Do Today’s Young Doctors Lack Empathy and Competence?
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?
 
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COMMENTS

Eashan

2 months ago

This article brings to mind a very important quote by Charlie Munger ...
“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.”

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 Hyderabad”


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....

REPLY

Dr. Velmurugan

In Reply to Eashan 2 months ago

I agree. Superb Answer Sir.

Saravanan R

In Reply to Eashan 2 months ago

True. Very practical approach. But it works best retrospectively. Everybody thinks deep when there is no pressure externally. Real-time solutions are always subject to hits and misses. So quality of acting and reacting works best in retrospection.

Saravanan R

2 months ago

Dr Imran Shaikh's anger is understandable to those young lacking empathy and competence. Those two lacunae are common in all the fields. But life saving situations make exception. Whipping the journalists and media ( that too magz like highly reasonable and responsible like moneylife.in) smacks of impatience or the undue investment made for the profession.

REPLY

atmaram v p

In Reply to Saravanan R 2 months ago

The article has glaring lacunae as far as medical wisdom goes. Moneylife is truly a responsible and reasonable financial mag, but the medical/health columns have mostly left a lot to be answered. This is layman's anecdote on her neighbours cousin's father, nothing more nothing less...to generalise that to the medical fraternity in the whole country is a farce .

Shriprakash Soman

3 months ago

Surely there is Lack Empathy and Competence, not only in Medicine but all fields , its an all pervasive factor.
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.

Dr Imran Shaikh

3 months ago

All you seem to be interested in is doctor bashing. You have only one side of the story, that is your neighbours. Did you bother to speak to the orthopaedic surgeon in hyderabad who initially treated him?
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.

REPLY

Shankeran MV

In Reply to Dr Imran Shaikh 3 months ago

Author's comments are not entirely out of place. The point is that Most young Doctors are not good at attention to details, especially when you show yourself in big corporate hospitals.

Dr Imran Shaikh

In Reply to Shankeran MV 3 months ago

How do we define young? Is it age or experience? If it's lack of experience, then most big


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???

Dr Guruprasada

In Reply to Dr Imran Shaikh 3 months ago

I totally agree with Dr Imran Shaik. As per the history available in the article, it was an incomplete or undisplaced fracture which cannot be diagnosed on day one and got displaced on further weight bearing. Either an immediate CT scan or re x-ray after 8 days will clear the doubt. Will the patient agree for a CT immediately, who was in a hurry to go home. Will you not blame the doctors for unnecessary CT scans.
"Paropadeshe pandithyam".
Dr GURUPRASAD, orthopaedic surgeon.

Eating Mushrooms May Improve Blood Sugar Control
Diabetic and pre-diabetic conditions have contributed to severe life-threatening diseases including heart disease and stroke. According to the Centers for Disease Control (CDC) in US, 100 million Americans had diabetes or pre-diabetes, in 2017. Now, a new study has found that eating white button mushrooms can affect glucose, or blood sugar, regulation, thereby reducing diabetes and other metabolic conditions, such as obesity. Consumption of these mushrooms is believed to create subtle shifts in the microbial community in the gut which could improve the regulation of glucose in the liver, according to the research.
 
In diabetes, our body does not produce enough of the hormone insulin which helps regulate blood sugar levels. Insulin helps transfer glucose from blood into the cells to provide them with energy. Diabetes occurs either when there is not enough insulin or the insulin that is made is not effective, resulting in high blood glucose levels. Essentially, the researchers wanted to see whether white button mushrooms could influence the production of glucose in the body. 
 
The study was conducted by researchers working in various departments at the Pennsylvania State University. The team of researchers showed that feeding white button mushrooms to mice changed the composition of gut microbes - microbiota - to produce more short-chain fatty acids, specifically propionate from succinate. Previously conducted research has shown that succinate and propionate can change the expression of genes needed to manage glucose production, said Margherita T Cantorna professor of molecular immunology in Penn State’s College of Agricultural Sciences. Furthermore, “managing glucose better, has implications not only diabetes by other metabolic diseases as well” added Prof Cantrona. 
 
Published in the Journal of Functional Foods, the study showed that mushrooms can alter the gut microbiome and that pre-biotics, which are substances often derived from the foods we ingest, support the activity of microorganisms in the gut to boost the growth of beneficial bacteria. 
 
The research was conducted on two types of mice—one group had microbiota, the other group comprised germ-free mice and did not carry microbiota. The latter acted as the control group. “You can compare the mice with the microbiota with the germ-free mice to get an idea of the contributions of the microbiota,” said Prof Cantorna. “There were big differences in the kinds of metabolites we found in the gastrointestinal tract, as well as in the liver and serum, of the animals fed mushrooms that had microbiota than the ones that didn't.”
 
The mice were fed a daily serving size of the mushrooms which would be about three ounces for humans. The results of the study suggest that consumption of these mushrooms sets off a chain reaction in the gut bacteria, expanding the population of Prevotella, a bacterium that produces propionate and succinate said Prof Cantrorna. These acids can change the expression of genes that are key to the pathway between the brain and the gut that helps manage the production of glucose or gluconeogenesis.
 
Beyond the possible benefits of mushrooms as a pre-biotic, Prof Cantrona said that the new study also shows more evidence that there is a close connection between diet and microbiota. “It’s pretty clear that almost any change you make to the diet, changes the microbiota,” said Prof Cantorna.
 
Although this particular study was done with lean mice, the researchers are keen to observe the reaction in obese mice and, eventually, in humans. 

 

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Be Careful with ‘Alternative’ Therapies
Due to adverse reports about modern allopathic medicines, many people are moving towards alternative therapies and healing techniques. But have you ever wondered how effective these are? The point to be noted is that almost everyone wants to make money by exploiting the fears of others. This is a sad but a bitter truth.
 
In their attempt to find a solution to their problems, people start believing in alternative therapies without bothering to verify their effectiveness. They forget that they may not be moving towards healing or getting cured, at all. People who get swayed by all the positive feedback and heaps of praise on social media about a service are often gullible. 
 
Let me narrate my own encounter with alternative therapy when I was struggling for months trying to correct a ruptured heel (it is a condition called plantar fasciitis). An ayurvedic centre in Pune, that follows a Kerala-style ayurvedic treatment, sent me on a wild goose chase for close to 65 days. The doctor's charges were nominal (Rs100 for consultation) but what is the point if the medication prescribed is useless? I spent close to Rs3,000 on different types of oils, painkillers and a diet that restricted all milk and milk products.  
 
When there were no results, despite religiously following the treatment prescribed, I approached an allopathic doctor in the neighbourhood. He scoffed at my decision and questioned me about why was I skating on thin ice by running after alternative therapies without knowing whether they would be effective or not.  Luckily for me, I was in the liminal stage of my ayurvedic treatment and so I had no reservations about dumping all those oils and painkillers and embracing allopathy. Now, two months later, I am relieved. My pain has vanished and I am in the pink of health.
 
Readers, please do not think I am undermining the alternative healing techniques. No, I am definitely not. Nor am I suggesting that allopathy has all the answers. It does not. However, I am only trying to caution—for every one therapist who is earnest and genuine, there are 10 others who make a fast buck, comfortable under the thought that they are accountable to none. 
 
Out of curiosity, I approached the same ayurvedic doctor again. He was smart as ever. He put the blame on me saying, “Madam, you are not following the diet that I prescribed. Sometimes, ayurvedic treatments may take 6-8 months to show a positive impact. I shall do one thing. I will write you one more ‘kashayam’ that is priced only at Rs850 and I am sure that this will work well for you.” Needless to add, I ran away from there as fast as I could.
 
Sound therapy, bell therapy, flower therapy, salt therapy, water therapy, fish therapy - innovations like these are not bad per se. But, when they are untested and the orientation is skewed more towards extracting money and less towards recovery, the problem begins. I have begun aerobic exercises now. I have been training for yoga under a gentleman who collects only Rs300 for a three-month course in yoga, read a lot and listen to music. I meditate whenever I have the time and I have come to believe that self-healing is the best form of healing.
 
The experience of one of my cousins with hypnotherapy in Mumbai was also not so great. These people seem to be taking money for talking to you and not ‘counselling’. They market their services very well using testimonials from a few customers to lure new prospects. After you pay through your nose, will these people even refund half of your money in case their treatment is ineffective? 
 
So, dear readers, be aware and beware. There is no need to drain your hard-earned money for these, so-called, experts who have no basis for their pricing. Often, there is a cartel and each one of them has a quid-pro-quo kind of arrangement. There is a nutritionist near the Mumbai-Pune highway who supposedly follows a 'holistic' approach. She charges Rs12,000 for a 45-minute consultation and promises that further consultation can be provided on Skype or WhatsApp. How has she arrived at this price? No idea. If her treatment fails, she will conveniently blame the patient and move on to another patient. 
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COMMENTS

Hemant Gedam

3 months ago

Hi
Good article.
I am also suffering from plantar fasciitis since many years and have consulted many doctors without any improvement.
Is it possible to provide additional details of the treatment which has relieved your heel pain?
Thanks
Hemant

REPLY

Girija Santhanam

In Reply to Hemant Gedam 3 months ago

Hello Hemant, Plantar Fascilitis is a painful condition however you can do regular cold pack/ hot pack before sleep. Gels are available in medical shops; you can refrigerate this pack and tie it on the heel area; then you can sit and watch TV serials; after 20 minutes, tie this cold pack on the other heel area; Do this regularly; Check for Vitamin D (D3), Serum calcium, Vitamin B12 deficiency; these are actually blood tests and any pathological center will do this; Then your general physician may prescribe supplements; I am still taking Vitamin D supplement every week; One advise is that don't over exert yourself while walking; I switched over to wearing soft shoes that are priced upwards of Rs 3000/-; while walking, do not rush. If you are a diabetic then do minimum walking that is needed; if you are not, then avoid strenuous exercises for a few days; Keep telling yourself that you are getting better and better every day; a good physio therapist may treat for heat treatment called IFT. You should remember that plantar fascitis is painful because of the inflammation of the nerves from the heel to the toes;
For almost three weeks, I used to keep my feet in a bucket of hot water for 20 minutes and then afterwards keep my feet in cold water for 20 minutes'; now i am regularly keeping cold pack; it is good to listen to music/ watch TV while you are doing this to avoid boredom.
Believe me, plantar fasciitis is only a temporary condition and if you take proper care, you will be healed quickly; but check the credentials of any doctor whom you visit.

Hemant Gedam

In Reply to Girija Santhanam 3 months ago

Hi Girija, Many Thanks for the reply.

archana_rahatade

3 months ago

I agree with you. I have same experience with ayurvedic treatment from one of the known brand. I have spent almost 5000 Rs. but no cure. As usual doctor blamed me for not following diet properly.

REPLY

Girija Santhanam

In Reply to archana_rahatade 3 months ago

Very sorry to know about this Archana. There are so many ayurvedic centres that have cropped up in every nook and corner; Ayurveda is in principle a good alternative therapy; but quacks and money minded practitioners have made it into a business to exploit people.

Anand Vaidya

3 months ago

Here's how you decide which one to choose: For acute illnesses (eg: need a surgery, severe pain, bleeding, infections etc) choose allopathy.
For Chronic illnesses(high BP, asthma, allergies, obesity, T2 diabetes etc), alternative med and methods (including diet/exercise/mediation) may have better treatment than pill pushers of the Big Pharma.
Use your judgement. Don't use a razor to chop down a tree.

REPLY

Girija Santhanam

In Reply to Anand Vaidya 3 months ago

Dear Anand, I agree with you. Let me share an example of a friend who took a second opinion when he had pre-diabetes like condition and he was having HbAc ie glycosolated haemoglobin of 6.8; he was taking Patanjali's drugs and juices regularly; however he admitted that he wasn't careful about his diet; this is the problem; people think by taking diabetes drugs, diabetes will be under control; but unless you supplement this with proper diet and regular exercise, controlling diabetes is going to be a challenge.
Coming back to the friend, he took second opinion from a MD in cardiology and self styled diabetes consultant (almost every MD in cardio seems to be making hay while the sun shines by calling themselves diabetes specialists). For a five minute consultation, the doctor charged Rs 800 and may to be justify his charges, he recommended my friend to double the dosage of the Metformin drug that he was taking.
Why I am writing this is because medical opinion is highly subjective; some doctors adopt a minimal approach; some are extremists in that they recommend high dosages; It is upto the patient to take care of his health and do what he feels is right; If you wish to avoid metformin, then first your blood sugar should be under control and then you can experiment with Patanjali or other drugs/nature cure; without this, the patient is putting himself under grave risk. Let us accept that diabetes is hereditary and is a life style disease; if you watch what you eat and actually count your calories, then 50% of the problem is solved then and there; self diagnosis is harmful; diagnosis under the care of a trusted medical/ alternative healing practitioner is recommended; but one thing is for sure - please don't go for hypnotherapy as it can turn counter productive if the therapist is not adequately trained.

Anand Vaidya

In Reply to Girija Santhanam 3 months ago

Madam, I agree whole heartedly with you. The "western" medical system educated doctors for whatever reasons fail in the following. My list is from actual observations during treatment:
Prescribed anti-hypertensive drugs and statins for my relative and when we checked her blood test readings , both were normal and healthy range!!!
Some of them don't even listen to the patient and ask about food/stressors/other hidden causes etc, They want to spend 3 mins max , scribble a prescription and get rid of the patient.
I have scolded one doctor for using a faulty BP measuring device (for my mother)... Ultimate!
My suggestion is , for lifestyle ailments we can't r/ should not rush to an allopathic doctor. The medicines they irresponsibly recommend will cause more harm than good. We must google, read, understand and cross question the prescription.
I am sure Dr. B.M.Hegde would agree!

Anand Vaidya

In Reply to Anand Vaidya 3 months ago

Now for small problems (cough, fever, upset stomach etc) we have standardized on a neighborhood Ayurvedic doc whose treatment with empathy and minimal pharma drugs + herbals (usually, ginger, tulsi etc based pills)
But if I were to see some one with a heart attack, I will definitely rush to ER of an hospital, no doubt

Rajnish Bahuguna

3 months ago

Same is the case with most of private big hospitals even in allopathy, they charge you exorbitantly without any logic or ask you to get operated even if you don't need. These type of people exist in all industries, not just "alternative therapies." Even the so called specialists have also been found to be "fake," so customers beware
https://timesofindia.indiatimes.com/city/mumbai/20-specialists-found-to-have-fake-degrees-80-more-under-scanner/articleshow/63635033.cms

REPLY

Girija Santhanam

In Reply to Rajnish Bahuguna 3 months ago

Rajnish, this is indeed scary; we all know about the unholy liaison between medical fraternity, pharma companies, Third party administrators and health insurance companies; if I am not mistaken, then ML has covered this in the past; we as consumers fail to look at the elephant in the room. The Hippocrates' oath has long been forgotten - so it appears considering the credibility of the medical professionals today; Doctors seem to be becoming impatient and lacking empathy; if you have built a multi speciality clinic and purchased expensive equipments, then you have to trap patients to undergo those tests whether they are needed or not. God help us in the future!

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