With the advent of myriad tests, everyone can be ‘made' a ‘patient' by detecting insignificant abnormalities which do not call for any intervention
“One of the first duties of the physician is to educate the masses not to take medicines.” — Sir William Osler
While the hi-tech, modern medicine has done a lot to take care of the sick, it seems it is causing injustice to the apparently healthy by over-investigating and over-treating. Extensive, needless health check-ups may reveal insignificant abnormalities in many healthy persons. With the advent of ‘total body scanning' and the myriad laboratory tests and procedures of investigation, everyone can be ‘made' a ‘patient' by detecting insignificant abnormalities which do not call for any intervention. Detection of these ‘abnormalities' causes jubilation to the technological, pharmaceutical and medical industry from the commercial point of view! Hippocrates, the ‘Father of Medicine,' should pardon me for associating medicine with the word ‘industry,' for he doesn't know what happened to medicine since he left this world in 377 BC! The present-day consternation about ‘health check-ups' is not so much about the rationale of it as about its marketing and application with ulterior motives — mostly of the murky commercial deals and monetary exploitation of patients. The erosion of standards and values in research, reporting, marketing and application of the science to humanity calls for critical comments to stem the rot.
It is shown that “to prevent one ‘stroke' we will have to treat 850 normal people unnecessarily with anti-hypertensive drugs (which are not without side effects) for well over five years.” The big business bosses have continuously been trying to reduce the “normals” (normal lower limits of blood pressure readings, blood glucose levels, etc.) through “paid research” so that many millions of normal people could be labelled as patients, which means filling their coffers! And we gullible doctors simply swallow these “scientific” reports as gospel truth, which are pumped in by their high-powered marketing strategies.
They brainwash the medical profession, and condition their brains through other unethical means. Beware the endless efforts of these industries to ‘make' new patients out of the healthy population by ‘creating' a scientific basis to change normal limits of blood sugars and blood pressure and a host of other parameters so that more of the ‘normal' population is brought into the ‘net' of diseases out of their vested interests. They even create new diseases on paper to make more money. Awareness of these abnormalities and the inescapable ‘further investigations' deprive happiness and produce ill-health due to anxiety, depression and even neurosis.
Just a few basic investigations and a thorough clinical examination will do in most of the apparently healthy individuals to detect significant problems and common diseases, or just to have the psychological satisfaction of being in good health.
It has become a fad in the higher socio-economic strata to run to specialists (not family doctors — a tribe which is almost extinct) for every trivial symptom, have needless investigations done, and get a long ‘laundry' list of drugs. Some of my patients, with great pride and satisfaction, show bulky files of periodical health check-ups and tell me that they have routine check-ups and routine medication with Aspirin, Atorvastatin, Alprazolam (the 3 ‘A's considered a panacea against heart problems !) and a host of other drugs, thinking that these compensate for all the bad lifestyle they live with. Many of them receive a premature divine call.
Meera — it is her pseudonym — had cold and headache for a week and went straight to a neurologist. He promptly ordered a CT scan of brain which revealed some age-related changes. Worried a lot after reading the ‘abnormalities' in the scan report, Meera lost appetite and started losing weight. Later, she was referred for an ENT check-up which revealed the presence of a small polyp (insignificant) in the nose. On seeing the endoscopy report, she lost the remaining appetite and got depressed. The loss of weight prompted a referral for a pulmonological check-up which included all tests from CT scan of the chest to pulmonary function tests and beyond.
Severely stressed, Meera got admitted to a huge hospital where all the specialists descended on her like eagles and took away their pound of flesh. The team included a psychiatrist to whom we doctors usually refer finally to wash of our hands. Finally, no significant abnormality could be found except the stress (doctors' induced psychological and financial stress)-induced loss of appetite and weight. The original problem of cold and headache, perhaps, subsided naturally, for “treated cold lasts for one week and untreated cold lasts for seven days!” Meera, a graduate in Arts, should consider herself lucky to get out without her abdomen or skull opened in the name of ‘evidence-based' treatment.
Pritham Bhattacharjee, Editor-at-Large of Pentasect and Founder & Chief of Wordsmith at Wordsmith Communication, while narrating incidents connected with this subject, wrote to me: “In Edinburgh, I went to register myself in National Health Service. Once all paper formalities got completed, I was told to come next week for a Health Check-up. I sincerely told the lady: “I pray to Lord that I may not need to come again after that.” The lady's brows twisted, and then I said: “Don't you think my prayer is sincere?” She understood and burst out in a laughter of understanding.”
Certain studies revealed increased morbidity in places where there are more number of doctors!
(The writer is a pulmonologist at the ‘Pay what you can' Clinic, Perundurai, Erode district, Tamil Nadu. His email ID is drtramaprasad@gmail.com)
Keywords: medical education, healthcare sector
Comments:
When I read the opening sentence from Sir William Oslers 'i could imagine the article might be something different from a columnist doctor's sermons on 'dos & do nots". Slowly my guess turned out to be true & I must confess I read the entire article in one breath. More than anything else, I realised there are one or two 'Real doctors'still left in the community when I read about Dr. Pritham Bhattacharjee's honest opinion. Again the story of Meera will speak volumes how an ordinary person becomes gullible in the name of advanced state- of- the art health checks ! I recall an elderly doctor saying that the ideal method is by talking with the patient face to face possibly for an hour & by seeing the pulse, but seldom follow it. And this is the first time I have heard a doctor alerting a laymen on the authenticity of the modern clynical tests .Dr. Ramaprasad deserves our wholehearted praise for his frankness thus leaving a post script 'et tu Brute' The Hindu equally is to be praised !
Dear Dr., with your permission i am sharing this article on my Facebook.I find this article has been written straight from your heart.I am not sure how the Doctor population at Erode or Perundurai would view this article. Sir i like to salute you for your boldness.
Hi, I do accept with Dr.Prasad regarding the unnecessary medical check ups. One of the reason I think is the percentage of kick backs on the bill amount the doctors gets from the diagnostic centers which are enormous. Today in urban areas most of the IT people are insured, once the IT person goes to a hospital and if the doctor knows that he has insurance, they start writing for more diagnostic tests. It's sad this holy profession is becoming multi-source money minting business.
Thank you Gopalan. I appreciate your citation of a doctor's opinion about the value of interacting with the patient more. In fact patient listening to the patient itself often gives a reasonably accurate diagnosis. Prof. B.M. Hegde wrote: "... Modern medicine has been riding piggyback on technology. To compound the problem the manufacturers of technological and pharmaceutical products have been spending billions of dollars to sell ideas to doctors from day one in the medical school till they die ..." The young brains are so much impregnated with ideas that a young doctor in a primary health centre in India laments that he cannot do anything here without the brain scan facility for treating head aches ! In most cases what the head aches require are a few pills and a little common sense, not ideas of top-heavy academic approach which is not without hazards, let alone the staggering bills.
Thank you Dr. for the article. I agree with Gopalan's comment yes there are real doctors still left in the community... Few of them demonstrates the way they live.. I have Dr.Ramprasad as one of real Dr along with his friend Mr. Sivanna. I thank God for having them known in life. Thanks much Dr. for making an effort to bring your practical knowledge to the world. I shall request your permission to have this published on the facebook too.... let e-world benefits as well... thanks again.. Wish you all happy pongal and wonderful year ahead...
Very true and i agree to this. This is to be read by every individual no matter how healthy one is..
My initial comment to this, is that Dr. is absolutely true while pointing out that patient in this new age should actually be ready to undergo serious dent on his pocket and mind in order to treat his aliment which at times is illusion. In the same breath I would also like to second what Gopalan said "real doctors are still left in the commuinty". There are two aspects to this: one is overinformed patient . Since access to internet has taken a shape of basic human right you are getting much more information than you actually require as a result everyone has become an expert which triggers people to undergo such unncessary tests. Second aspect is obviously tricky business tactics coming in the medicine world at all levels.
Another question is how strongly you can decide for yourself and not get lured. This statement is actually valid at all sales counter be it offline/online or in this case the doc's shop. You need to extract what he offers while refraining from what he wants to sell.
I also agree with u doctor.Many doctors have forgotten ethics only very few like u are still in their field to give their helping hands to the public.Defnitally we can hope that more masses will join u in future to
treat patients as their family members with extra care there by following the code of ethics as a doctor and also as a human being.For this purpose we request u to write more articles to open the eyes of young doctors and future doctors.
Alaa! I pray that this should be the way doctors to be and set an example for the future generation to look after themselves. Enjoy life by going around walking, cycling and improving health instead of just sitting before the idiot box or computers. Let us think of the article as a message given beautifully by a person concerned about humanity and mankind.
Thank you Dr.RamaPrasad. I have already shared your article in my page without your permission.(actually i read in paper... then particularly i search for it and shared in my page). While seeing your comment again is more impressive to see Excellent Service minded Doctor are there....Really, Doctors - only a few will have this much courage to reveal the truth...so many may feel at mind but they won't come out frank...Those patient with chronic ailments with common sense and interest, they can easily understand by experience(symtoms and pathology) and also gaining much knowledge about the disease & also about medicines. I am one such example/case, b'cos of my Doctor just like you and blessed to be in a nice hand. Really happy to see people like you Nowadays...Thank you very much Doctor!!!
Very few doctors like Dr.Prasad are in the world. Very glad and happy for having known him in my life. GOD BLESS for your service doctor.
Great article! Thanks to both The Hindu and the doctor. Almost everyone would like to be under the care of doctors such as Dr.Rama Prasad. Unfortunately, not all of us can go to Erode every time. How do we go about identifying and mapping out such right-minded doctors, in the places where we live?
Sometime back, I went to a doctor after losing sleep for nights over a significant pain in my left breast. Thanks to the free flow of abundant information and self-proclaimed layman experts on the internet, I was convinced that I had breast cancer...well, considering I am just 23! The doctor, a young woman, smiled at me, did a perfunctory check and told me that pain was not as bad as we make out
to be. I was unconvinced and angry. I was scared that she was negligent.
Well, that was 4 months back. The pain slowly subsided. Today, I am glad she did what she did though she had all the chance to use it to make a lot of cash
It has now become fashionable to resort to never ending tests on patients, and I am not in a position to blame them as well, considering the impending cases against them as per the Provisions in the Consumer Protection Act for medical negligence. In my own case, some four decades back, I was suffering from continuous caugh, and a doctor after an xray, suggested a medicine for a disease, that caused a big setback to me. My nephew, who was undergoing training as a senior house surgeon, took me to the cmc hospital at Vellore for an expert opinion and there I was subjected to several tests. Being a doctors relative, the hospital received a VERY NOMINAL PAYMENT for the tests, and the senior professor Advised me to take ATROMID S for three months and I had no complaints later. My nephew told me then, that these tests were done to exclude certain diseases, and the doctors opinion after the first xray was wrong.A clarification from my experience.
Astonishment writ large on my face when i read your open statement. Sir, we are in the era of commercial. Build wealth on others health is the policy. Even god can not save.Whwn we compare with other fields, it is negligible.Knives are out and criticism mounts, if a pharma marketing man fails to promote in anyway.Oherwise he has to face the hurtful words, damaging comments, unfair criticisms, malacious mudslinging and insulting gestures and all provocative acts. anyhow you won our respect with you greatness and won our love with your goodness.
Dear Doctor,: The article that you have written on Hindu, must be read by everyone and they must understand " Why they must go for health check ups ?" and What is their real problem? " . As mentioned rightly, People straightly go to specialists for each and every small problem and they are happy and proud to say that they have been admitted in big hospital for open heart surgery and they go for routine checkups for sugar and pressure. Very few doctors like you point out what is going on with boldness. Thanks for your eye-opening article on Helath check-ups and I wish many people should benefit after reading this article.
When the new age doctors are produced by the self financing colleges the common man is suffering from these useless and futile test
The author being a medical professional would have have been much more authnetic in his data.His quote about need to treat 850 patients for 5 years,is certainly less than that. If health check up's are not requires how we can diagnose diabetes which is totally asymptomatic for many years.How we can diagnose breast cancer, cervical cancer, bowel cancer etc. at a stage it is curable. I think scientific world should have a thorough and sound discussion before advising health check up for a particular country. It may not be valid to treat blood sugar for an African country which can't even feed their population. But at the same time it may make sense to control B.P.in all diabetic population in India as it is well known to prevent complications.It may sound sense to treat all hypertensives if they belong to Corporates in U.S.In India with 2 to 3 different sets of population and 3 to 4 differrent level of healthcare,health check up can't be uniform.
Many would have encountered the stiff resistance posed by staff of most "Modern" & Specialised hospitals, to "Leaving Against Medical Advice" (LAMA)by a hopeless patient trailing for weeks as a vegetable on Life Support. We faced an extremely painful time seeing a family member - himself a doctor - on life support suffer for weeks. He could not communicate but his disapproval of the goings-on was obvious by his puckered brows and shivering from constant administering of intravenous fluids. The "Specialized Team" simply kept increasing the dosage of 'Dopamine' and recording the outcomes, practically using him for experiment. Braving some opinions in the family, when we decided for 'LAMA', they tried everything from specious reason to brute intimidation and shaming ("Would you do that to your loved one?" etc.) in convincing us to leave our patient in sheer pain under their insensitive endeavours. Wheeling the stretcher away from the "life support" after LAMA, we saw him die peacefully.
Fantastic article.It clearly shows that we have to pay the bulk of our salary for normal consultation. Thanks, to Dr.ramaprasad. It is axiomatic that health expenses exceeding the wealth of common man. I agree it,sir. Thank you again.
I experienced similar nightmares when my son fell sick years back in Indonesia. He was hospitalized for almost 20 days for frequent vomitting. When my little son said, 'head ache', the doctor promptly asked for a head scan. After many such tests, I was fed up and moved my son to another hospital. I requested the doctor there, just on hunch, that no medicine be given to my son for a couple of days. On the second day, after 3 weeks, my son said he was hungry. We gave him a little 'rasam sadham' - he didn't vomit! Obviously, the medicines themselves became the cause for his vomitting! On the third day, the junior doctor who was attending on my son said, "take him home as the hospital environment might make him sick". Again, in Madras too, we saw the hospitals fleecing the patients with unnecessary tests. God, help us from corporate hospitals and unscrupulous doctors. "Manavi Amaidhavellam Iraivan...", said Kannadasan. This could very well apply to "Doctor Amaidhavellam...."!
I wish to narrate my experiences with a reputed specialist in Chennai.He is a renowned ENT expert. When I visited his place along with my son,one junior doctor examined him and prescribed a battery of tests to be carried out in the laboratory attached to the clinic and the tests varied from blood test to X-Ray etc. Then we were asked to meet another doctor senior to first one. He added
few more tests.We paid the stipulated fees and completed them and it took more than three hours. With the results with us, we were to meet the expert in the afternoon. Eventually, we met him. He never bothered about the reports and did not even glance at them but asked us whether we have completed the scan. As his assistants have not prescribed the test, we could only give a negative reply. He then flared up and ordered us to go out and come another day with the scan-report.We were taken aback and returned home dejected, incurring expenses unwanted and waste of one day in his clinic.
My wife had an appointment with a gastroentrologist who has a lab attached to his clinic. He prescribed a battery of tests including X-Ray and E.C.G. We were perplexed as to the role of X-Ray and E.C.G. which may be required only when a surgery is to be attempted. But we could not protest as the expert himself has suggested them. We meekly paid the fees for the tests and carried out all but one.The expert completed the examination of the patient and suggested a line of treatment. He did so without the E.C.G report, as on that particular day the person in-charge of the test was absent! Is it not clear that it is not needed for the examination of the patient and to suggest the line of treatment? The suggestion of E.C.G is to get a return for the investment of the required equipments and the salary of lab-technician.
First of all my prayers to the Lord to bless our country and the world with more and more Dr. Rama Prasads! Secondly, it is my sincere feeling, based on my long experience (nearing 80 years),that it is of utmost importance to live with a general feeling of 'good health', without the psychological burden of the negative sides of the so- called exhaustive tests so often prescribed by the some experts. After all, the deep power of mind over body is so great that the very thought, deep in the mind, actually materializes. It is really unfortunate, in a world full of most advanced medical science, the negative sides take its toll just due to human avariciousness. In this context, I believe, alternate medicines could help us a great deal in that there are treatment systems based on 'energy', helping us to get over based on our positive strengths.
Dr. Ramprasad,
It was an excellent article coming straight from an authoritative source. The source of the problem is the huge fee for undergoing a medical course. Every one is concerned with the Return On Investment. If we want to have good quality doctors, it is necessary that medical education should be available to the deserving (those that really care for other individuals) and not so wealthy candidates. As a person who has avoided taking medicine and getting seriously involved with the doctors by proper diet and sleeping and exercising habits, it appears to me that importance should be given more to prevention than treatment.
The factors that contribute to ill health are gross commercialism in medicine industry and its propaganda mechanism, unabashed adulteration of food items, social factors that place strain on a healthy living style that compel the members of the society to submit themselves to an unhealthy living style. They include all programs that compel
Doctor, the article is very nice and a valuable one. You are a boon to the mankind.As far as my knowledge is concerned no doctor is running a clinic "Pay what you can - Clinic ". Many doctors are not able to make a good diagonosis with respect to a patient. They prescribe costly medicines which in turn give more side-effects. People also have little tolerance when they are affected by small problems. Immunity is going down. I wish a happy and long life, sir, to serve the people.
Kudos to Dr. Rama Prasad for his thought provoking article which is an eye-opener for all. I recollect having a chat with the auditors (who are one of the well known CA firm in chennai) of a well repute hospital in chennai, who, in a reply to a query, mentioned that it is true that the doctor advises the patient to undergo several tests in order to diagonise the problem and they do not want to take any chance which some times patients may feel unnecessary. He further justified it by saying that accurate diagonsis is very much essential for the line of treatment and cure. Here, we feel the need of a family doctor who knows the background of the patient very well and can act as per his advise. It is a long way to go awakening the mass about dos and don'ts as pointed out by Mr. Gopalan. Article like this from an expert on the field will enable us to move an inch foward in this direction.
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