decay. “The diet meant to control diabetes not only stopped cavities, it turned soft tooth enamel hard and glossy.” These findings were published in 1928 in the Journal of the American Medical Association. Dr Boyd’s diet consisted of milk, cream, butter, eggs, meat, cod-liver oil, vegetables and fruit. 
     
    Dr Bang and Dr Kristoffersen also explained how the Alaskan Inland Inuit diet changed. “While previously all able men in the village frequently were out hunting, trapping and fishing, only a couple of the young men were still actively engaged in such activities in 1965. Manufacture of souvenirs had proved more profitable and the income financed the purchase of refined foods from the local stores. Consequently, only some 20% of the food intake was made up of native foods, mainly caribou meat. Hunting was now mostly limited to the short periods when the caribou came close to the village. In 1955–1957, the percentage of calories obtained from protein and fat was high while the percentage derived from carbohydrates was low. In 1965, the intake of protein was about 50% lower (carbohydrates intake was 50% higher).” 
     
    The Eskimos were no longer subsisting on their native diet but, instead, a diet much higher in refined carbohydrates. They were “living under the same environmental conditions as far as geographical location, climate, housing and clothing is concerned,” wrote the researchers, compared with those from 1955 to 1957. The most important change in their lives was the change in their diet. The dental examinations in each period were carried out by the same investigators using a similar method under identical conditions. 
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