I can never forget an incident about 30 years ago when the son of a close friend in Punjab came back home after finishing his MD in diagnostics. His parents, who were already running a successful small factory, added a diagnostics wing in the same premises and ordered equipment for x-rays, ultrasound, cat scans etc. The family scion was to start a professional life in style. As the parents already knew the medical fraternity in town, he was hoping to get good referrals.
On the very first day, as the young man was doing an ultrasound, his assistant came and whispered that a highly reputed big doctor wanted to speak with him urgently. Reluctantly, he apologised to the patient and left midway to take the call. “Puttar, I have sent Roshan Lal (name changed) for an ultra sound, please confirm his gallstones”, “But uncle I don’t see any stones” responded the young doctor. The man at the other end was livid “You have started work today whereas I have been in practice for 60 years, will you now teach me these things, I know he has stones in the gall bladder and needs an urgent surgery; if you can’t ‘see’ any stones, just tell him your machine is out of order and send him to another lab. And, don’t expect any more referrals from me,” said the worthy and slammed the phone!
Poor kid was in tears and literally ran to his parents’ office. When they heard the name of his caller, they were also scared and told him, “We can’t make the Doctor Sahib our enemy, we will call on him in a day or two and make amends. Right now please do his bidding”. The guy was aghast but had no choice. He decided to get into diagnostics! Well, soon he understood the ‘system’; apparently there was a printed list circulated by the association of labs in the city. Rates for all tests were fixed – x-ray Rupees 10, u/s 30, CT 100 and so on which had to be sent in cash to the referring doctors religiously every week. ‘No payment, no referrals’ was the accepted norm. So, his lab prospered while his dad kept a meticulous account, prepared small white envelopes every Sunday that his peon would go and deliver at the doctors’ homes. There were no secrets and no bashfulness in this straightforward business. Once, at a party, our bright young man accosted another doctor and asked why he hadn’t sent any patients; the reply was quite frank “I haven’t received my envelope last Sunday”. Sure enough, dad had slipped up!
I tried raising this issue at several meetings of national industry associations and chambers but was patronisingly corrected by CMDs of large chains: “You must be talking about independent labs in small towns. Such things don’t happen in large corporate diagnostic outfits”. I hope and pray they were right and the malaise is confined to small places.
*Do I really need this surgery?
Early in 2019, I started feeling pain in the calf behind my right knee. This was odd as I am used to walking seven to eight kilometres every day. I sought an appointment with a doctor friend at one of the big hospitals. I was asked to lie face down on the examination table and the doctor first flexed my left leg – which was okay – then the right, may be with a little jerk, that made me almost shriek. I was advised to get knee x-rays and an MRI of the right one. A week later I was back at the doctor’s office with all the reports. He walked in, trailed by half a dozen juniors, had a good look at the reports, pointed out a ‘meniscus tear’ in the right knee and advised ‘orthoscopic medial meniscus balancing procedure’ “which might give you relief for anywhere between a few months to a couple of years”. I was told that this minor intervention is being suggested “in view of our friendship” as, with the degenerative changes, I was likely to need TKR (total knee replacement) pretty soon.
I was shaken and decided to seek a second opinion. My quest took me first to another doctor friend at another big hospital who didn’t think a surgery was needed and advised an ultrasound of the right calf and also some digital x-rays of the spine; also some tablets. Thoroughly confused, I met yet another doc in the same hospital, who noticed ‘degenerative changes grade III’ and prescribed B-12 injections, ‘no brisk walks’ and also suggested that I meet someone for herbal potli treatment. My next visit was to an old school orthopaedic surgeon who too ruled out surgery, felt that the ‘meniscus tear’ was not a problem if I wasn’t jogging/running and advised a knee support while walking, a spray, good old ‘seven seas fish oil’ capsules and some more tablets. Even more confused, I wasn’t ready to give up and met yet another specialist who felt that my case was “far from a surgery” and the problem could possibly be resolved with some injections – either synthetic or protein-rich part from my own blood or stem cells.
By now, I was ready to write a thesis on the ‘finer nuances of pain in the calf’ but decided to first meet my neighbourhood physiotherapist. His prognosis was truly heartwarming. “Sir, you are not likely to need a TKR for at least ten years. Just have a couple of sessions with me and God willing you should be fine”. Sure enough eight sessions of thermal, ultrasound, vibration, manipulation etc. did give me a lot of relief. Five years have passed and – touch wood – I am doing my usual walks, haven’t had to visit the physio more than perhaps five or six times, do some daily exercises at home and life is pretty much back to normal. Of course, I have no clue what is in store tomorrow.
I would like to believe that the advice for an orthoscopic procedure and later TKR way back in 2019, was a case of ‘human error of judgement’ and not an attempt to force me into an unnecessary surgery.
*Need for Mindset Change
As this is my last column, for now, on the Public Health theme, I want to add a few words about the Indian Mindset that ignores the need for preventive care – be it for cancer or heart or other NCDs – that ultimately leads to bigger problems and the unbearable load on our very busy and very expensive tertiary care hospitals (as discussed in my last fortnight’s column in BW). This load can be considerably reduced if the Health and Wellness Centres (as the PHCs are now called) are tasked with prentice care through regular screenings.
