Dr. No…! Or Dr. Knows!

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

Advertisements

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!

Bravado or Truth!

Accept the tough situation in life and face it upfront!

The other day my niece’s husband Dr. Makarand asked me a very pertinent question. He said, “Kaka when you were going through treatment for cancer, we all could see that you were very positive during and after the treatment. Can you share with me if this was Bravado or that is what you really felt?” It was a very valid question. In the face of tough situation as the cliché goes, “Tough get Going”! It is all fine to mention clichés, make a show of not being bothered or nor showing any concern. 

Makarand’s question got my thought process going and I went back four years, to 2013 Dec 1st, when my cancer was detected. This detection was done by Dr. Sant in his clinic and set the wheels rolling. Raju was with me; when we came out from the clinic Raju said, “You don’t worry, I will drive the car.” We had taken my car. I told him, “Oh, come on! What has diagnosis got to do with my driving the car? In fact, first let us eat something as I am hungry.” Our next step was the hospital where Atul was waiting for me to get the CAT scan done, to check the extent of spread. What were the thoughts in mind, besides deciding what to eat? Honestly, I did not feel worried, afraid or did not have a question in my mind “Why me?”. In the CAT it was found that there was no spread and the growth looked local. Was I relieved. I don’t remember having any specific feeling of relief.  

It was decided to perform the biopsy on 7th December. We took a family decision that managing newly born Kittu and my cancer treatment cannot be handled together, in our regular home. We had already hired one condo next to Priya’s. We took a decision to move stuff to the new condo. Next 4/5 days we were busy moving our stuff to this condo. That week was very busy, and I did not have time to think of anything other than shifting furniture. Did I have apprehensions about the result of the biopsy? Not really because Dr. Sant was very confident that growth was cancerous. I had totally believed in his judgment and did not get unduly worried when Lab confirmation was received on 10th Dec. 

Another ten days in deciding the logistics and getting the drug from Pharma Company. Jaya and I were busy setting up the new condo, plus my work continued. When I was told that the first immunotherapy was to be given in an ICU, I did feel apprehensive. What is the reason for ICU? What can happen? What can go wrong? Somehow, I had a feeling that cancer had luckily been detected at a very early phase then why this sudden change in threat level? I asked my Onco surgeon. He said, “Pramod, this is just a precaution we are taking. Once in a blue moon some patients have reaction against the drug hence this step.” I was relieved and was back to my normal mood.  

Ignorance reduces your anxiety levels. When the cancer was detected, I was told that there would be Radiation therapy along with Immunotherapy. My lack of knowledge prepared me for a couple of radiation sittings. When we had our discussion with Radiation Oncologist, the doctor told me that there will be 32 to 34 sittings. For a moment, I was stunned. But when the doctor explained, I understood the process. He said that 1 or 2 radiations are given in case of patients who have tough cancer and need palliative treatment. He also said that when chances of overcoming the cancer are good, number of sittings are more and depend on different factors. Knowledge acquired, I was back to normal way of thinking.  

Coming back to the question asked by Makarand. Was I truly not much concerned or was it my bravado? I can safely conclude that it was not my bravado. Why was I not worried? Why do people get worried? It is natural to get worried, anxious, it is ok to get terrified also. There are some situations in life which tend make even tough people panicky! In my case, I do not know why I was not worried. Maybe I have learnt to take things in stride. Maybe my mind is such that I move on. I am a normal human and I also get anxious, worried but somehow, I never remember being afraid of a situation. Maybe I have never faced a situation which can scare me,yet. Rather than being brave or tough, I feel that I am a normal person who is little luckier than others, who was never required to face a situation where I was almost required to give up. Another possible reason could be that I am pragmatic and accept situations which are not under my control.  

Am I the person to preach people how to handle the difficult situations? Definitely not! But I can share my experience with others. Did I pray to god? No, I believe in some high-level spirit which can be called God. But I am not into prayers, since childhood. I have always seen my father doing Namaskar to God but he was never into prayers and pooja! This was imbibed in me from childhood. Other than this, I always had great support from Jaya and my children, especially during my tough phase. Positivity of the whole family including my nephews and nieces went a long way I keeping me balanced.  

Makarand, yes, I was really not afraid, nor did any of us panic! It was not bravado but overall managing the whole situation as a project, keeping emotions in control, when it was necessitated. Thank you for asking me this question which made me introspect about the tough phase in our life, it was not only my life! I have not done something great that I can advise people but I have suggestions for all who get into any tough situation; it could be illness, it could be family issues, it could be money issues. Be in it together, face the situation upfront. Acceptance is the key to fighting back. Every fight is winnable to an extent. Leave rest to Him!