Wednesday, July 20, 2011

TMI: What is happening to the medical profession — by Concerned senior citizen

What is happening to the medical profession by Concerned senior citizen

July 20, 2011
JULY 20 — As I write this I am saddled with a sadness wondering if the years of hard work and effort spent at the medical college by medical students before they can be certified as medical graduates is indeed worth all the labour and time.
I have spent more than 30 years serving the people but today I am at a crossroads wondering if I am witness to the beginning of the end of the glorious and noble profession that is the medical health sciences. Sadly there are growing signs that the sacrosanct ideals of the profession seem to be fading.
My close observation of the profession — and that includes all healing sciences be it medical, dental or any other as long as healing is involved — is that the number of doctors present in this country is ever increasing. The number of hospitals is equally impressive; both government and private.
The private establishments attempt to equip themselves with the most expensive facilities in terms of style, décor and sophistication in terms of equipment for diagnosis, treatment and of course patient recovery. This must also be accompanied by patient comfort. Having said this, my observation is that the cost of patient care has become inflated to an extent that it is hugely frightening for a citizen when he/she falls ill.
Is the medical cost in tandem with the citizens per capita income or within his/her means? If a patient is struck with an illness like stroke or cancer or organ failure then the fear of not being able to meet the cost is even more frightening. If this is really the case then are the doctors still holding on to the sacred belief that their duty is to heal the patient at all costs.
Now, the phrase at all costs may be contentious for a debate but not forgetting that it is the aim of every doctor to heal the sick. If a patient cannot be healed by a doctor then it defeats the purpose of that visit and it also defeats the purpose of the doctor meeting with the patient. What does a doctor do then? Has he a choice of doing anything else to achieve that goal. This is something that is left to the doctor himself/herself.
The point I am driving at is this. Being able to come to a correct diagnosis is good and this can be obtained with expensive technology.  But is this going to make it impossible for the patient to afford this service? If it is really the case then how does the doctor adapt himself to make it possible for him to do what he is supposed to do and that is to attend to the patient and achieve the healing.
Now the question: Is healing based on all the expensive machinery and the most expensive drugs available in the market? This is something doctors must most honestly search their minds and answer. Then again I have to ask. With all the expensive machinery and drugs available, why is it that many of the diseases are still left incurable. Is cough and cold curable? How then does it get cured? Is cancer curable? Is diabetes curable? Is eczema curable? When I say cure I mean that the disease becomes non-existent.
This is what I mean. If a patient has to be on a drug on a lifetime basis then it is not a cure. The disease is still inherent with the symptoms merely being blanketed by drugs till death takes over. The aim of a doctor is to heal the sick. If the healing has not been obtained then it is only logical that the treatment could have been either wrong or insufficient.
This unfortunately is the saddest part of being a doctor. Where then is the missing link? This is food for thought. Is it the training or the modus operandi of the system that has led to this sad state? Or is there a divine anomaly somewhere that doctors have lost sight of. The answers to healing is available in this universe. It is all left to the doctors to go and look for the answers.
There seems to be blatant disregard for ethics. Advertising seems to be rampant though however hidden it may appear. Lighted neon lights are being flashed around at the place of business. Many doctors are found to be rude, arrogant, and dishonest with their diagnoses. The dishonest diagnosis is meant to scare the patient into accepting the expensive treatment. This is not a myth or fault finding but is a real happening in the market.
Doctors’ behaviour towards patients can be a rude awakening for patients. They shout, scold and threaten as if the patient can be subject to bullying at his whims and fancies.
I have personally seen and witnessed doctors being rude, disrespectful and even threatening to patients in the presence of their spouses and children. This cannot and should not be condoned.
I have seen doctors even quoting their fees to patients based on whether he/she wants a second-hand Proton or a Mercedes Benz. I have seen doctors who despise other doctors with no care for their reputation or welfare. Everyone else is wrong except himself.
The extent to which professional jealousy exists is frightening. If one doctor begins to do well in practice out of sheer dedication and hard work, then the others in the same profession would do everything to cause him/her harm. This indeed is despicable.
Are doctors waiting for the day when patients will begin to lose their patience and bring in gangsters into clinics and beat up doctors before the other patients. Please do not wait till that sad day.
Remember, the people are becoming wiser and more knowledgeable day by day due to technology. Or are they lost in their own time wrap? Time to wake up.
These days it is common for one doctor to derecognise another doctor when he/she comes for treatment. They charge fees as they like. Of course there is nothing wrong with charging a decent fee to cover costs, no sane person would deny a doctor this.
But it is the blatant mercenary attitude that I condemn. There have even been instances when a colleague has been “detained” in the clinic/hospital till the full fees have been brought by family members. How low and despicable is this.
Today, private hospitals have become a business enterprise and that is why so many businessmen have started investing in them. It costs almost half a million ringgit to become a doctor today and there one must make his or her first million in the first year of work. This seems to be the prime motivation of every medical graduate. This is shameful.
My honest suggestion is that every doctor should open their doors to cater to patients at least once a week and start healing the sick at no cost. If you can do this for the rest of your life then and only then will you realise what healing the sick really means and then you will begin to value the great and sacred virtues of the profession. Till then I offer my prayers for each one of you.


Winston said...

In today's world, it looks like most docs would like to drive a Merc or a Rolls as soon as they qualify.
Perhaps, the only way to put a cap on such commercialism is by having a plentiful supply of qualified docs, including specialists, so that nobody can hold the sick to ransom.

Maurice Chew said...

You have hit the nail on the head. It does appear that some doctors are greedy and unscrupulous . Just look at the amount of aesthetic clinics that have sprouted up recently. In aesthetics, you are in fact treating a patient who is not sick--she just wants to look better--and if you are not careful, you could end up getting into serious trouble.

GP practices and even Specialist fields have changed drastically over the last few years. Newer drugs such as ARBs and statins can virtually reverse hardening of the arteries (arteriosclerosis) and plug formation.
In Diabetes , GLP1 analogues such as liraglutide is able to reverse early diabetes and preserve beta cell function and prevent deterioration to insulin use and ultimately end organ damage.

In cardiology , PCIs and stents have revolutionised the way cardiologists are able to treat ACS. Not to long ago PCI was only used for ACS STEMI .
Today is is also recommended for ACS non STEMI if there is unsable angina.
In addition to the usual coronary angiogram which is the gold standard, there is recently increasing use of technetium tetrofosmin mycardial perfusion tests to detect areas of under perfusion with a view to further revascularisation with additional stenting.

So where does all this lead to?
We all know that the pathophysiology of ACS is plug rupture and once infarction has been establish further revascularsation does not prolong life and the best way to go is with optimal medical therapy with statins.

My view of the whole affair?--as long as the patient can afford it , he should be given an informed choice, and time to think about the options that are available. Secondly -- the treatment or investigation should never do more harm--hence I am never for investigations such as routine CT Coronary angiogram. They tell you very little and expose you to unnecessary radiation. Yet I have seen even doctors exposing themselves to this.

In the end - before subjecting a patient to a particular investigation or treatment I will always ask myself-would I be willing to subject myself to it if I were in his shoes.