Doctor Vs High-tech Gadgets in Medicare.

For a patient suffering from some disease, what is more important – a good doctor or a set of modern high-tech equipments for him to get the best possible treatment? As in most such matters a judicious combination of both would be ideal. Let us try and analyze to see what is in the best interest of the patient.

Clinical Diagnosis was the most important pre requisite to start any kind of suitable treatment based on precise diagnosis. But how to make a correct diagnosis?

Making a Diagnosis – the old method:

The “old” teaching was that the doctor/clinician, as he was otherwise called was expected to make a systematic and detailed examination of the patient. He was expected to spend lots of time talking to the patient, listening to his “history”, so much so “history taking” was considered an important pre requisite before starting a “physical” examination.
The “physical” examination had to be detailed, systematic and methodical and followed by some simple so called clinical “tests” like a per rectal or vaginal examination. The physical examination consisted of steps like ‘inspection”, “palpation”, “percussion” and “auscultation” in that order. Eyes most, ears and hands next and tongue not at all was the advice given by our teachers. After this detailed “Clinical Examination” the doctor/clinician should be in a position to conclude tentatively as to where is the disease? and what is the disease? This is otherwise called as Diagnosis, which is the precise condition or disease that his patient is suspected to be suffering from. Quite often, the clinician cannot precisely conclude what is the diagnosis, but will have the list of possible diagnoses. The most probable among them is the “Clinical Diagnosis” and other possibilities are called as “Differential Diagnosis”.

Modern Gadgets/Equipments for Diagnosis & Treatment:

With “advances” in medical science it is now possible to diagnose a “brain tumour” by simply ordering a CT scan of the head in a patient suffering from headache. It is possible to diagnose Cancer of the Liver, pancreas and many other organs by doing a CT scan and/or MRI of the abdomen. When a patient comes with symptoms in some part of the body, the modern doctor now makes a “quick examination” and orders a “workup”, consisting of all possible tests to find out all the possible diseases. Apart from ‘routine lab. tests’ done on every single patient who comes for any complaint, a large number of expensive tests are also done. The specialist or the super specialist then reevaluates the patient going through all these reports and writes out a prescription or other form of treatment. The patient will be given a thick file consisting of all these reports as a permanent record of his normal health.

Most of the large “tertiary” or “superspeciality” hospitals are very well equipped to take care of these patients referred from smaller Hospitals or well off patients directly coming to the centre. The equipments are quite expensive and it would fetch more income if put to use as much as possible. Also a specialist who orders these tests more and hence “supports” the Hospital would be encouraged and in turn given special incentives and considerations by the management. Many of these patients are also happy that all possible and latest tests have been performed on them, proudly announcing their wonderful experience in the Hospital and displaying their thick medical files to friends and relatives.

The medical bill is either paid by the super rich client himself (rarely) or it will be expense account from his company or it will be paid by the Mediclaim Insurance Company. It is somewhat surprising that more Insurance Companies have tie-up with these Hospitals than other smaller or mid size hospitals.

What is the Best option for a patient?

It is for the patient to decide what kind of medical care he wishes to have. Whether he should opt for his traditional family doctor and friend first and only on his suggestion seek the help of Specialists in Institutions suggested by him or straightaway approach the super specialist in a Large Corporate or Tertiary Care Hospital. Also it is up to the Family Physician to choose a “good’ specialist, who has good clinical skills to make a proper diagnosis and has the necessary expertise to take care of his patient or submit him straightaway to a large tertiary Hospital and allow him to be handled by them without often having any say in the care or follow up of his patient.

It is in your hands to decide what is best for you!

Best wishes,

Dr. M.Mohan Rao,
Director& Senior Surgeon (Retired)
Dr. U Mohan Rau Memorial Hospital, Chennai.
Visit: www.mohanraohospital.com