Medical malpractices continue unabated, no matter how developed we may be. Patients have little recourse. Things are still much the same as they were decades ago. Proliferation of medical colleges across the nation and the increased availability of paid seats have resulted in a lot of incompetent doctors starting practice.
Some of them soon realise where they stand and switch tracks—either by working in pharmaceuticals research or by switching over to an alternative career path.
Salem-based Dr Yogi Adith Surendranath found that more than medicine, it is astrology that can make him rich. So, he learnt KP astrology (KP stands for Krishnamurthy Padathi) and has a flourishing astrology business in Salem. He has even international clients. But how effective his predictions are - your guess is as good as mine. Today, astrology is about cheating gullible people and making money the easy way. There is no consumer court that will come to your support in case the predictions turn out to be false.
Many of today’s young doctors have no patience. They are least interested in knowing about a patient's history and then proceeding towards a proper diagnosis of the ailment. All they are interested is in filling the time slot, if they are employed at hospitals and earning their salary.
Hyderabad-based KP Krishna had this harrowing experience. He happens to be my neighbour’s cousin. Krishna's father, Parshuram, is 82 years old and based in Thiruvananthapuram . The father and son were travelling from Mumbai to Hyderabad. Mr Parshuram had undergone an angioplasty last year. He is also hard of hearing. During the security check at airport, a security official admonished him for carrying his mobile charger with him in his shirt pocket. Mr Parshuram couldn't stand the verbal attack and tripped during the security check. He hurt his right thigh and found it difficult to walk. The doctor on duty at the airport refused to examine him. He said, ‘There is nothing wrong’. After some persuasion, the young doctor applied a spray to Mr Parshuram's thigh.
With some difficulty, they boarded the flight to Hyderabad. By the time the flight landed, Mr Parshuram could not move. He needed a wheelchair. He was brought home and shown to a young orthopaedic doctor in Hyderabad. An X-ray was taken and the doctor assured him that there was no crack; so, he could expect to recover within three to four weeks. He was prescribed painkillers and recommended a spray called Oxalgin. For the first three days, thing seemed to be okay but, on the fourth day, the pain was slightly more. As Krishna had little support system in Hyderabad, Mr Parshuram was taken with proper care to Thiruvananthapuram.
When the pain started increasing, Mr Parshuram was admitted to a hospital in Thiruvananthapuram. The X-ray and scan revealed that there was a hairline fracture that had got aggravated and needed major surgery. The family went through tense moments. Since I know them well, I spoke to Krishna's wife Sudha who said that the orthopaedic surgeon in Hyderabad had not cared to read the X–ray carefully. The surgery was successfully completed. Mr Parshuram is now convalescing at home. Krishna has engaged a full-time help to support his mother Saraswathi Devi. It will take at least another two to three weeks for Mr Parshuram to start walking within the confines of their Thiruvananthapuram home. Sudha said it was a nightmarish situation because of the deluge in Kerala even though Thiruvananthapuram was spared the floods.
Now who do we blame, in this case? If this is how young medicos diagnose cases related to senior citizens, does this augur well for the future? What is in store for Indians, if we have doctors who are lack competence or empathy or both? Any answers?
“You’re not entitled to take a view, unless and until you can argue better against that view than the smartest guy who holds that opposite view. If you can argue better than the smartest person who holds the opposite view, that is when you are entitled to hold a certain view.â€
The author has started off the discussion by clearly mentioning that she is writing the article purely on the basis of an anecdote told to her by a neighbour's cousin...
Why on Earth did she not try to get the opposite side of the story by cross-checking the story with the Doctor at the airport or in Hyderabad...ohh ofcourse...it's a lot of work.
But then, if that is how Moneylife approached all it's other articles, then I wouldn't spend a dime reading it....
Also...the author has just missed an extremely valuable point made by Dr. Richard Feynman in his extremely educative video (The one where he teaches about magnets)...You have to have a proper framework before you start asking WHY?
For example,
Mr. Parshuram was taken to the hospital..WHY?
Because he fell down and hurt his hip
Why did he fall down?
Because of gravity ...
Obviously you & I have fallen down plenty of times...but we didnt break our leg..so that begets the question as to WHY did he break his bone when he fell down?
Depends on the exact biophysical nature of his injury..but also Because his bones were weaker than normal...
WHY did he have weaker bones?
Probably because of his age...
WHY do the bones get weaker as we age?
Many reasons, chiefly because we do not undertake resistive exercises as we age...like lifting weights etc.
Could somebody have done anything about weak bones?
Probably...they should undergo atleast a screening DEXA scan to get to know the condition of his bone density...
But ofcourse, we don't get to hear anything about the author regarding the predisposing conditions...which seems to be a lopsided story....
Now that he went to the doctor at the airport...WHY did the Dr not see him properly
Could be many reasons..
1) May be he is just disintersted in all his patients and treats all of them in a similar fashion
A) He is incompetent
B) His nature is like that
2) May be he did not treat Mr. Parshuram specifically because
A) His duty was about to get over
B) He was in a bad mood
C) He was in a hurry to go somewhere
D) He is not being paid accordingly.(If you throw peanuts, you will attract monkeys only)
....there could be multiple reasons...but the author has just managed to focus on one since that is convenient to the story.
You will never get the right answers if you dont ask the right questions...
Coming to the Dr. In hyderabad...WHY did he not pick up the hailine fracture?
Could be many reasons
1) He is an incompetent nincompoop..
2) He did not want to treat Mr Parshuram
3) The fracture line was too fine to be visible to an ordinary eye...
..again..could be many reasons..
When Mr. Parshuram went to see the Dr. In thiruvananthapuram, they repeated the scan which showed that the fracture had got aggravated...
And that is when the author made the biggest blunder – she (wrongfully) claimed that it was because the Dr. In Hyderabad did not care to read the Xray carefully.
It is basic mathematics that even a 11th standard student can tell you...its called Bayes theorum...
Now I am going to ask you some simple questions...
1) Given that the final outcome of the patient is NOT KNOWN, what is the probability that the fracture was missed on earlier Xray ?
2) Given that the final outcome of the patient is KNOWN, what is the probability that the fracture was missed on earlier Xray ?
As you might see...the probability of missing the fracture line on Xray DEPENDS on knowing the outcome of the patient (Bayesian statistics)....
But the ultimate test of whether the fracture was actually missed or not can only be done if we put the same Xray to a group of “Old & Competent†doctors of the same field with no knowledge about the patient or his outcome.
If a majority of them can pick it up..then we can rightfully lay the blame on the incompetence of the “young Dr in Hyderabadâ€
Another important point to be noted about medical services in India...
The doctors in corporate hospitals are not really free to do as they wish...they are also given targets to be met and prescribed time slots....If the hospital is paying the Dr. 20 Lakh and getting business only worth say 15 L....
Bye Bye Doctor....
Also, one will logically argue....what about those Dr. Who are self emplyed..shouldn't their practive be better?
For this, I would like to point out that NOBODY would pay a doctor a high fees for good, sound and scientific advice..
Case in point – For Mild Dengue fever...only plenty of fluids and Paracetamol SOS is needed....But the patients will never be satisfied with just that
The quality of SOME doctors is definitely not upto the mark...and some of them are doing malicious practices...agreed..
But what happens to the overall group as a result?? (Apply basic game theory)
Think of it like a bunch of apples....if you KNOW FOR SURE that lets say 10% of this bunch is going to turn out rotten.....the price of the entire bunch as a whole will be reduced....so even if there is a good apple in the basket...it's price will also be kept low...
Same is true for Doctors...since in India, literally anybody (Even pharmacists, quacks etc. Etc.) can open shop and start prescribing drugs.....the price of the bunch as a whole is reduced...
So if you have a VERY honest and good doctor...even he wont be paid as much.....since there is a probability that he might turn out to be a 'bad apple'....
SO..he has to reduce his price....but in order to make the same amount of money..he now has to increase the NUMBER of patients
And ...as you already know....you cant have Quality with Quantity.....or atleast it is difficult to maintain....
So my humble advice to the author...Charlie munger is smarter than you or me....his words are worth something....
With loss of merit and admissions being brought at a price every vocation, cannot expect much in Indian Society.
Gone are the days of pursuing a profession out of pure passion, the reason there is no heart in it.
Obviously not. Hairline fractures need to be managed conservatively.
It's quite possible that the elderly gentleman had osteoporosis and probably did not avoid weight bearing on the affected joint.
Had this doctor earlier advise surgery, you would have harper about how doctors are exploiting patients through unnecessary procedures.
So, please stop making such sweeping generalisations.
All professions (including journalists) have their share of black sheep.
Looking at things with such a lopsided view such as yours does not help any cause.
hospitals will not give such doctors senior /consultant
positions.
The author has brazenly implied that a young doctor does not take patient history or exam him well. This is
unfounded and based on a second hand opinion.
I doubt whether she has been to any government hospital
where doctors have to see 200 - 300 patients everyday
excluding emergencies.
She has blindly given in to her neighbours opinion that the doctor did not read the x-ray correctly without any factual basis for it being the case.
It's so easy to put a question mark at the end of the title of an article and to make all sorts of allegations
It's a highly irresponsible and amateurish way of looking at things....
I wonder if she's a... Young.... columnist???
"Paropadeshe pandithyam".
Dr GURUPRASAD, orthopaedic surgeon.