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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