Wednesday, January 10, 2018

The Principles and Practice of Medicine – Clinical Diagnosis versus Evidence Based Diagnosis

Clinical Diagnosis versus Evidence Based Diagnosis
A Fictional Spoof



When I was a small boy living in Pune in the 1960 if you felt sick and became ill  you called your family doctor to your 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
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  SPECIALIZATION is the buzzword. 

Yes – nowadays  General Practitioners (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.


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 dont 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...”


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.

Copyright © Vikram Karve 
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© vikram karve., all rights reserved.

1. This is a fictional 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.

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