SUPER SPECIALISATION MORE A DRAWBACK

With increasing specialization, the doctors are becoming myopic and they concentrate only on their field. The result of all this is high cost of medical treatment and very often ruining diagnosis of simple diseases. Dr. V.N. Jindal .

WHEN, I WAS small, I remember whenever I fell sick, my father would take me to a middle- aged doctor who was one of the very few qualified M.B.B.S. doctors among the 1.5 lakh population in the town. This doctor had his consulting room in a small room with a partition where his compounder was dispensing various kinds of medicines, mostly in the form of powder and different coloured syrups made in-house. The doctor was a very simple man. He didn’t have a secretary for appointments. In fact there was no need to make appointments. The doctor dressed in simple but neat clothes. I cannot recollect now his professional skills, but I do remember, he was very thorough in his job and had a humane touch. Instead of putting you on the examination couch and poking you here and there, he would ask the patient about his work or studies and about the welfare of his family. In spite of the tremendous crowd in his clinic, he always patiently listened to everyone and then, with gentle hands, he would perform a thorough examination irrespective of the complaint. He had very few gadgets in his consulting room and I remember, these were limited to a torch, stethoscope, blood pressure apparatus and tongue depressor. I also remember that most of his patients used to get well after consulting him. He was a very highly respected man in the town and people considered him akin to God. He never refused to see a patient, even in the middle of the night, and mostly visited his patients on a cycle.

Today, when a patient goes to a general hospital, he is asked what the problem is and depending upon his major complaint he is referred to the concerned specialist. The specialist is usually a master of his specialty and knows very little or nothing about the rest of the medical field. As soon as the patient narrates his symptoms and if it fits into the consultant’s speciality, he starts exploring the various possibilities. Even examination of the patient is limited to his own speciality only. He does not bother to look into other parts of the body. For example, a patient going to a neurologist or a neurosurgeon with complaint of headache, will usually have complete neurological examination without his blood pressure being examined, while it is a fact that hypertension is a major cause of headache. Unfortunately, if the so called specialist cannot reach a diagnosis, the patient is immediately referred for hi-tech investigations like C.T. scan or M.R.I. etc. These investigations cost a fortune to the patient and he is awed by the huge machines and the ambience of these investigation areas.

In case these investigations reveal something the specialist feels very happy, irrespective of the fate of the patient and in case, he does not find anything positive, a chain reaction sets in whereby the patient is turned from one specialist to another, each one ordering a set of high tech investigations, till the patient is either bankrupt or is fed up of going through this ordeal. Very often, it is found that after going through all this in the end it is found that the patient is suffering from a simple disease which could have been diagnosed if a thorough check up was done in the first instance or simple investigations in the form of plain X-rays or blood investigations would have been sufficient.

Specialization
SPECIALIZATION IN medical field is not something new. Herodotus, in his history of medicine of the people of Nile, wrote thus: “The art of medicine is thus divided; each physician applies to one disease only and not more. All places abound in physicians; some are for the eye, others for the head, others for the teeth, others for intestines and others for internal disorders.” Similarly inscriptions on Hieroglyphics are as follows: ‘The greatest doctor’ (the Dean of Sais – 3000 B.C.) was ‘keeper of the king’s right eye.’ A doctor by name Iri (2500 BC) was entitled ‘keeper of the king’s rectum.’

Art of medicine always meant care, compassion and special empathy for the patient. A doctor should be a symbol of sympathy and care. Advent of high-tech gadgets and latest technology has depersonalized medicine and has deprived it of human touch. Over-enthusiastic super-specialization is self-defeating as it negates the holistic aspect of medicine.

Myopic Vision!
WHY IS THIS happening? Both the medical profession as well as the patient is to be blamed for this. With increasing specialization, the doctors are becoming myopic and they concentrate only on their field. Also availability of high tech investigations prompts doctors to take short cuts. Instead of spending time with the patient to examine him in detail, they find it much easier and profitable to subject him to various costly investigations. Similarly, on the part of the patient, it has now become a status symbol to go directly to a specialist. The higher the consulting fee, the more posh the consulting room, the better the doctor is supposed to be.

The patients themselves demand high tech investigations to be performed, even if their consultant advises them against it. This is because such hype has been created that the layman feels that these investigations can cure his ailments without realizing that they are just tools to reach a diagnosis. My patients have often requested me to let them have C.T. scans for complaints such as sudden increase in grey hair, or that they are getting married or even for a reason as silly as that they are going abroad on a holiday and need to clear doubts.

The result of all this is high cost of medical treatment and very often ruining diagnosis of simple diseases. Unfortunately, we have completely forgotten that human organs or systems do not function in isolation and the whole body works in unison. The concept of holistic medicine, so strongly advocated by traditional systems of medicine in our own country, has been completely ignored. The medical profession as well as the patients do not realize what tremendous harm is being done to the medical profession as well as health care because of this. I think it is high time we sit back and do some introspection and realize the importance of holistic approach to the human body. Nobody denies the importance of specialists in certain conditions, but one should go to them only if it is absolutely necessary and after going through a general physician who has the patience to do a thorough check up and after common ailments have been ruled out. If we don’t pay attention to this, I am afraid, alternate systems of medicine will take over from allopathic system and this has already started happening, not only in our country, but also in the west.

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