DC keeps its finger on the pulse of clinical diagnosis
Right prescription: Future of the family physician
Chennai: A huge crowd of patients sits outside the clinic patiently waiting for the doctor. With too many patients, the doctor has little time to spend with each person, and in less than an hour he disperses the crowd. While a decade ago, a general physician would spend at least half an hour with each patient, clinically examining him/her from head to toe and listening to their family history, the situation has now changed drastically with doctors prescribing and relying only on test results.
While patients claim that they are subjected to unnecessary ultrasound scans and MRIs, and that they shell out huge sums of money, doctors opine differently. Renowned general physician Dr V. Gurumoorthy stresses on a thorough clinical examination.
“We can diagnose 90 per cent of diseases just by clinical examination. A detailed relevant history is needed. Inspection, palpation (using one’s hand to examine the body), percussion (tapping on a surface to determine the underlying structure), auscultation (used for the purpose of examining various systems) are all used,” says the doctor who spends at least half an hour to one hour with a patient. “Even now I see patients but not in large numbers. I attend to referral cases,” says the doctor, whose students are now renowned doctors in various specialties.
The 80-year-old doctor says his guru is Dr Prof. K.V. Thiruvengadam who has taught and trained generations of medical students for more than 56 years, and is still quite popular for his diagnosis. “It hurts me when I see an increase in the number of patients with a decrease in the quality of treatment,” he says.
Recalling an incident, Dr Gurumoorthy said that a patient approached him with a chronic headache and that he diagnosed it as stress. “But the patient was not convinced and visited another doctor who told him the same after prescribing a CT scan and MRI. The patient spent almost '7,000 only to realize that the headache was due to stress,” he said, adding that clinical medicine is a beautiful combination of art and science and has to be thoroughly enjoyed, learnt and put to practice sincerely and methodically. “Detailed history taking is very important,” he added.
Most doctors prescribe various tests, which patients often complain are unnecessary, and depending on the result, doctors usually start the treatment. Former director of medical education Dr V. Kangasabai says that doctors prescribe such tests as patients these days are not convinced unless they see the evidence.
“Patients are well informed. Earlier, if a patient suffered from fever, doctors could say that it might be due to malaria or a urinary tract information and prescribe drugs accordingly. But now patients ask us how we diagnose the fever as malaria. It is good that doctors ask patients to go for various tests to confirm the disease. Also, heart attacks and diabetes are no longer seen only in the elderly population, so doctors have to think of every other possibility,” he says.
Health care delivery is now becoming costly due to irrelevant diagnosis. We get a lot of information when we talk to patients, says Dr J.S.N. Murthy, vice-chancellor of Sri Ramachandra University, adding that even now students learn the art of clinical examination in classes.
“Doctors do not have patience these days. When we were house surgeons, we had limited resources and we were questioned when a CT scan was prescribed for a patient. Nowadays, more facilities are available and it is becoming investigation-oriented. Ultimately, only patients bear the cost of such unnecessary diagnosis,” he adds.
‘Can't say all investigations unnecessary’:
While it is alleged that doctors prescribe tests like MRI or CT scan or even mammogram as hospitals purchase equipment worth lakhs and crores and that they have to put them into use, Dr. V. Kanagasabai says, "It is not true.
There may be some doctors who do it, but we can't say all investigations prescribed are unnecessary. If doctors suggest diagnostic facilities for tests, immediately patients think labs pay them commission for referring patients and it is not so."
However, general secretary of Doctors' Association for Social Equality (DASE) Dr. G.R. Ravindranath says a majority of doctors get commission and nobody can deny this as health has become an industry and not a service. "Everything has been privatized and if a neurosurgeon or cardiologist at a corporate hospital says that he would not prescribe unnecessary tests then the person can't work there," he says.
Family physician is the need of the hour:
General physicians say that patients these days approach specialists directly and these specialists see only specifically and not holistically like them.
“The concept of a family physician is not prevalent here. A super specialist thinks from his angle, whereas a general physician thinks holistically,” says Dr K. Baraneetharan, general physician at Global Hospitals.
The general physician denies that doctors these days do not spend time with patients. “The volume of diseases has increased and so have patients. These days doctors have assistants who usually listen to patients’ history and write them down,” says the doctor.
Unlike earlier, the rapport and trust that patients had with doctors are missing these days and patients too do not have time to wait for a long period, say doctors.
( Source : dc )
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