Managing rapid changes in the medical field
Recently, for a minor ailment in the family, for consultation and treatment, I had consulted a general practitioner, who had a medical degree, acquired six decades ago, with a wealth of experience behind him in medical practice, including including government service in a very high position. for more than six decades. After a detailed examination of pulse, chest, lungs, saturation levels, blood pressure, weight, etc. on his own using a stethoscope and associated devices, the elderly GP over 80 prescribed treatment. He being neither a specialist nor a super-specialist, depended mainly on clinical and physical results instead of passing diagnostic tests. This is however not the case with a medical specialist or super-specialist on the whole, although there are quite a number of exceptions.
Visiting a medical specialist or super-specialist and getting an appointment is a laborious process, often resulting in righteous indignation. After paying a large sum as consultation fee and waiting for long hours, tracking BP, saturation, pulse, weight, etc. checked by paramedics outside the doctor’s consultation room, the patient is allowed to enter. Although governments provide these specialist services in a few hospitals, for example in Telangana, for well-known reasons, patients still prefer private hospitals and specialist doctors. One of the reasons could be the availability of insurance-linked treatment, in case hospitalization is required, either for surgery or for medical reasons.
Except very few, many specialists rarely use stethoscope or BP or any other medical device (obviously no longer needed as in the past) on their own. Upon hearing the patient’s health problem, the specialist’s immediate response is to suggest diagnostic tests. The reports brought by the patient are not considered by some, who insist on having them redone either in their hospital or in the laboratories of their choice. Chances are that results will vary from lab to lab sometimes!
The costs of diagnostic tests are exorbitant and several times higher than the consultation fees. For example, a PET scan (Positron Emission Tomography) costs between Rs 30,000 and 40,000, an MRI (Magnetic Resonance Imaging) around Rs 15,000 and even a CT scan costs around Rs 10,000. Diagnostic services are provided mainly by private centers or made available in specialized hospitals. Although this facility is now available in public hospitals, for example in the state of Telangana, there is a need to establish diagnostic centers in the public sector, in large numbers, at an affordable price or free of charge.
The treatment of specialists begins only after the reports arrive and depends mainly on the interpretation of the pathologist and radiologist. It is the general feeling of many patients that scanned images or x-ray films are not even seen by some specialists. Some of the busy senior specialists hire an assistant physician who records all patient details, including medical reports, before seeing them. Despite all this, the best of skills, knowledge and attitude exhibited by the majority of specialists is very exemplary. But there are gaps!!! All of this is a harsh reality and a necessary evil. What is good and what is bad in this, the experts only have the answer. It is true that only technology-enabled health care would be the need of the hour.
Rapid changes in medicine and health are a welcome feature, but the other side of this change is a bit concerning and often unpleasant too. About a few decades ago, the majority of doctors preferred to stop at MBBS or at most MD or MS and used to choose either a government job or a private practice. When the patients came, from checking the pulse to all aspects of the treatment, they took care of it personally, whether it was injecting, seeing blood pressure, etc. The patient was extremely satisfied. Surgical interventions were also performed by a general surgeon. With the advent of specialist, super and multi-specialist physicians, the situation is changing. The joke is that even for the right and left parts of the body there are separate specialists.
In this context, it is worth emulating the experience of the late Dr. Y Radhakrishna Murthy (YRK), a former member of Rajya Sabha, who practiced for about six decades with only the MBBS qualification in Khammam. He could handle a variety of medical and surgical issues with just experience gained over a period and continued training. When I was writing his biography, he told me that despite the rapid changes in treatment systems in recent times, he had the satisfaction of providing the best of medical care with the facilities available at the time.
YRK was the first doctor to perform tonsil surgery and start vasectomy operations in Khammam. Some of the other surgeries he has performed include hydrocele, hernia, appendicitis, fractures, tumors, etc. which are currently being handled by specialists. He did them with no problem. The cost of the surgery was only Rs 25. There was no X-ray facility, let alone CT scan, MRI, PET scan. At a time when other doctors were hesitant to treat tetanus and tuberculosis, YRK bravely admitted them to his nursing home. He also expressed his dissatisfaction with the use of multi-drug treatment leading to resistance.
With tests available like X Ray, IVP (Intravenous Pyelography), the late Dr. KR Prasad Rao, an illustrious surgeon five decades ago, with his MS qualification, headed MGM Hospital and Kakatiya Medical College in Warangal, diagnosed ureteral calculus with non-functioning small kidney on my wife. For further confirmation, she was referred to Dr. GP Ramaiah, FRCS, a reputed surgeon from Hyderabad Fernandez Hospital with specialized interest in Kidney Disorders by his own volition. He performed a retrograde pyelography. They decided to surgically remove the ureteric stone first and wait a while given her young age (16) and do a nephrectomy later if the kidney remains non-functional. As a result, removal of ureteral stones and nephrectomy one year later was performed at MGM Hospital, Warangal.
Looking back into the past, there were times when villages had quacks in the form of RMPs who prescribed allopathic, Ayurvedic and homeopathic medicines. Fevers like flu and malaria were treated by them by giving APC tablets and a mixture of colored water and sometimes injections. For severe cases, the patient was taken to the nearby town in whatever transport was available, often an ox cart accompanied by an RMP doctor.
The days have changed and are changing rapidly. A large number of MBBS Doctors, Specialists, Super Specialists, Multi Super Specialists, Nursing Homes, Super Specialty Hospitals, Multi Super Specialty Hospitals, etc. are available in the private sector. Equally and even better than them, many of these specialized facilities are made available in the public sector like in Telangana, free of charge. A large number of Basti davakhanas and Palle Dawakhanas appeared like in Telangana. All of these provide free primary, secondary and tertiary care to patients. Several hospitals have facilities for free diagnostic tests. There is availability of qualified doctor these days everywhere in one form or another. It’s like Alwyn Toffler’s Future Shock.
While continuing to develop all kinds of hospitals, it may be desirable to create a large number of dispensaries or clinics with general practitioners (even retired ones) to provide the primary health care which a large number of people normally need. Perhaps this will go a long way in bringing back the concept of “family doctor” with a personal touch. Why not try ?
We do not need “expensive health care” tied to insurance or dominated by the gifted, but care with the philosophy of “affordability, availability, accessibility and acceptability”. The health care facility chosen by the patient is important. Although no one is interested in old-fashioned treatment methods and systems, everyone prefers personal attention and touch whenever possible. These days, that such health care is certainly absent, with a few exceptions, is the general feeling of patients. There is an urgent need to fill this gap.