Wednesday, September 19, 2007

My thoughts.Screening for disease

Two days ago I dwelt on the matter of doctors/ institutions performing unneccessary tests and the reasons why they do these, at least why they do in this country [India]. I also said that screening for disease is required and it should be selective. Let me elaborate on this a bit. Let us presume that a woman has a history of mother or her [mother's siblings] having had breast cancer.Then it becomes mandatory that this lady needs screening for breast cancer through out her life.This includes 3 monthly self examination of breasts beginning at 20 years and a mammogram from the age 25 owards [follow the laid out protocol as to the periodicity, older the patient more frequent the screening]. Let me give another example. A smoker needs a chest xray done every year even though he remains symptom free.The risk of radiation in him is too small compared with the risk of getting lung cancer. A person who has a strong family history of diabetes, hypertension, heart disease, cancer colon also needs to be screened.
What about this bogey of blood lipids and statin use? Blood lipids when abnormal needs to be monitored and treated with statins. But on routine testing if a person is found to have normal levels of lipids he needs no furthur testing for next 5 to 10 years for lipids. Same is true for blood sugars.
Often patients pressurise doctors to do these tests. Doctors should become educators and should be willing to spend time with patients. But where is the time? This brings me to another topic of waiting time at doctors chambers.

Recently I was asked to comment on an article criticizing the ways doctors work in India. The author was very critical of the way the patients were taken for granted and he had suggested ways to improve the patient management methods. He was all praise for the system that is being followed abroad. Though biased he had made several valid points. I thought it is worth bringing these to the notice of our readers

Patients waiting time. In most busy practices this is common. A full waiting room can be stressful to the patient and the doctor. It may give the doctor confidence and satisfies his ego, but to the patient it will mean stress filled boredom in addition to avoidable waste of time. It is also unhealthy for the patient and attendants as it is ready made for cross infection. Is there some way we can lessen this rush? The author goes to great lengths to describe the advantages of appointment system and tells us that it is a win win situation. Let me share with you my experience. I see patients by appointment for two hours every day. Many don’t keep the appoimtment.The reason given is forgetfulness, being out of station or simply that he got better and therefore didn’t feel the need. The other less told reason I suspect is that he has gone elsewhere to seek attention. Basically our patients are not captive; in the sense they are abroad where they will have to see one particular doctor as the health scheme they are members of dictates it. In such a system it is not difficult to follow the appointment system. Here we also have a large number of acute cases who demand urgent attention, how would one accommodate these which form at least 50% of our practices?
One way out is to see all chronic cases and follow up patients by appointment and others as and when they come at a given time. Feasible you think?

Sits up front at a meeting
Looks keen and interested
Laughs and claps loud
Knows how to suppress a yawn
Asks questions and also answers
Doesn’t know what is right and what is wrong
Is a doctor long past his prime.

1 comment:

leelahp said...

My primary care physician (GP) arranges appointments somewhat in the way you suggest. If you call in the morning and have a pressing problem, they will give you an appointment for the same day or next day. Otherwise, they will schedule you in when they can (often within the month or so). Also if your problem arises later in the day, then there is an urgent care center that runs 2pm to 11pm, where a doctor will see you (by appointment (if available) or walk in). The cost for a visit at the urgent care center is higher, though.