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Midnight Madness 2022 New Year Eve Party
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BIG FAT New Year's Eve 2022
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Lack of Early Testing Leads to No or Mis-diagnosis
About two years ago, one of my childhood friend’s elderly wife suffered a fracture of the mid-shaft of her femur. He called me from India after an orthopedic surgeon inserted a stabilizing rod. I was somewhat surprised to learn the unusual location of the fracture, and that too without any major trauma. (The common site is the neck of the femur, and not its shaft).

I suggested that he discuss this point with the treating surgeon to find out why the fracture occurred at that location in the first place. They were told that there was an underlying cyst at that area and no further testing is needed. At least, this is what he mentioned to me. This bothered me. Despite my insistence, that she must have more testing to determine the exact nature of the cyst, he did not feel a necessity to further investigate. I had to give up reluctantly.

A few months ago, she developed pain in the chest wall and back. The evaluation for heart disease was negative. She was shifted to another facility for further evaluation. Now retrospectively, the cyst was felt secondary to a kind of cancer, involving ribs, sternum, and spines for which a PET Scan and biopsy was being planned. Had this ‘cyst’ been evaluated thoroughly a couple of years ago at the time of fall, an earlier diagnosis would have been much easier. A simple rule of thumb is that suspicion of cancer at that stage of life should be suspected in case of any unusual symptoms prompting full investigation.

Having received both of my medical degrees, M.B.B.S. (bachelor’s degree in medicine and surgery) and M.D. (Doctor of Medicine) or postgraduation, from India, I know better that the knowledge of physicians in India is as good as anywhere in the West. Yet, the medical care in certain aspects may be lacking. First, the number of people living in the rural settings far exceeds the urban population. The sophisticated testing required for proper evaluation is usually unavailable in rural areas due to lack of machinery, trained technicians and physicians. Additionally, the cost for expensive testing may be too prohibitive for the rural patients on the whole and middle-class families in urban setting. Refusal on religious grounds or at the advice of ill-informed relatives acting as pseudo practitioners is more common in rural settings.



And then, forget not the quacks sitting at every street corner promoting themselves as specialists in every illness one can think of. Having no degrees, but loaded with persuasive power, their widespread tentacles do not spare anyone from getting ensnared or entwined. A belief in the so called wisemen, baabaas, saints and swamis, etc. may also influence the most sophisticated people against these tests. By the time, the expert care is sought, the disease has already progressed to a level where proper diagnosis and cure might not be possible. And it is too late.

The physicians’ behavior in the countries of the East is neither ideal not on par with what we see and feel here. Brushing aside patients and relatives with a thought that they could not understand the issue, is all too common albeit not always. Spending time in clarifying the situation is perceived as wastage and below dignity. The patients, on the other hand, may place their treating physicians second only to God itself yet lack of education prevents them from following the scientific advice they are offered. If something goes wrong due to delay in diagnosis, a ‘Will of God’ is invoked rather than delay.

In contrast, medical professionals here understand clearly that the guy across is also a human being, has a brain and is only here because he is hurting and is seeking help. On coming out of operating room, the surgeons sit down with the anxious relatives to explain at length detailing what was done and the outcome. An arrogant and brazen exhibition or social status gap is not displayed by the physicians and the patient is not made to perceive itself at their mercy at all. The physicians know that brushing them aside, not answering or satisfying them could backfire and cause serious legal repercussions. The general knowledge of the people of the West keeps patients on guard and helps in early diagnosis.

Most of the people here in the West have some kind of medical insurance to help meet the expenses. The hospital management may also come out with an ongoing payment installment schedule, based on the ability and resources of the patients. Back home, the concept of medical insurance is still mired in infancy. Convoluted hurdles are placed to avoid refunding the patient, the one who paid prodigiously for many years. When time comes to the benefit, reimbursement is not available and impractical and obstructive stipulations are placed . This may delay the diagnosis.

But fortuitously, there appears to be a light at the end of tunnel.

First, the patients, the world over, are increasingly becoming more aware of their rights and their illnesses, thanks to the onslaught of social media, easy availability of Internet and Mother Google. Most of the youngsters have needed information on their fingertips. The patients know that their lives are online, have become proactive in assuming responsibilities in becoming equal partner. Their inquisitiveness keeps their physicians on their toes to do what needs to be done and without delay. Their behavior has shifted towards conviviality rather than one of avoidance. The use of newer testing techniques and trained technicians are easily available at increasing number of places. Gone are days when respect for a patient, especially a poor one, was hard to come by and asking a question from the physician was a taboo. A physician is now aware that he will have to cover all the avenues. Today’s patient wants perfection in everything, and then more. Why should they not?

A fear of litigation, plus awareness for regular follow up, gradual availability of elaborate testing, willingness and openness of the physicians in sitting down with the patients to answer questions as is true in West, is now happening in our native land. And that is good news!!

*Author of several books on diaspora Issues