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Updated: June 16, 2013 11:48 IST

‘Clinical diagnosis a dying art’

  • Saranya Palaniappan
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Paediatrician K. Manonmani
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Paediatrician K. Manonmani

The art of clinical diagnosis is fading fast. Modern day doctors rely more on state-of-the art diagnostic facility than on trusting in the time-tested method of touching the patient to identify the problem, says K. Manonmani, the earliest of Coimbatore’s paediatricians. Recalling her practice as a paediatrician and Coimbatore’s development into a healthcare centre, Dr. Manonmani explains that clinical diagnosis involves learning the medical history and thorough physical examination of the patient. Trusting the sensory organs of a practitioner — observation, olfaction (smell), auscultation (sound), palpation (touch) and verbal questioning — is the basis for any treatment. With the advent of cutting edge laboratory diagnostic methods, this essential first step of clinical diagnosis is omitted.

“Close observation of the child for a few minutes is enough to locate the problem,” she says. Most doctors today seldom take the effort to look for the glaring symptoms in patients.

Dr. Manonmani compared the past with the present after the release of her autobiography Amballuril Irundhi America Varai (from her village Amballur, near Jolarpet, to her higher education in medicine in the U.S.)

The paediatrician recalled how she was commended at the University of Chicago, when she clinically diagnosed an African child of enteric (typhoid) fever in the 1950s. “It was simple, I looked at the child, (her) coated tongue, high fever, toxic appearance, liver and spleen enlargement, it was evident, (it was) enteric fever, even a third year medico could diagnose it.”

She says the four-and-a-half-feet-long clinical examination bed is her intensive care unit in her nursing home. She diagnoses children and only if the case warrants she refers them to hospitals for laboratory tests.

She says doctors, especially paediatricians, should know when and where to draw the line. Just as diagnosis is important, so is the next step of effective treatment. Referring patients to a super specialist as the case demands is important in saving lives.

M. Allavudeen, Founder, The Blood Foundation, says that Dr. Manonmani was the first AB Paediatrics (American Board) certified doctor in the city and also the first one to set up a nursing home on Cowley Brown Road (in November 1958) that is now teeming with hospitals.

A paediatrician to three generations to many families, she says the 1950s was the age of talismans and conjurers to cure diseases for many in Coimbatore. Allopathy was not a preferred science of medicine. Patients were sceptical of trusting doctors. Because of scarcity of doctors in their areas, patients from Salem, Palakkad, and Kozhikode would travel down for consultation.

Sitting behind a table adorned with yellowing photographs of children of various age groups, the 87-year-old cheerful veteran says: “I love my work! I love my children! This is what keeps me going even at this age.” As a paediatrician who has treated about 10 lakh children, she believes, paediatrics does not just involve treating children, but the holistic grooming of the child to be a better adult.

She adds the city today has grown to be an eminent medical hub,

“Within a five mile radius, you can meet almost every specialist doctor there is in the field of medicine.”

But she laments that the rapport between the doctor and the patient is missing. She believes empathy instils that assurance in the mind of the patients when they step in during dire situations.

At the release of the autobiography, B.K. Krishnaraj Vanavarayar, Chairman of Bharatiya Vidya Bhavan's Coimbatore Kendra, praised her for being an exception in an era of corporatisation of healthcare. G. Bakthavathsalam, Chairman of KG Hospital, lauded her achievements. The others who felicitated her included N.V Nagasubramaniam, Trustee, Siruthuli and Parveen Sultana, Tamil scholar.

clinical examination is extinct with the demise of medical ethics.
Corporatization is the major culprit. Added to this, commercialization
not only of medical profession but medical education as well. Rather a
syndicate involving doctors, pharma companies and insurance companies--
all with the blessings of political patronage--share the blame.
As for Dr. Manonmani, she has remained steadfast in following clinical
examination and recommending some beneficial traditional practices like
oil bath; see how massage has taken the center-stage in integrated
approach health care. Let us salute her for the genuine dedication.

from:  kaliappan
Posted on: Jun 17, 2013 at 19:28 IST

It is a very good and informative article which actually opens up the
true picture to the general masses. Doctors nowadays are very gadget
inclined, from the moment you step into the Doctors room they listen
to all the problems that you face, and keep on typing with their eyes
glued to the computer screen. Once, you ended the listing of problems,
there comes a print out from the Doctors printer asking you to collect
the medicine and also he places a stamp of seal on it and also signs.
There are cases of Doctors who opt for Computerized Signature or some
prescriptions where no signatures are required even. Thats the end of
the consultation with the Doctor and if you as a patient sound more
fearful or afraid in a tone, the Doctor will just refer you to their
in-house Diagnostic facility to get certain parameters checked. For
certain tests, you must abstain from eating or drinking anything for
12 hrs in prior.

What we need is the human touch! Which is missing now.

from:  Ram
Posted on: Jun 17, 2013 at 13:00 IST

I always have great respect for Dr. who practices such ethical medical practices & I always prefer to take my child to only to those Dr who examines as Dr Manonmani does. These Dr practice medicine with certain ethic & their passion for their profession soothes the patient when they need the most. I pray & wish all happines for these kinds of Dr.

from:  Velmurugan Venkatarathinam
Posted on: Jun 17, 2013 at 09:12 IST

A Doctor with human touch is worth 100s times more than the results of a
lab report. Hats off to Dr.Manonmani for her years of tireless service &
care to Coimbatore's citizens.

from:  Amar Asher
Posted on: Jun 16, 2013 at 14:29 IST
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