Medical doctor, Dr. Manoj Kapoor of India wrote an interesting book, sharing with us his experiences and wisdom. Here are some of the quotes which you may wish to ponder on. Is this something that is happening today, not only in India but also in other countries (no matter where you are)?

• This is a book about doctors by a practising doctor who honestly did not want to be a doctor. Strange, isn’t it?
• … my father said that he wanted me to … study medicine. I submitted to his wishes …. I succeeded and became a doctor. I completed an M.S. in Surgery … I practise in the field of gastrointestinal surgery … and set up a rudimentary kind of hospital in 1991. It took seven years of struggle to get reasonable results.

Reality of Present-day Medicine

• All doctors do not treat all patients successfully all the time.
• Medicine is a tough, demanding profession, but God has created a machine which has an in-built auto-healing processes. Human race is older than …. (modern) medicine. Patients survived then and will continue to survive and live.
• Medicine still remains an art in applied common sense while treating most ailments. The moment we leave reasoning and correlation out and start applying modern technology advances, we get trapped in misdiagnosing.
• A clinical diagnosis is followed by technology to prove that we are on the right track. After diagnosing correctly, the treatment modality may vary from conservative through wildly flamboyant to utterly nonsensical. Example: They used an AK-47 to kill a fly rather than something lighter like a plastic spatula.
• Patients are the best teachers. All successful clinicians are first excellent history takers.
• Science has progressed by leaps and bounds. A paradigm shift has happened. It is ” I treat and I cure”. However, the irony is that a cure for diseases like the common cold has still not been found.
• Science has fantastic treatments for all the symptoms, but the disease has not been eradicated…. and new ones are emerging.

Four Kinds of Doctor

• What kind of a doctor would you like to consult? The directory of doctors is akin to …. four types of eating outlets.
• At the top of the category come the ones which serve the best food and are famous because of that.
• The second … consists of the ones which are famous because of their marketing and business skills and not necessarily the …food they offer.
• The third … comprises of the ones who serve fantastic cuisine and are authentic in taste but are not famous.
• The fourth category …which neither serve good food nor are famous.
• Take your pick. If you can get and afford those who are famous and also good, you are lucky. And if you get any of the other three categories without knowing, God be with you.

Drug Company and its Sales or Medical Rep

• The focus of the pharmaceutical industry … is definitely growth and profit.
• It should be admitted that a multinational and national company official knows more about … drugs than the doctors themselves who profess to treat patients.
• Good reps teach doctors about the molecule, its pharmacology, its powers, its side effects and the indications for using it.
• The marketing guys are very reticent about the side effects of a molecule. They try to avoid any adverse comment till a new more advanced molecule of the same family of medicines in launched. The older molecule is dumped because it had limitations, they then venture to say.

Reality of Life

• I realised that brilliance in one’s subject, honesty and hard work need not translate into success always. We are good doctors but not marketing experts.
• Survival of the fittest is the order of the day in the profession of healing.
• The need to earn is there in every profession and every business.
• To-day’s world is fast-paced and everything is materialistic … but the greed for luxury and the lust for earning a lot of money to feed that greed is driving sane people towards insanity.
• Experience has taught me that free counsel is least appreciated and rarely acknowledged.
• The definition of a successful person in today’s world is “one who has money and knows how to flaunt it.”
• Somebody wrote … Money can buy a house, but not a home; money can buy amusement but not happiness; money can buy medicine but not health.

Rabbit, Tortoise and Fox Ways of Earning Money

• There are numerous ways of earning money and getting rich … the way of the rabbit, the way of the tortoise and the way of the fox.
• Who these quick foxes are in something that is largely known to the medical fraternity, but there has been a tendency in the profession to close ranks and, in effect, shield such persons.
• An effective system of checks and balances has to be evolved to see that patients are not exploited for the purpose of earning more money. If a reasonable option is available, the patient should be told about it.
• The quick foxes may be an outcome of the system which is slowly being taken over by money-minded, non-medical businessmen and administrators.
• The rich businessman and entrepreneur create the best working places and employs good professionals. As the doctor gets trapped in working at the best places where the elite of society come, he is forced to adopt the tricks of the trade.
• The quick money game is run in the name of these credulous doctors. These naive brethren of the fraternity end up being puppets in somebody else’s hands. Professionally competent people who know nothing beyond patient welfare get exploited.
• Targets are given to these main doctors who become the power lobbies and earners of the hospital. Little does this gullible set of doctors realize that it is their reputations which is at stake.
• The administrators patronized and promote the ones who toe their line. No doubt a good earning potential is realized and a hand in glove policy gets initiated.

Honesty and Ethics

• Do we knowingly mislead those who do not know what we know?
• Does the professional get away with it all because everything has several answers and multiple angles?
• … if any decay has set in, then we need to acknowledge collective responsibility – society, governance machinery, the socioeconomic milieu, the increasingly competitive medical industry, all have contributed to the way things are.
• I count myself as a part of the entire system. I blame the system and not the individual who falls prey to it. All I want to do now is to wake up and work together with my medical brethren, unite for a clean and ethical medical fraternity.
• … the appeal is not to make it a money-spinning machine at the cost of fellow human beings’ sufferings.

A living problem is better than a death certificate

How many of us understand the above wisdom? We don’t. Let Dr. Kapoor explain what that means!

A rich and famous person woke up in the middle of the night complaining of chest pain. One of the best physicians … was summoned to his bungalow. The patient’s blood pressure and electrocardiogram (or ECG — a test that checks for problems with the electrical activity of your heart)  turned out to be normal. He was given anti-acidity medications with a sleeping pill. He slept well.

However, in cardiology, protocols of chest pain investigation are such that any pain in the chest is considered to be heart related until proven otherwise.

The patient visited the hospital as per the advice.

A repeat cardiogram was normal. Blood enzyme studies … was normal. He was nonetheless asked to get an echocardiography done (a sonogram of the heart.  This  is not abbreviated as ECG. Echocardiography uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart. Echocardiography has become routinely used in the diagnosis, management, and follow-up of patients with any suspected or known heart diseases).  It turned out to be normal.

…. Stress test or TMT was requested by the doctors … this too was absolutely normal.

Nonetheless, angiography was advised (Note:  Angiography is an X-ray exam of the arteries and veins to diagnose blockages and other blood vessel problems. During the angiogram, the doctor inserts a thin tube into the artery through a small nick in the skin. Contrast agent (X-ray dye) is injected to make the blood vessels visible on the X-ray).

In those days (in India) angiography could itself lead to complications. It is after all an invasive procedure.

Unfortunately, the patient died after this procedure.

The dividing line between valid investigations and unnecessary investigations with commercial motive … is difficult to draw. To what extent does an action by a doctor in the course of treating a patient qualify under the fox category?