How to Practice Medicine

MEDICAL PRACTICE – THEN AND NOW

Clinical Diagnosis versus Evidence Based Diagnosis

A Spoof

By

VIKRAM KARVE

MEDICAL PRACTICE – THEN 

THE GENERAL PRACTITIONER (GP) – CLINICAL DIAGNOSIS 

When I was a small boy living in Pune in the 1960s – if you felt sick and became ill – you called your family doctor home and he checked you up.

Every family had their own family doctor – a General Practitioner (GP) – who was like a member of the family. 

He knew all about your medical and family history and you had explicit faith in your family doctor – and you had a mutually rewarding relationship.

If you were sick – your family doctor would come home to see you.

After a thorough physical examination to diagnose what was wrong – your family doctor gave you medicines or an injection then and there.

Then – the GP asked someone to come over to his clinic to collect medicines – which were mostly mixtures of ground tablets or liquid concoctions prepared by the compounder – and – these medicines were given to you in bottles with dosages indicated by stuck paper strips.

A doctor friend told me that this approach is called Clinical Diagnosis. 

Surfing the internet – I found that clinical diagnosis is a diagnosis based on a study of the signs and symptoms of a disease (The American Heritage® Medical Dictionary 2007) – or – a diagnosis made on the basis of knowledge obtained by medical history and physical examination alone, without benefit of laboratory tests or x-ray films (Mosby's Medical Dictionary, 8th edition, 2009, Elsevier).

MEDICAL PRACTICE – NOW

THE SPECIALIST – EVIDENCE BASED DIAGNOSIS

Nowadays – SPECIALIZATION is the buzzword. 

Yes – nowadays – GPs seem to have vanished – and – you have to go to a Specialist if you fall ill. 

There no such thing as a family doctor – and – the specialist will not come and see you at home.

You have to go to his clinic or the hospital where the specialist practices and you have to wait for your turn for the specialist to see you.

Then – the specialist sends you for a series of laboratory tests – blood, urine et al.

You run around to the pathology laboratory – get the tests and investigations done – and – you report back to the specialist – who then studies the reports and prescribes medicines accordingly. 

The doctor friend told me that this is called Evidence Based Diagnosis.

In a lighter vein let me share with you a humorous story – surely apocryphal – that my doctor friend narrated to me on this subject.

CLINICAL DIAGNOSIS versus EVIDENCE BASED DIAGNOSIS

The Story of THE PET and THE VET 

A woman brought her unconscious pet parrot to a Veterinary Doctor (Vet).

The Vet physically examined the lifeless bird and told the woman that her pet parrot was dead.

The distressed woman wailed: “Are you sure my parrot is dead…?”

“Yes. I am sure. Your parrot is dead...” the Vet said.

“How can you be so sure that my parrot is dead? You did not do any tests or investigations on my parrot...” the distraught woman said.

“Madam. There is no need for any tests. I am sure that your parrot is dead...” the Vet said.

“I don’t believe you. You are just an ordinary Vet. I want to show him to some good Specialists. I want a Specialist Opinion...” the woman demanded.

The Vet nodded his head and said: “Okay...”

The Vet then turned around and left the room.

The Vet returned a few minutes later with a Dog – a black Labrador (Lab) retriever.

As the woman looked on in amazement – the Dog stood on his hind legs.

Then the Labrador Dog put his front paws on the examination table – and the Dog sniffed the Parrot from top to bottom. 

The Labrador (Lab) Dog then looked up at the Vet with sad eyes and shook his head. 

The Vet patted the Labrador Dog on the head – and the Dog went out of the room wagging his tail.

The Vet again left the room.

A few minutes the Vet returned with a Cat. 

The Cat jumped on the table.

The the Cat delicately sniffed the Parrot from head to foot. 

The Cat sat back on its haunches – shook its head and meowed softly.

The Vet lifted the Cat – and he sent the Cat out of the room.

Then the Vet looked at the woman and said: “I am sorry – but as I said earlier – your parrot is definitely dead.”

The Vet then went to his desk – and he wrote out his bill – and he gave the bill the woman.

The woman – still recovering from the grief of the death of her beloved pet parrot – was totally stunned with disbelief when she saw the bill.

“What…!!! 2000...? Two Thousand Rupees…?” the woman protested in bewilderment.

“Yes. The bill is 2000 Rupees...” the Vet said nonchalantly.

The woman was furious and she shouted at the Vet: “You are charging me Rs. 2000 just to tell me that my Parrot is dead...? This is ridiculous!”

The Vet shrugged – and he said to the woman: 

“I am sorry but it is you who wanted to show your Parrot to Specialists. 

If you had taken my word for it – my bill would have been just Rs. 50. 

But – you were not satisfied with the diagnosis of an ordinary Vet like me – and – you insisted that I refer your Parrot to Specialists and get some Tests done.

So – I got a “Specialist” Labrador (Lab) Dog to examine your Parrot – and –  the “Lab” Report cost Rs. 950 

Then – I got a “Specialist” Cat to Scan your Parrot – and – the “Cat” Scan cost Rs. 1000

That is a total of Rs. 1950 for the “Lab Report” and “Cat Scan” 

And – along with my Consultation Fees of Rs. 50 – the grand total amount is Rs. 2000...”

MORAL OF THE STORY

Long back – when I joined the Navy – our health was looked after by General Practitioners who were very competent doctors.

But even in the defence services – the trend of specialization started taking root. 

If you want good health-care – what the country requires are good GPs – but – we tend to be producing more and more specialists – many of whom seem to do the job GPs are supposed to do.

Are you one of those who believe in going only to medical specialists? 

If so – whenever you are tempted to go to a specialist for a minor ailment – do remember this story of the “Lab” Report and “Cat” Scan.

This story is about doctors – but the “moral of the story” is equally applicable universally in all professions.

VIKRAM KARVE

Copyright © Vikram Karve 
1. If you share this post, please give due credit to the author Vikram Karve
2. Please DO NOT PLAGIARIZE. Please DO NOT Cut/Copy/Paste this post
© vikram karve., all rights reserved.

Disclaimer:

1. This is a spoof, satire, pure fiction, just for fun and humor, no offence is meant to anyone, so take it with a pinch of salt and have a laugh. 

2. All Stories in this Blog are a work of fiction. Events, Places, Settings and Incidents narrated in the stories are a figment of my imagination. The characters do not exist and are purely imaginary. Any resemblance to persons, living or dead, is purely coincidental.

Copyright Notice:

No part of this Blog may be reproduced or utilized in any form or by any means, electronic or mechanical including photocopying or by any information storage and retrieval system, without permission in writing from the Blog Author Vikram Karve who holds the copyright.

Copyright © Vikram Karve (All Rights Reserved)

     

© vikram karve., all rights reserved.

 

Revised Version of My Story First Posted by me Vikram Karve in this blog "Academic and Creative Writing Journal Vikram Karve" on 03 September 2010 at url: http://karvediat.blogspot.in/2010/09/clinical-diagnosis-apocryphal-story.html  and http://karvediat.blogspot.in/2012/05/pet-and-vet.html and  http://karvediat.blogspot.in/2015/04/medical-practice-then-and-now-clinical.html

Humor in Uniform – Second Opinion

HUMOR IN UNIFORM

My Hilarious Encounters with “Fauji” Doctors – SECOND OPINION

THE MILITARY DOCTOR AND HIS CIVILIAN DOCTOR WIFE

A Spoof

By

VIKRAM KARVE

This happened around 31 years ago – in the mid 1980’s – at IAT Girinagar Pune.

I had newly arrived in station – IAT was an inter-service training establishment – but it was run in typical Army style.

During my evening walk – I saw a crowd of young student officers and families sitting on the lawns of the house of our unit Medical Officer (MO).

“So – Doc is having a party – is it...?” I shouted to them.

“No, Sir. We are waiting to see the doctor for medical treatment...” they said.

I was impressed.

I had thought that our Medical Officer (MO) was a typical “fauji” doctor.

But – I was impressed to see that he seemed to be such a good doctor – that patients were going to his house in the evening for consultation and treatment.

And – our unit Medical Officer seemed so sincere – that he had started an evening OPD at home for their convenience.

“That’s great. I did not know that our unit MO sees patients at home,” I said.

A student officer looked at me and said: “Sir – we have not come to see the unit MO. He is a useless good-for-nothing doctor. We have come to see his wife. She is an excellent doctor who works in “XXX Hospital” – the best hospital in Pune. In the evening – she does her private practice here at her home – and everyone comes to see her – of course – she charges quite a lot – but then – she is a really good doctor.”

Yes – she was a really good doctor.

Once – a young officer got a strange cough.

During his morning run – in the expansive picturesque campus – he would suddenly get a spasm of cough – so severe – that it was almost like a convulsion.

He would sit down – terminate his run – walk home – and drink water – and take rest.

For the rest of the day – he would be okay.

These fits of cough happened only in the mornings during his runs – and – while jogging in the open.

The officer reported to the unit Medical Officer (MO) in the MI Room.

On hearing the symptoms – the Army MO immediately concluded that it was Asthma – and – the unit MO referred the officer to the Specialist at Command Hospital (CH) Pune.

The officer was due for his “sea time” immediately after the course.

His fellow officers scared the shit out of the officer – by putting all sorts of fears in his mind.

They said – that if he went to the Specialist for Asthma – he would be subjected to all sorts of tests and examinations – and – the Specialists at CH would surely downgrade his Medical Category.

Now – if his Medical Category was downgraded – that would be the end of his “sea time” – and his Naval career would be badly affected.

The officer’s wife advised the officer – that before he went to the “Fauji” Specialist at the Military Hospital – it would be better if they took a “second opinion” from the doctor’s wife (the lady doctor who practiced at home).

In the evening – the worried asthma afflicted officer went to the doctor’s wife.

The doctor’s wife – the civilian lady doctor – she heard him out – and she said: “Don’t worry – it is not asthma – it is just a seasonal allergy due to pollen from the “congress grass” which is abundant on the campus. This allergy happens to some people in spring. Just stop your morning runs for a month or two. Don’t go out in the open in the mornings. You will be okay. Once it is summer – you can start your morning outdoor exercise and running again.”

“Any medicines – any treatment...?” the officer asked.

“Nothing,” said the doctor’s wife (the civilian lady doctor) – and then – she advised the officer, “if you want just add some gavati chaha (lemon grass) to boiling water when you make tea in the morning – it will act as a placebo – there are plenty of gavati chaha bushes growing wild in the campus.”

Within a few days – the officer’s cough disappeared.

And soon – the moment the season changed – the officer was absolutely fit and fine – and – he started his morning runs again.

Of course – the officer scrupulously avoided going to the unit MO in the MI Room – during the remaining part of his course. 

And – at the end of the course – fit and fine – he went for his “sea time”.

VIKRAM KARVE

Copyright © Vikram Karve 
1. If you share this post, please give due credit to the author Vikram Karve
2. Please DO NOT PLAGIARIZE. Please DO NOT Cut/Copy/Paste this post
© vikram karve., all rights reserved.

Disclaimer:

1. This story is a spoof, satire, pure fiction, just for fun and humor, no offence is meant to anyone, so take it with a pinch of salt and have a laugh. 

2. All stories in this blog are a work of fiction. Events, Places, Settings and Incidents narrated in the story are a figment of my imagination. The characters do not exist and are purely imaginary. Any resemblance to persons, living or dead, is purely coincidental.

Copyright Notice:

No part of this Blog may be reproduced or utilized in any form or by any means, electronic or mechanical including photocopying or by any information storage and retrieval system, without permission in writing from the Blog Author Vikram Karve who holds the copyright.

Copyright © Vikram Karve (All Rights Reserved)

     

© vikram karve., all rights reserved.