Over the past 35 years the attitude of patients to illness has changed. Much of this is towards the better. They now realize the importance of diagnosis and don’t insist on immediate relief. They also have realized the importance of investigations in the management of illnesses. Many have taken to exercise and prevention of disease has its due place in patient care. Despite all this, one obsession remains strong. This is the love for getting injected. The belief that medication given in the injection form is better than oral form still remains strong. This is more so with the lower socio economic sections of the population though an occasional educated upper class patient surprises me by requesting an injection.
This reminds me of an episode which occurred more than 30 years ago. The middle aged man came in supported by his son. The complaint was pain in the low back radiating down the leg. Diagnosis of disc prolapse was fairly easy. Those days we made the patient’s life miserable by confining him to bed for three weeks with the additional insult of taping the leg and attaching a weight which dangled from the edge of the bed. This we thought provided the required traction and imagined the disc would slip back into place.
We also gave liberal doses of pain killers and the prince amongst these was a drug called ergapyrin [butazolidine], a highly toxic drug but quite an effective pain killer. Adding insult injury we gave this drug in the injection form which meant a house call every day. This kind of activity took most of our time. I tried to be an exception and told this patient the illness takes three weeks and he can be managed with oral medication. He would have none of this and insisted that I give him an injection to relieve his pain for the moment and later he will try my oral medication. Very reluctantly, I prepared an injection of butazolidine and proceeded to inject this into his hip. The patient stopped me and asked what was I doing? I explained. He said that is not the place to give the injection but to his leg [he showed me the calf muscle] where there is maximum pain. My reasoning that the best place is the buttock muscle fell on deaf ears. He said his own doctor always gave the injection to the part where it hurt most and it had produced the best results.
My refusals made him tell his son, ‘let us go back home and wait for Dr----- to come back’. I lost another patient. Those days I lost two patients to every patient gained because of my methods were contrary to prevailing practices. Situation since then is better but the love for injections still remains.
Taking people for a ride
I have on occasions written about the futility of yearly screening for healthy persons. But the practice is becoming more rampant as the years go by, screening must be selective and the physician should decide who should be screened and who should not be. Young fit men who have no history of heart disease are subjected to a variety of tests which includes a hemogram, urine test, Liver and kidney function tests, blood test for lipids and sugar, Lung function test, a treadmill ECG and a resting ECG, Echocardiogram and chest X-ray. Package deals are touted in the lay media and even on television. The latest gimmickry is the laboratory/ Hospital going to the person’s residence/ office to do these mostly useless tests. If you don’t come to me I will come to you seem to be the approach? In any case they will not let you go without these tests! Needless to say that there is active connivance of the medical profession and the HR departments of companies in this money wasting [making] exercise.
Screening for disease is important for some and this should be left to the physician to decide.
Going once a year to ones doctor and taking his advice is far better and cheaper way to health than getting inveigled into these unnecessary tests done by the unscrupulous investigative agencies.