Wanted: A family doctor

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Where are the ethics of this noble profession?

 

 

Those were the good old days. The days when one used to have a family doctor and a ‘personal physician. There was a logical reason for this. A personal physician or a family doctor was the only one visiting your house in the good old days. He alone knew your exact ailments, your body structure, and the body’s chemistry in reaction to different medications, and so on. My maternal grandfather, surgeon MAH Siddiqui (after whom is named the Siddiqui Hall of King Edward Medical college), was the personal physician to the Shah of Iran. The doctors then knew their patients inside out. They relied more on their extensive clinical knowledge rather than newfangled tests to act as a doctor. Without the aid of which the doctors of today fail usually to come up with a diagnosis. Let me hastily state I have nothing against newfangled tests. Yet I have everything against newfangled tests when used to fan the greed of healthcare institutions.

Let me recount a horrific period I went through that haunts me, and has created a deep insecurity within; come what may; I am incapable of ridding myself of it.

In early April 2014 my husband suffered deep heaviness in his chest. He complained of pain arising from his stomach. When the night brought no relief, I suggested to him to visit the nearby hospital in order to get medicine by prescription. We went to this very expensive, very private hospital nearby. He was given a painkiller injection in emergency and prescribed a medicine for stomach acidity. He was perfectly fine within five minutes even before his blood pressure and ECG was over that was picture perfect. In walked in a doctor from the cardiology department. He suggested a Troponin-T test for my husband. This ill fated test is a blood test that shows whether or not your enzymes are raised. However, a Troponin-T test may be positive for both cardiac and non-cardiac conditions. At any given site there are many reasons for a non-cardiac situation and also may include any skeletal muscle going in a spasm.

In our case, the cardiologist yelped as the result came in; a weak positive. My husband was immediately whisked away to the ICU and I was told he had suffered a heart attack. The next twenty four hours were traumatic. The walk in the corridor outside the ICU, the long hours of praying and begging Allah for mercy.

At that time, when you have been caught in the net, you cannot say; oh let me go and research this one out! When you are caught, you are caught! He underwent a battery of tests, including echo, and many newfangled ones. Nothing was supporting the Troponin-T test result, which incidentally a few sites reveal give different results for medicines of different companies used in a test can be very different from each other. So high is the factor of this difference, that Agha Khan does not conduct the test when we checked out at their outlet close to my house. Since by the next day, the doctors could find nothing to support the weak positive my husband was discharged.

As I refused to let him away without a bed rest, once home, I had a lot of time to research the subject. Of course, both of us felt we needed a second opinion on this one too. Then started the second phase of our nightmare.

The first cardiologist we visited wanted a daily ECG from his clinic in Phase V DHA with us for the daily visit to him in order to monitor any changes. It was painfully obvious that the technician on job did not know the placement for different electrodes on the chest; neither did he put gel under the clamps that go on the wrists. The result was a wild looking ECG; when we told the cardiologist that his technician seemed not very competent, we were viciously informed that the two arteries of my husband’s heart were completely blocked.

The doctors then knew their patients inside out. They relied more on their extensive clinical knowledge rather than newfangled tests to act as a doctor.

Later that night researching, my computer threw up picture of an ECG that was an exact replica of the one in my hand as an example of a ‘wrong’ ECG. But yes, said the site, the cardiologist seeing it must know it was faulty. Before moving on, let me say this particular outlet was full of people willing to pay extra for good healthcare. Diagnosis based on faulty tests can only lead to more complication, not treatment.

That was the last we saw of this cardiologist. A friend suggested, upon hearing this, that we must have the ECG checked from the renowned hospital where she worked. Lo and behold! It was another wild test! My husband, deeply upset told me the technician put on clamps over the socks while taking an ECG. Thousands come here daily for healthcare.

The next stop was another cardiologist. Famed, he looked at the reports and dismissed them lightly. On a casual note, he asked my about husband his line of work. Thinking that he will probably advise taking less tension, he told the good doctor what he did for a living.

All of a sudden there was a spark of interest in his eyes, and without further ado, he started laying out tiny boxes in front of us. One, showing delicate filigree metal was the metal stent we were told. One will cost us two and a half lakh rupees, however if two were used, we will be given a discount of one lakh rupees. However, if, we vote in favour of latest technology; the fibre stent, well, well, we are making a modern choice indeed. It dissolves itself in the body in a few months by which time the artery repairs itself! This one my dears is five lakh per piece and should we need two; total cost is ten lakh rupees and a special discount of one lakh for us (beats the clearance sale of clothe outlets no?). As a very special favour, he offered to cancel all appointments and undergo the angiography there and then.

We both looked at each other; that is my husband and I and the communication was clear. We had knocked at the wrong door.

The last cardiologist looked at the reports, looked at us and I started questioning him. He understood, I knew what I was talking about. I threw a straight one,” What are the chances of my husband having a heart attack if I do not take him out of this round of opinions leading nowhere right now?” He looked at my face, those newly formed lines near the eyes that were not there before and said, “On a scale of one to four; two.” Asked my husband, “And what is one?” He responded, “A new born baby!”

Something snapped in me then. The pain and anxiety I had been subjected to, my worry came pouring out.

What I was subjected to raised a question; where are the ethics of this noble profession? When did humanity lose and greed take over? I am, by the way, talking of the most expensive outlets. God forbid the diagnosis the poor people in this country get.

Yet who will address these issues? Who is addressing these issues literally of life and death? The answer is no one.

Edward E Rosenbaum, in ‘A Taste of My Own Medicine: When the Doctor Is the Patient, rightly said, “Doctors are great–as long as you don’t need them.”

He must have visited our shores.

41 COMMENTS

  1. I had sore knees with defused pain for years. As an athlete I thought it must be an old football injury, but why both legs. It was annoying. One day after some heavy leg lifts my legs became really painful. Went through the same sort of stupid exams without any diagnosis. Years went by, I lived with occasional unease. Finally I decided to look for my own remedy. I goggled sports injuries, muscle stiffness and finally found my problem a stiff and less flexible hamstring, a common problem of many aging athletes. Three stretches each 20 seconds cured me in a weeks time, now I just need to maintain it. Try asking any of these same doctors about Reactive Hypoglycemia, have they ever heard of it. A common ailment of ppl who eat lots of carbs e.g. like we do, eat wheat chapptis three times a day. They r slaves of test results and never use history, general health of the person etc.

  2. A real bitter reality. I m sure u will get more to write if u visit the Govt hospitals. U may cry more for the "ill humanity"

  3. Interesting ! I live in phase 5, DHA Lahore. Would b helpful for us if u share the names of the doctorz. U might b saving a life by doing that.
    Regards
    Tariq

  4. Support PTI. The health system will be revolutionised from top to bottom. Take our word for it. We don't lie.

  5. The most clear impression one gets from this tale is a negative one of the Begum writing it.

    Her husband was discharged from hospital with a clear diagnosis and instructions. She did not accept this because this arrogant person thinks she knows better than the professionals who treated her husband. She even considers herself competent to give an opinion on whether a Troponin T test is appropriate.

    She then proceeds on a shopping spree of medicos in private practice with no clear purpose in mind and I am sure misrepresents the consultations. I am not sure what she was seeking or what she is complaining about and I do not even understand the relevance of mentioning her relationship to the deceased doctor who may have attended the Shah of Iran or of the role of the newborn infant.

    • Correction:He was not given a clear chit but advised angiography.
      This is one case of many I hear & witness where doctors misguide patients.
      Kindly note I quote Agha Khan as an Authority on Troponin T test.
      You sound angry….a doctor by profession…I wonder?

      • Sister! disregard the objection. Imran Ahmed is that, "technician seemed not very competent".

          • @laila you are obviously as empty headed as the ranting lady and unable to comprehend the written word. The lady has herself given the information. She makes uninformed comments on medical tests, tries to bask in the reflected glory of a dead relative and makes ridiculous claims against professionals pitting her skills acquired from surfing the net against trained professionals and pronouncing them wrong. Ridiculous trash.

          • I asked a genuine question: why is is rat tail on fire?
            Did he see the reports in this case?
            No.
            Why are you upping too?
            Another ignoble of the profession.
            Since U both seem to be vets, stick with animals.

  6. Why do a doctor has to ask a patient what he does for a living? Depending on the income of the patient, doctor would suggest 'appropriate diagnosis' which seems to be in-line with his projected income for the week of his private clinic. Just like any other profession in Pakistan these black sheep have turned this noble profession into a money grubbing dishonest trade.

  7. Dear Madam,
    80-90% doctors these days are more of 'mind readers' then experts in their specializations. Like you mentioned, the stunts came into display after the doctor asked your hubby what he did, as a profession. Therefore, the next time God forbid, act and dress mediocre. And I remember the 'family doctor' with a doctors bag carried to the patients by our servants. Something like the Santosh Kumar movies.
    Then, you mention the ECG episode; the first one with wild readings displaying a faulty machine (and the doctor justifying the technician's heroics), and the other reading on the socks. IF I WERE YOU, I WOULD HAVE SUED BOTH OF THEM, ESPECIALLY THE FIRST ONE.
    Anyways, hope your husband and you have got over haunting horrific period. And Allah give health to you all, and those in this email list. Ameen.

  8. The Trop T was a highly appropriate test. And the subsequent admission with a slightly raised result was by no means wrong. I work in a UK Emergency departement and wwould have referred anyone with a upper abdominal pain and a slightly raised trop t, the person would have been admitted and would have had an angiography done at the very least as an outpatient. Yes the "clearance sale" was definitely wrong but the doctor was giving them there options hopefully. Even doctors have to follow guidelines these days. We are not randomly pulling stuff out from our behinds. And noone will take the risk to let you go home without letting you know what needs to be done.

  9. YAA,

    Somewhere along the way we have lost our moral compass….I taught for
    six years at the newly founded Aga Khan University Hospital and had the
    pleasure of teaching some of the brightest medical students. My opening remarks
    to all incoming students was a simple message…." First and foremost be a kind and compassionate
    physician. We will train you to be the BEST in your field but never ever forget that medicine
    is a NOBLE profession. More than a science , it is an art. Practice the ART and you will
    be successful beyond your wildest dreams ."

    There were however many many instances of not only so-called famous doctors in the city
    'milking' their patients but committing gross and wanton malpractice.

    This was a quarter century ago and remains true to this day !

    Dr Nasir Ahmad M.D.,FRCS.,FACS.
    Indus Hospital,
    Karachi.

    • Nasir Bhai,
      One of my dear Friend a very well known Radiologist, who was well paid,
      left Aga Khan Hospital, for the simple reason of "ethics"

      Good to hear that you are in Indus Hospital. A fine hospital indeed
      rendering great services to people, that too most of the time "free of cost"
      Highly commendable and praise worthy.

    • Dr Nasir Ahmed
      Sir, I am disappointed at your support of an unfounded rant.
      Opposition to Troponin Tests is misleading and dangerous. All the doctors concerned whom the author directly or indirectly accuses of greed or incompetence without proof have advised investigation of her husbands coronary arteries.
      The author has throughout only jumped to illogical conclusions with little evidence to offer and not only dismissed but insulted professional advice on the basis of proud ignorance.
      Imran Ahmed MB, FRCP

      • Dr Imran,
        You are disappointingly taking up arms for the ignoble of the profession. Hundreds have suffered in hands of them. Thousands.And, you have been ticked of well & proper on your stupid stance by the authoress. Here you come again trotting to this site for more diatribe. Why is your tail on fire?

  10. Yasmeen, fortunately your intelligent and enquiring mind enabled you to understand and extricate yourself from this horrible trap.
    I have also come across this breed of doctors. The health of some family members actually deteriorated because of wrong diagnosis and unnecessary treatment.
    Of course, there are many good and honest doctors but, sadly, there are many others who are out to catch people in their web – only for financial gain.

  11. Yasmeen very eye opening story, which have been narrated by many others, but no one dare to put in words and let others know about such vultures; don't know why we call just politicians with this name.
    May I make two requests:
    1. As an Attorney, I strongly urge you to bring a law suite against for all those vultures. This is the best way to bring change when there is week and incompetent rulers.
    2. As an intellectual and writers make an NGO who prepare a list of such criminals, accompanied with Blog listing all such true stories.
    Societies change, not just due to the fear of God but fear of law.

  12. greed should not have set into this noble profession but as we all know everything is for sale in Pakistan. no moral values and doctors are no exception

  13. That was a harrowing experience. I'm sorry for what you went through. You have reflected what has become the norm. The family doctor disappeared decades ago with the industrialization of not only the pharmaceutical companies (listed on stock exchanges) for which the profit bottom line is the topmost or sole priority, and which is also responsible for corrupting the medical profession. I guess I'm lucky I grew up with a family doctor — never went to a doctor during my childhood or early adulthood — he came to us.

  14. How is Naveed Sb. NOW ?
    What was his final report about having or not having a heart condition.
    I have had to get THREE (Latest version ) stents installed, two years back.
    SHW

  15. My prayers for quick recovery of Naveed.

    Things started changing after 1962. We had Dr McCauley who would come after receiving a call through our servant. ,His fee was Rs 5/-.

  16. YAA
    So long the doctors focused on higher studies in UK – an element of ethics did remain. The diagnosis also was less dependent on Lab reports but more clinical symptoms. Come US and we find a class growing with greed. And then not only the Doctors but the pharma industry and then the other connected disciplines got cleverer and every one started biting the flesh of the patient – sometimes stand alone and sometimes in unison – and worst providing service much inferior to what happens in US – where usually a patient is fully explained and satisfied before he/she leaves the doctor.
    Having said that I am not aware if you are describing the experience of Karachi (not knowing if there is Aga Khan out let in Lahore or not) – and further when you described that the paramedical person taking ECG put the clamps on the socks- beats me a bit. With your research – can the tiny current flow through the socks? and if not then what were the traces that came out on the ECG?
    However if you experienced this torture (which I would call so) In Karachi – then Divine help Lahoris. My own personal experience of the conduct of the Lahori Doctors has generally been loathsome and disgusting. They need not only a few lessons on ethics but also on behaviour.
    regs

  17. Malik Sb. Please recommend a good medical madressah which turns out the cardiac hakims who do not need ECG’s, Lab tests, heart scans to diagnose problem.

  18. A very sorry state of affair all around and all over and noble profession is no more noble any more they are mostly conman and shop keepers up the ladder & down the ladder (with the exception of a very few), anyway this is the way it is.
    I wish your hubby full recovery and a very good health.
    Regards

  19. there was a very great journalist Muhammad Idrees [ Government college alumnus]
    who tried to address such personal cardiac
    issues in the decades of the sixties and until his death[?date]

    He was not treated at all well at Mayo Hospital.

    Someone was direlict of their duty and the patient suffered .

    My close friend late Brig Azmatullah suffered a tragic end
    under grevious circumstances .
    He was writhing in the agony of very severe
    angina , but the nurse at Mayo would not administer morphine
    since the duty physician was unavailable .

    Ironic situation, since he was my senior house physician
    at Mayo Hospital some decades prior
    to his own crisis.

    I can provide details of similar stories , even in Canada

  20. Yes indeed we need a family doctor.we must try to keep following our family tradition of producing atleast one doctor from our respective sibling.we are living in a corporate global era where money has lost its value in line with the moral value.It is business, business and business without ethics.The world is moving in the wrong direction and nobody is bothered to look back to history and the purpose that Allah created the universe and mankind.
    Regards
    Fahim

  21. I am very sorry to learn of your experience. But you are very correct, Jasmine.

    Warm regards,
    SQ

  22. Very sad to read it. I have gone through some experience in this field. Had two stents an year ago. Have not recovered. Yet. Multiple side effects of medicines that I was not told about. I almost became a vegetable. My muscles diluted. I was passingly told that it was because of cholesterol control medicine. I can not walk straight. Well that was by the way. May Allah swt bless your
    With Husband with good health.

  23. YASMIN, Sorry to learn of NAVEED's Illness; How is he Now?

    I wish you had straight gone to the CARDIC Centre at CMH Lahore or PIC on Jail Road. The Private Hospitals are just MONEY MAKING MINTS and no longer Medical Units??​

    warm regards and early health to NAVEED.

    shahbaz

  24. Ma'am, it's a very depressing and traumatic account indeed…!
    God forbid….God forbid….if you again need to have a near and dear one checked up or treated for heart problem, please if possible, drive down to Rabwah to Tahir Heart Institute and consult Gen (r) Dr Noori there. If nothing, the ethical aspect of the treatment and advice is guaranteed.
    I'm not doing his publicity, nor he needs it. I don't deliver this advice to every Tom, Dick and Harry. But you and dearest Naveed Tajammal are very special in my eyes and I don't have to explain the reason for that respect.
    Regards.
    Latif.

  25. Our Doctor's are without any soul…money, money, money…..the good ones go abroad, the ethical ones are kidnapped & killed…..best then to go to a faith healer !

  26. Exploitation for profit is common practice in medical profession, the better the doctor is known the more he extracts profit from patients with minimal necessary effort at treatment. Doctors receive commissions from pharmaceutical companies for prescribing their branded drugs which cost many times more than if the same drug is sold in its generic name.

  27. YAA
    Doctors are the worst. From 500 they have risen to2000
    And no time to be given to patient come and go is on.
    Worst is that some hot selling doctor's PAs take under hand 500 so you end up paying 2500.
    Some dr in lhr are the worst greedy.

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