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Flawed system shelters incompetence

By Rasana Atreya

Published nationally in The Hindu

ARUNA CHANDARAJU’S article (“Do not doctor yourself,” The Hindu, January 14), while informative, brings up other issues I would like to address.

Lots of doctors actually prescribe unnecessary medication. A case in point — I was five months pregnant when I had a major bout of food poisoning. As a precautionary measure I went to a gynaecologist in Hyderabad. She prescribed 10 medicines without asking about my medical history, what other medicines I was taking (to prevent adverse reactions) or whether I was allergic to any medication. When I asked her why I needed to use so many medicines, she said she was covering all bases. I got a second opinion from a respected gynaecologist who asked me to throw all those medicines out!

Anyone who has had prenatal checks in the West will tell you that doctors are very reluctant to prescribe medication to pregnant women because a lot of times they have no idea how it will affect the baby. In the last two weeks of my second pregnancy in the U.S. I had a pelvic bone fracture. The doctor strongly advised against potent painkillers as well as x-ray, but said that the choice was mine to make. Though in excruciating pain, I accepted the doctor’s advice.


Informed consent

In India doctors expect you to take the prescribed treatment on faith. You are rarely told about the various pros and cons, or allowed to choose a treatment plan with side effects that you can live with. More often than not, the doctor decides for you.

Aside from the fact that giving the patient the right to accept or decline treatment (called informed consent) is the right thing to do, it is also a legal requirement in the U.S.

To quote another instance, I was prescribed an antibiotic for a sprained ankle in Pune. I asked the doctor why the antibiotic was necessary. He said people come in expecting lots of medicines, especially antibiotics; so if he did not satisfy them, they would just go to the doctor across the street. He said since the doctor across the street did the same thing anyway, he would rather not lose patients!

This doctor said that abuse of antibiotics is a “Western notion” not applicable to India. The Centers for Disease Control and Prevention (USA) sees it differently; it calls antibiotic resistance (caused by indiscriminate prescribing) one of the world’s most pressing public health problems.

In the U.S., it is very common for patients to ask doctors questions; in fact questions are encouraged because the doctors want you to make an informed choice. In India it has been my experience that doctors do not think that you are asking questions because you want to know what is happening to your body; they feel you are questioning their judgment.

But we need to remember that medical errors can and do happen. No one is infallible, least of all doctors. In November 1999, the American Institute of Medicine published a report saying that as many as 98,000 people die in American hospitals each year as a result of medical errors!

In the U.S. you can call the State Medical Board to see what qualifications the doctor has, how many malpractice complaints there have been against him/her, etc. In India doctors are not required to post their license number in their clinics, or on their prescription pads. They are not even required to periodically update their medical knowledge and get tested for it.

An additional safeguard in the U.S. is that your pharmacy’s computer keeps track of the medicines you have taken previously. The pharmacist will often warn you about medicines that have a potential to interact.

Finally, I have never forgotten a line I read in the Reader’s Digest a long time ago, “Even the guy who graduates at the bottom of his class gets to call himself a doctor.” This is especially worrisome to me because in India we have no way of tracking medical incompetence.

I am not trying to say that U.S. doctors are superior. Indian doctors are as good as their American counterparts, if not better. What I have a problem with is our flawed medical system.

Published in The Hindu, all editions
Sunday, Jan 28, 2007

http://www.hindu.com/op/2007/01/28/stories/2007012800051400.htm

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