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.