I will continue my story with “doctor” series as promised. I am happy and surprised that I am writing it with much less delay compared to my first doctor article which was in 2018! I believe, slowly I am getting better in completing my small projects or milestones. If that will persist, only time will tell. I mentioned in fall of doctors that I will provide some examples from personal experiences and observations around me. This is what I will cover in this article. All the examples are told as a 3rd person Johnny and his social network. Some of them are mine, while others are not, but all of them are real cases, which happened to someone. I believe it is easy this way to keep anonymity. So, without stretching the prologue further, lets get into the examples right away.
Johnny was just leaving his teenage years behind. One fine day, while doing his stretching exercise, he felt pain in his lower back. The pain was enough to stop him doing the standing touching nose to knee stretch. He went to the doctor and he got a pill and instructions to avoid exercise. He did so for a couple of months and felt that he does not feel pain anymore. He started with his exercises and realized that he cannot even reach his toes anymore. He let it go and continued with life. He was travelling around at that time and would still feel a pain in his lower back from time to time. He went again to the doctor, he got pills again. With time that muscle spasm reached to a level that it was hard to laydown or sit or standup for a long time. It was especially painful to change the position e.g. to get up after sitting for an hour would need its transition time. The daily life was hard despite popping pills in his mouth. Once on a travel he found a book on back pain. A simple book with some instructions. He followed the instructions and got better in a month. In 6 months he could play again! Why does a patient has to go through such a pain and struggle and find solutions from a random book, while all an expert would do is to write a pill? Can he go back in someway to the doctor to complain about all the suffering that he went through?
Time went by and Johnny was fine with his back. As the fate had it written, he met an accident. During the accident, he isolated his collarbone from the socket. He remained in bed for 6 weeks due to that. In the emergency ward, he had to force the doctor to check his shoulder as doctor at first just said that all is fine without even touching the arm!. Finally, it was put in place and braced. Johnny could feel that it does not feel at normal position. He went for a 2nd opinion to another expert he was recommended by the visitors coming to meet him. The doctor checked, ddid something and put the brace again. When Johnny asked, why does it not feel right, he got a reply, “Don’t worry, this is a soft joint, breaks easily and repairs easily. If anything goes wrong, we are here for you.”. Johnny could not get his head around the statement. What does that doctor mean? If after 6 months he sees that bone has connected at a wrong place, what would the doctor do? Will he break that joint again and try to put it back at the right place or what? On the other side, while it is understandable that not all joints are equally strong in the body, it does not mean that we do not try to put it back properly and just let them be!! As Johnny feared, from the 1st to 6th expert he went to, all had the same attitude. While it was clear that in a normal position the collarbone was about 1-2 cm out of its location, but during checkup, doctors will twist and turn the shoulder and arms to bring about the same protrusion in both left and right and claim, “Viola! See they are both the same now”. How can Johnny use the claim, “we are here for you”, to the fact that he got limited motion in right arm and weak muscles around that joint? Would Roger Federer or Queen of England or even a local minister for that matter get that kind of answer?
Reuters report on broken medical education system in India
Thankfully, it is not always Johnny who is in trouble. He was once on holidays and was visiting his relatives. He was meeting an uncle after a long time. Uncle told Johnny about the plight of Johnny’s aunt. She had some kind of trouble with her tongue and it needed an operation. They went to a well known hospital as they were advised to go. The doctor analyzed the problem and told them it needs an operation. As per the given time slot, operation was done, in which a part of the tongue muscle was removed. Hospital told them operation is successful and all is fine. After a couple of month, they realized the normal functions of the tongue are not coming back. Aunt cannot eat food, she cannot talk. Tongue is out of use to the extent that she cannot even control her own drool. They visited the hospital and they did some test and told them all is fine, tongue is fine, muscle has recovered and there is nothing prevented her from using her tongue for daily tasks. Uncle was so respectful of the hospital and staff, as to how kind they are and how willing they are to listen and so on. He told Johnny that all that Johnny’s aunt needs is to do exercises for the tongue, as the doctor told, she need to learn how to use that muscle again. In a side note he mentioned that doctor said, they (hospital) should have put her on the therapy to mobilize the muscle and build up to the gradual use of the muscle; just this small part they missed. After more than a year of operation and multiple visits to the hospital, all she get is to create a will to use the tongue with no real rehabilitation program behind it. And of course uncle is paying for travel and hospital visits every time they go for consultation! I mean a renowned doctor who claims to do such surgery’s on regular basis has no checklist, no standard to put people on controlled rehabilitation program to develop their muscle functions? And how can one report against such a thing, atleast to improve the situation for others, if not for your pain and suffering? How many people have knowledge, funds, will, patient and persistence to go against a big hospital?
Johnny’s friend, Mike, was an active boy, who was usually working in farms and no stranger to physical work. He would go for long walks and bike rides often, if not every other day. One day, he felt a pain in his neck during sleep. He applied some cream and thought it will go away. For a week he did that and the pain was still there. One day, during a walk through hills, he realized that one of the collarbone is out of its place. He knew from Johnny’s experience what it meant and figured that this is the root cause of his neck pain. He went to an osteopath, who gave him a massage and told him to relax his jaw muscles as he thought this is causing further stress in his body. He later visited a chiropractor, who told him not to worry as this bone can some times just come out when you are lifting your cup of tea! Mike after that session came home wondering as to what does that mean? How many people are there who isolates their collar bones while lifting their cup of tea? If they do, what is wrong with those guys and how come all those footballers are not losing it? It is not that Mike is an inactive guy and does not use his body at all to have weak muscles and he did not have a fall or did some extreme exercise. Can he take some precautions to avoid any further such happenings? Any advise from “health practitioner”?
The third-leading cause of death in US most doctors don’t want you to know about
Well, Johnny does not have just one friend, thankfully. Once he was visiting his friend Lucy. Lucy had recently moved to a big city with all fancy multi-speciality hospitals with in-house facilities and “best experts in town”. She had some problem with her sinuses. She went to visit once such popular hospital as she thought this way she is probably safer to get a better and expert advise. Johnny went with her to support. On the visit, the doctor told her that she needs an operation and it would need hospitalization for 1 day. Considering that Johnny was there, she decided to get admitted. The doctor advised Johnny not to take room in a dormitory and rather select room of 4 or less. With no idea himself of the reason, he agreed. Johnny went to administration to get the formalities of room and operation done. Administration told him that, there are no free room with 4 beds. But, they do have VIP room, which they can give for the price of single room! He asked for the price estimations. Total price for the single room was 4-5 times higher than the dormitory. What surprised him that apart from facility charges of the specialized room and dedicate support staff, the operation charges for the doctor was twice than in the dormitory. Johnny asked the administration, “why operation charges of doctor are double than dormitory? Is he going to a different type of operation in dormitory of some lower quality or what?”. Administration staff said smilingly, “No, it is the same operation. Why do you bother? You have insurance and they will pay for it!” Reluctantly, he agreed as he was leaving in 2 days and there was not enough time to find another hospital. Johnny was left wondering, who to blame? The hospital, the insurance system or the doctor? This is one thing that hospital has designed a system that abuses the insurance system. But, as a doctor, as a person who’s profession is to help, to treat patients, he can remain off the system not to advise on the financial terms. I am sure that in the evening, he would go to meet his friends and chat about how corrupt politicians are. Btw, the dormitory was only 6 beds and not that it had 50-100 beds to create a chaos.
Supplements is a big topic and huge industry. There is a lot of chaos, misconception and abuse as well. Other than just vitamins and minerals with magic Vitamin or the root of all minerals, there are herbal supplements and magic drinks as well. Most of those are sold with label, which in one or the other way would mean that it is not any kind of solution and there are no guarantees. The standard multivitamins would come with a label, “please consult your doctor, before use”. A lot of people are self-medicating themselves, just because a friend said or they read on WebMD that a certain symptom means magnesium is low. While supplements and multi-vitamins are not controlled like FDA approved medicines, but they seem to have a way to involve the formal system by mentioning, “consult your physician”. That seems to imply that doctors/health practitioners/physicians are expert on these topics. Are they really? Do they have a specialized course/subjects/topics that covers the theme of multi-vitamins, supplements and so on. As far as I am aware, no it is not a part of medical education system. Knowledge of Vitamins and minerals exists as chemical concepts here and there especially with extreme cases related to diseases e.g. Vitamin D and rickets or Folic acid and neural tube defects to list a couple. But, doctors are definitely not educated to the complex mechanism of vitamins and minerals combinations taken at ad-hoc level vs individual components as mentioned above. On top one needs to relates to the cultural and geographical variations, let alone individual variation in response to these components. As far as I am concerned by reading and watching, lectures from experts in this field, there is NOT enough knowledge/evidence on the benefits of these components, other than very well known cases. They agree also that there is a gap in the education system, but still they would say consult your physician. I understand that manufacturers this way transfer responsibility to doctors, but are doctors ready to take on the responsibility? Let’s look at an example from Johnny’s life.
Johnny went to a specialist as advised by his doctor for certain pain he was feeling. The specialist did some tests that she thought were relevant. As per her, everything is ok. Johnny asked, based on his own research, if she can perform test about Vitamin D and magnesium. She said, “No, there is no need. You are healthy and there is no need for us to meet again!”. Johnny still had pain, so he went to another expert, who looked from his perspective and said, “all is fine, you can try to take Vitamin B complex and/or try acupuncture and see if that helps!”. I mean really, just pop pills for Vitamins.. Why? Can you not do a test to check if they are high or low, before recommending? Why did I come to an “expert physician”? For how long do I need? How will I know, levels are fill and need to stop or how to check the progress? To make it special, it was off the record advise by an expert. No where he wrote down in his logs that he has advised those pills or even an accupunture!! With no luck, Johnny went on to do some tests privately. In those tests, he found that he has Vitamin D deficiency and was really low at magnesium and some other components on high or low, but related to his symptoms. He came to a specialist again and showed her the report. The specialist, kept her eye only on Vitamin D and recommended to take Vitamin D for 4 months (1 ampule per month) and to have checkup after 6 months. When Johnny checked the documentation from the company making those ampules, it said in a deficiency like this, it should be 1 ampule per week for 1st month and 1 per 2 weeks and then 1 per month. Nevertheless, he followed as suggested and went for control. Unfortunately, he came across another expert (who in fact was senior/mentor to her). Without looking at anything, he simply declares,” you are fine Johnny, go home”. When Johnny persisted and showed him the reports, he said, ” oh, these tests does not show much. One day less Vitamin and other day more Vitamin”. Seriously!!!, this is an expert view? Johnny persisted again and then expert said,” when it is really low, then Johnny should take it for 1-2 years and not just 4 months”. With that he send him away, without writing any prescription or next steps. Why did the 1st doctor gave only for 4 months and that too with very less frequency? If I am not wrong, they are tested with certain dosage to test their effectiveness. Anyhow, keeping himself positive, he went to the next one and gave her the reports. She, as well did not check the full report and ordered Vitamin D tests, which as expected came again deficient. She wrote prescription this time for twice per month for a year and then once per month. She closed the case. Johnny, in the meantime has finished his homework and showed the list of other components which are low or high and in each case relates to his symptoms. At his persistence, she saw the list and then checked the report and wrote to check all those after 6 months. If, Johnny has to do his own tests, do his own analysis, read medical documents, read chemical compositions and description of medicines, then why does he need to go to an expert and pay them? Are the experts only working to write, if they can read something in plain language in a single line on a single page? If the report comes on a multi-page document, they seems to lack the capability or will to read and relate those findings.
Doctors in India profiteering from sick patients
Let me take one more example. This time it is another friend of Johnny, lets call her Mary. Mary had started to feel some pain in her head. She got some pills at first, but that did not help. To make it a bit complex, she was also having some trouble with calcium deposits, for which she was visiting another set of doctors. Calcium deposits were so painful that she could not move her arm. From pills to massages to oil to exercise, she tried various things. One expert would say do exercise while other would say absolutely No exercise. Some would say massage is the solution, even when week after week it pains more with massage. She was going through all that, while the head situation was keeping its toll as well. She was given “relaxing” medicines, no help. She went through some other procedures, including some tests, but doctors could not say anything. Mostly, it kept coming down to stress. Slowly, it started to get worse. She is a smoker and one day she realized that she cannot smoke anymore. Every time she lit one up, she would feel like vomiting. Slowly, she started to lose control on her movements. Some expert told her that all that is happening due to some problem in her feet and if she does some exercise, it will be fine. Slowly, she started to get slow in her movements and her thoughts. Still, no progress. She reached a state, where she could not walk long without a feeling to stop and put her hand to a wall or an object. She fell couple of times. She got so fed up in a year visiting here and there with no progress, that she did not want to go to another doctor. Family was now persisting that he must get another visit. She finally went to hospital, when it was too bad and she fell again. In hospital, at first, she was told that it was depression and given some medications. That medications back fired. Another expert told her something else. At last some expert from another city found the root cause. They had to operate in one section of her brain and the very next day, she was all attentive and active person. Could move around by herself with confidence and was smiling again. Thankfully she is doing fine now. If you watch in all those TV shows about hospitals and doctors, they would keep on stating, “Patients should come early to us. They come to us when it is too late”. But the trouble is, in most cases doctors (including the system as well) are not at the state, where they can detect anything at the early state. A big reason for that is unwillingness of the expert to spent time on dotting the i’s and crossing the t’s.
Just as I finished the last paragraph, I was reminded of another related incident. Let me write down another related example about doctors and the system. Johnny was visiting a doctor with his mother. His mother had trust in this doctor as he is a really good one. While sitting and waiting, Johnny was observing what is going on. This doctor was talking to patients, taking phone calls in between, addressing his assistants and was being interrupted by ad-hoc visitors. It was clear to Johnny, that this is not a good setup at all. Then he heard the doctor telling some patient about a “good hospital”. As per him the hospital was really good because they will tell you upfront, if they can do an operation or not. They will tell you if they can do it, otherwise, they will tell you that for which risks they won’t do it and if the patient want, they can get it done somewhere else. As per this doctor, he sees this hospital staff as blunt and honest. Looking at industry from patient’s perspective, I see this hospital as a business and simply trying to keep his success rate high. It does not mean it is a good hospital, if their operations success rate is 100%. It simply means they do not take any operations, which they see could risk their reputation or ratings. Same is the case, as I mentioned in the last paragraph, when a patient comes early. Most of the doctors, for various reasons, are not equipped enough to write down a plan for the patient to avoid serious situations later on. E.g. one can easily say, its time to operate, when the person has fallen on the floor due to some brain issue or could not move his leg, because the “not so critical” discuss hernia suddenly collapsed after 8 years!!. This doctor was actually a physiotherapist. Johnny saw, that when a patient comes and tells his story, mostly the doctor won’t even move from his chair. He listens to the patient and recommends some therapy, which assistants will take care of it or he will say there is nothing wrong with you. Now, of course, it is easier to make someone feel good, if someone bend down and got a spasm in his back. Because, there is a clear situation and the “doctor” knows a clear path and he can show positive results immediately, thus improving his rating. However, if one comes with some small irritating pain, going on for years, it is better to send away that patient, as it will take too much investment or it will bring down the reputation!
This is of course not an exhaustive list. There are many more Johnny’s and like’s in the world, who are going through the suffering. For various reasons, some listed in earlier blog, the “doctor” today does not live up to that name. It is more often the case than we would like to believe. The whole world likes to go against politicians all the time as they are bad and corrupt. I mean what does an “honest politician” even means? On the other side, when we use the word doctor, it has a meaning behind it, it has expectations behind it. If it was not the case, doctors themselves won’t be fighting or being against other professionals working in healthcare industry calling themselves doctors. It is interesting that a “doctor” would fight, if a chiropractor or physiotherapist calls himself a doctor. But for a patient doctor is a person, who helps to get rid of his pain. So why not call a physiotherapist a doctor to whom a “doctor” would send the patient to get rid of his pain.
Well, there was a time there were no doctors, and now we have variety of experts and streams. We were smiling then and we are still smiling now. Someone said “a smile a day keeps the doctor away”. Does that mean we don’t smile enough now that we have so many doctors around?
Continue the series in next article.
PS: if you read the article from Reuters above, one need to be careful about reading data. The charts that Reuters used from UK General medical council, at high shows that India at top of the list of “immigrant” doctors in UK and India is also on top of the list of “sanctioned” or “bad” doctors! However, one needs to see percentages of bad doctors to get a real picture, if we are trying to judge how bad an overall system is. Compare the different picture painted by these graphs. I used latest data from their website.
Arundeep Singh A little Johnny joke