Dr. No…! Or Dr. Knows!

Doctors are Professionals like everyone else; they are experts but make same errors like everyone else!

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Whenever there is a discussion taking place about medical field, most of the reactions are, “These guys always cheat!” It is like a popular phrase in not so rich a country like India, “All business people are profit mongering thieves!” This sentence is contradictory. Business is an activity of making one’s living or making money by producing or buying and selling products (goods and services). The definition clearly states that it is an activity for making money. It is also said that doing a job is noble thing to do but we forget that when we do a job, we do it for someone who is doing business!

This discussion came about during a chitchat at home where five of the family members were doctors. Subject for discussion was basically how much is the right fee for medical advice, surgery, tests etc. Tests performed are standard procedures where almost identical methods are used for evaluation. The only difference could be a little more automation and sophistication of equipment. So, fees here should be uniform. But ultimately charges are market driven. Consultation and surgery fees will differ as these are dependent on individual skills and expertise.

A doctor friend of mine bought a modern computerized x ray machine. I asked him why did he buy this expensive machine. His reply was very different and interesting. He is my age. He said, “Pramod what is your opinion about my buying this machine.” I said, “Fantastic! Now you will be able to judge patient’s problems better!” His establishment is in the older part of our city where rates for services are generally inexpensive. He told me, “You are one of the very few who has appreciated my going with latest technology, most said what is use if you are not going charge fancy rates.” His further comment was most interesting. He said, “Pramod, consider this as my Mercedes! I would rather move around in a Wagon R as roads in this area are small and congested. I enjoy using this modern equipment, as it helps me improve my diagnosis.”

Among all the pathy’s, we have to accept a fact that only in Allopathy, a lot of research is taking place. All this research is sponsored by pharma companies, who else will do it? It is the business of pharma companies to find new drugs which help improve treatment and rate of cure. Fifty years back, when cancer was detected, death was imminent. There was no chance of cure. This was happening because the equipment of those days, knowledge of doctors, quality of drugs created a situation where it was always too late! But now all these things have improved so much that detection is early, equipment and drugs are better and so is knowledge of doctors. This has resulted in improving cure rate tremendously. When research is done a lot of money is invested. The companies try to get ROI as early as possible (it makes business sense) but when they get competition the prices of new drugs or equipment start tapering off fast. The pharma companies are not thieves; they are investing a lot of money for betterment of themselves and also of the mankind. It is duty of pharma companies to be profitable on behalf of the share holders as they are not a charity organization.

I am not saying that all the pharma companies are saints and there are bound to be black sheep. But this is true in all fields and in all pathy’s. It’s human nature to cheat but this % is generally similar everywhere. Also, like in every field there are checks and balances. There are organizations and associations which track malpractice. I will give you an example. Years back one of the giant pharma company’s sales guy met a doctor in Harvard Medical School. He suggested to the doctor, that if the doctor prescribed certain drugs to patients, they would pay US $ 5000/ month. The doctor promptly reported this offer to his management. There was a court case and the pharma company was fined US $ 940/ million! This still does not mean that such things are not happening but these are not as rampant as they are said to happen.

There is another theory. The threshold values of BP, Diabetes, Cholesterol are changed frequently to suit the pharma companies. This is done with the help of famous doctors. During last fifty years computerization has helped medical field as it has helped all other fields too! These threshold values are not absolute values. Medical fraternity decides this based on the study of large number of patients over a large period of time. Finally, they average it out. What computerization has done is that collecting data and processing it has become extremely accurate and fast. Previously it was taking maybe 30 to 40 years to analyze changes due to manual methods, now this is done every 10 to 15 years! Hence, we notice these changes introduced, as the changes are more frequent! Another reason for this is that in the modern world of internet, news and information spreads really fast!

The fees charged by doctors, medicines prescribed by them, methods followed by them are based on their knowledge and experience; obviously the fees are market driven too! We hear the stories about doctor A squeezes the patients but doctor B does not. The fees charged by these professionals are absolutely market driven. Do you know what fees are charged by Supreme court lawyers? Sometimes these are in lacs per day. I know of one patent attorney who charges about 20 k per hour! Heart Surgeons charge in lacs for bypass surgeries.

Now a new trend has started in medical field about which we all need to be careful. Dental technicians now start their own clinics and charge 1/5 th of the fees charged by the dentists. Many of their patients end up, going to real dentist after wasting money and sometimes with incorrect treatment.  Dieticians suggest diets to people sometimes without knowing medical history of patients. When I said this during a discussion, one of my friends was angry. He said, “Doctors have no clue about diets!” I asked him, “What clue do dieticians have about medical side of the person?” There are certain orthopedic technicians who start their own practice. Physiotherapists have started their own practice. One person has ten bed facility to give traction. I know of someone who has taken 40 plus traction sessions of one hour each, from this person, without medical advice. Traction is suggested by Orthopedic Surgeons based on certain criteria. Many patients take treatment from Physiotherapists without even taking advice from Orthopedic Surgeons. Patients go by treatments suggested by non doctors!

I am not saying that everything is hunky dory in the medical field. Major errors do happen even in case of celebrities. Hema Malini’s mother was operated upon right leg while she had problem on her left leg. That too in a hospital in New York. Mistakes and goof ups are part and parcel of this field. If you want to know first-hand, how things do go wrong, read a book by Dr. Atul Gavande, “Checklist Manifesto”! Atul is well-known Indian born surgeon who lives in America. Dentists have told me patients come to them after being treated by other doctors where they have undergone root canal treatment. On re checking they have found that the cheats had never performed root canal!

I will round up with a very interesting story told to me by my Daughter Dr. Priya. She is a pediatric dentist. An eight-month old baby was brought to her. The parents said that the baby had a gold tooth, yes Gold Tooth! 3 to 4 other dentists had already seen the baby and had declared that this gold tooth must be removed and can be done only under general anesthesia.  Parents naturally did not want treatment under anesthesia. Priya checked the baby and used a small tool to check the “gold tooth”. She just gave a small jerk and out came the gold tooth! Well it was an ear piece which the baby’s mother had lost, stuck in the baby’s mouth. Time taken ten seconds, anesthesia not needed, fees 0.00 rupees!

Friends, select your doctor in such a way that you get a great treatment if needed. And Yes! Don’t be scared, there are goof ups as in any field but % of cheats is also similar to any other field!

Diet! Don’t repair, if it ain’t broken!

Don’t fiddle around with your body if it is not needed!

Don’t repair, if it ain’t broken! This is a statement that needs to be uttered many times in our life! Internet and Google Baba have made it easy for people to understand the stuff and get information about almost anything. This also makes human race suddenly “smart and intelligent”! Selecting people for Nobel prizes is going to be tough in future as there are millions of people who seem be experts on almost all the subjects under the Sun!  

 

maharashtrian-full-meal

This thought came to my mind as I took part in a discussion on a WhatsApp group. Except me probably most knew a lot more on the subject of dieting! Majority had experience of 2 to 6 months on the subject. They said the diet A is a fantastic diet and works wonders. There were of course some hidden gems who did not take part in the discussion. I am not talking about any specific diet, its pros and cons! Its advantages and disadvantages! But above image which shows typical Maharashtrian square meal, if followed regularly, will ensure that no special dieting is required. We are a group of people around the age of 70. Some of us are thin and few others are plump, but only two are obese; some are fit and others are not so fit! I don’t know the actual figures but my assumption is that at least 50% from our group have some medical issue or the other, or maybe they have a history of some major health problem from the past. My judgment is that 10 to15% are lucky enough to have remained successfully free of major health issues.  

There are health experts or maybe the diet experts. Some are doctors and most are non-doctors. From what I read, majority of these are not from medical background. I had my basic question during the discussion. Who should diet? What is the age at which we should start this new regime? Under whose guidance should we start the diet? Suppose someone has diabetes issue, then should that person follow a diet which says that you must eat every 8 hours and the eating time should be not more than 55 minutes at a time? Suppose one is required to take diabetes medication three to four times a day, then it is an obvious no no! To me a majority from the group will be ineligible. Then why is it that people want to start something new, which can have effect on their health directly? Is it only for weight loss? Or is it for something else too? Is this something about novelty because people have too much time on hand? The people who have started this diet, to my knowledge, did not appear to have any weight issue.  My worry is that at our age, our body looks fit and may have dormant problems, waiting to happen hence we should be careful when start something new, and unproven method. It is claimed that a diet eliminates diabetes tablets. What is the issue if you are required to take a couple of tablets a day? Heavens are not going to fall on you!

As against this some people seriously need to do something about their weight, classic case was that of Anant Ambani. He lost 108 kgs in 18 months by natural process. https://www.indiatimes.com/health/buzz/here-s-the-secret-behind-anant-ambani-s-stunning-weight-loss-253270.html 

Of course, later on a well-known diet expert was declared to be his advisor, which was untrue. I am sure Anant must have followed a very strict regimen under medical guidance. His was a classic case where drastic things were needed under medical guidance.  

We need to understand something. Doctors are also people like you and me; they are also likely to make errors. Dieticians are not our regular doctors; how will they know about individual medical issues and about our body? I will give you an example of how tricky the situation is. I came to know about a person who had a medical issue, called vertigo. He is elder to me by about six years and lives abroad. When the vertigo attack comes, the person feels blank, dizzy, faint and gets vomiting bout for about ½ hour. Tablet prescribed to him can then be taken, once he stabilizes. I asked a question to known doctors in Pune, most said that he should stop driving, a couple of them said, no comments! But the treating doctors have told him to continue driving! (60 miles an hour?) If there is so much difference of opinion among the doctors on a serious health condition, should we start something new, as yet unproven, at the age of 70?  

To my understanding, at the age of around 70 our body has taken a lot of beating; under Indian conditions all this group is “driving on reserve tank”, using two-wheeler terminology. Average life expectancy in India is 65 years! Why not enjoy bonus life unless someone’s idea of enjoying life is going on a diet, as yet unproven! Try not to become a guinea pig, nobody is forcing you. During the discussion on WhatsApp group, a friend Sudhakar said, he feels pangs of hunger in the early morning phase. Then why? Why not enjoy your early morning chai, omelet, or fruit or whatever you eat. I am not aware if he has any specific health issue. I am sure that he is smart enough and won’t start something different if he has some health issues.  

I am aware of another diet being strongly followed in Pune. It is does not talk about timings for eating food, it says eat moderately every 2/3 hours. But the diet suggested by that expert is very much different than what we normally eat and drink! It starts with a smoothie made up of Pudina and different condiments. It suggests Jowar bread instead of Wheat bread and so on! Now at this stage of life, our eating habits are so much entrenched in us, that the followers of this diet, talk only about diet when they meet; they miss their “normal” food so much. Their socialization has come to zero. For eight hour wala diet, the socialization must have been  drastically cut down because if you are invited at different time, than your meal time,  for a drink and/or food, what do you do? Your hosts will not know that you have skipped the meal,  if there is a large crowd present for the party, but if you are invited in a small group/individually or during an office business meeting or during holiday travel how do you handle it!

There are other aspects also. Some of these people, charge you for treatment,  latest famous treatment is based on videos on internet. No consultation fee, no direct interaction with the expert- correct me if I am wrong! Another person, charges Rs.1.5/ lacs for a 5-day session in a Darjeeling resort. About others charge, I do not know. It’s about your need for a treatment, or about how much proven it is. Or maybe the expensive treatments give you bragging rights!

It reminds me of a famous fish treatment in Hyderabad; it is said that it cured asthma. What is done is that a family, who did this social work free, had a recipe for a potion! This potion they would stuff inside some small fish. This fish was supposed to be gulped (more pushed down your throat) and not chewed. I met a friend of mine after quite a few years. I was trying to fix up a time for dinner with him. But he said that he to go to Hyderabad for this treatment. He was quite gung ho and said that it was helping him to cure his asthma. I said, “How do you know it is helping you?” He said, “Oh! I go to Hyderabad every year for the treatment!” Every year? 

Something fishy!