THE ART OF MEDICAL PRACTICE
Clinical Diagnosis versus Evidence Based Diagnosis
Now-a-days SPECIALISATION is the buzzword.
Here is a story for all you who believe only in Specialists.
This story is about doctors but the moral of the story is equally applicable universally in all professions.
When I was a small boy living in Pune in the 1960s, if you fell 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.
After a thorough physical examination to diagnose what was wrong, your family doctor either gave you medicines or an injection there and then or he asked someone to come over to his clinic to collect medicines which were mostly mixtures of ground tablets or liquid concotions prepared by the compounder and given to you in bottles with dosages indicated by stuck paper strips.
My doctor friend tells 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).
Nowadays GPs seem to have vanished and you have to go to a specialist if you fall ill. And the specialist sends you for a series of laboratory tests – blood, urine et al – and then studies the reports and prescribes medicines accordingly.
My doctor friend tells 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.
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…?”
“Yes. I am sure. Your parrot is dead…” the vet said.
“How can you be so sure…? You haven’t done any tests or anything on my parrot…” the distraught woman 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 vet nodded his head and said, “Okay...”
He then turned around and left the room and returned a few minutes later with a dog – a black Labrador retriever.
As the woman looked on in amazement, the dog stood on his hind legs, put his front paws on the examination table and sniffed the parrot from top to bottom.
The Labrador then looked up at the vet with sad eyes and shook his head.
The vet patted the dog on the head and the Lab went out of the room wagging its tail.
A few minutes the vet returned with a cat.
The cat jumped on the table and also delicately sniffed the parrot from head to foot.
The cat sat back on its haunches, shook its head, meowed softly and the vet lifted the cat and sent it out of the room.
Then the vet looked at the woman and said, “I am sorry, but as I said, your parrot is definitely dead.”
The vet then went to his desk and wrote out his bill which he gave to 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…!!! Two Thousand Rupees…?” the woman protested in bewilderment and she said, “You are charging me Rs. 2000 just to tell me that my parrot is dead…? This is ridiculous…!”
The vet shrugged and said, “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 the Lab Report cost Rs. 950 and the Cat Scan a further Rs. 1000 so that totals Rs. 2000 …”