Thursday, August 25, 2016

Book review: This book openly tells the truth about how some doctors exploit their patients

Dissenting Diagnosis: Voices of Conscience from the Medical Profession 
By Arun Gadre and Abhay Shukla 

Reviewed by Jai Arjun Singh

When you spend a lot of time in hospitals as a caregiver, you can go through many emotional phases simultaneously. In the past few years, dealing first with my grandmother’s medical condition and then with my mother’s, there have been days where I have felt like superman one minute – marvelling at my own energy reserves, patting myself on the back for having been in six different places at the same time and juggled small and big problems – and then, the very next moment, like an enfeebled old man, wanting to be free of all responsibilities, unconvinced that I’ll ever be able to get up from the chair I have just sunk into.

And then something new comes up and you’re smoothening your cape again and rushing to stop a wily doctor in the MRI room from repeating a procedure that had been done the previous day, while nurses and ward-boys giggle on the periphery of your super-vision.

One source of entertainment in these situations is to record stories (always through gritted teeth) about the goof-ups, which can make Catch-22 and M*A*S*H* seem like documentary realism in comparison: the miscommunications between teams of physicians, the exhaustion that comes with having to repeat all the details of your patient’s history to a new and oblivious doctor every couple of hours, the many little instances of apathy or insensitivity that can rise to depression-causing levels over a few days. I remember my dadi’s exasperated cackle when she was being sent home following a stint in Max Saket in late 2014: after five days in the hospital where a doctor would drop by once or twice a day, give a curt instruction and swish out in 30 seconds (having added Rs 900 to our already-sizable bill for each such “consultation”), she was discharged with a diagnosis of piles when, even in her groggy state, she knew it was no such thing; that her gastric problems were an effect of the blood-thinners she had been taking since her angioplasty. How she rolled her eyes and muttered as we put her on the stretcher for the ambulance. (Sure enough, after she spent a very uncomfortable month at home, we were back in the hospital explaining her case all over again to a new set of smiling doctors who made the correct diagnosis this time – not so much because of competence, I suspect, but because there were only so many available possibilities.)

The symptoms
With many such adventures having accrued over the years, the new book Dissenting Diagnosis: Voices of Conscience from the Medical Profession – co-written by doctors Arun Gadre and Abhay Shukla as an attempt to record some of the ugly truths about medical practice in India – contained much that was familiar, giving me the shudders as well as the jollies.

That malpractices in healthcare exist will come as no surprise to anyone who has dealt firsthand with the beast; the subject has also been covered in investigative journalism and in books such as Rana Dasgupta’s Capital: A Portrait of Twenty-First Century Delhi, one chapter of which has the author in conversation with three caregivers about dehumanisation in medicine. Dissenting Diagnosis, on the other hand, is an inside account, organised around the testimonies of 78 disillusioned doctors (nearly half of whom consented to have their names published) from across the country. It’s a well-organised book with predictable but to-the-point section heads such as “Diagnosing the Malady” and “Initiating the Cure”. You won’t read it for riveting prose or for a cleverly crafted narrative – many passages are simply made up of quotes by the participating doctors, placed next to each other, held together by some basic commentary, and some of this material is repetitive – but it has a raw, urgent directness that you might not find in a more polished work.

The initial chapters contain information about things that most educated people have an inkling of: the nexus between pharmaceutical companies and corporate hospitals; the pressure on doctors to prescribe as many costly investigations and tests as possible, to earn a pre-specified revenue for their hospitals; the lack of transparency and the emotional exploitation of patients’ families in situations where every second counts and composed reflection isn’t possible. Included here are many little stories that should startle anyone who still holds a worshipful view of the medical profession. The one about a speed-obsessed senior surgeon, for instance, who accidentally cut a major artery during a routine kidney operation, consequently had to remove the entire organ instead of just the stones – and later told the patient’s family that he had executed a heroic last-minute turnaround because the kidney was damaged beforehand. Or the one about a hospital that hid a deceased patient’s body to put pressure on the family since they hadn’t been able to pay the full bill.

There are also pointers to how advancements in technology and knowledge, welcome though they are, have had downsides, as all technology potentially does. The amount of material now available online – for patients and caregivers keen to do their own research – can be a double-edged sword (increased information about things like platelet counts, the authors say, can make people unduly alarmed about variations on test results, and thus vulnerable to avoidable prescriptions). The rise of pharmaceutical companies, which should be a good thing in principle, has resulted in excessive commercialisation, competition and questionable promotional measures such as taking doctors on sponsored overseas trips.. Read more:
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