1. This post was not written by me.
2. It is entirely hypothetical. Therefore, it is likely to be truer than the real news you read in the papers.
3. The blog owner, unlike his moniker, is not really a doctor.
4. If he is, he is one mean son-of-a-bitch (a Rambodog), who will likely be condemned by the honorable medical profession for besmirching its fair name.
Read at your own risk.
So you are unwell, and your doctor has ordered some tests? No? Maybe you need to take an executive health checkup or a pre-employment checkup: a clearance that will take your career to the next level?
Whether or not you hate hospitals, doctors and needles (for few are able to hate the nurses), you are going to be subjected to some tests one of these days.
This post is not meant to be a detailed exposition on medical labs. I will merely reveal some of the lesser known aspects of tests.
* Comprehensive health checkup, something that has been popularised by many leading hospitals, is a big rip-off. Not only do the hospitals make money doing so, but the down side is that diseases are revealed, when they probably would not have needed treatment at that time, if ever. In other words, not all abnormalities need to be detected or treated.
Let me give you an example:
Ajanta was a 26 year-old executive who was asked to undergo a health checkup at one of these modern Indian hospitals. An x-ray of the chest revealed a spot like a coin in one of the lungs. The doctor asked her to go for more tests to diagnose it.
“Is this cancer?” she asked, trembling.
“I can’t say, but it could be in some cases”, replied her doctor.
A CT scan of the chest was done, and the lesion was biopsied with a needle. Unfortunately, the needle went into a blood vessel, as well as into some airsacs, and Ajanta started getting faint and breathless as the blood and air kept leaking into her chest cavity and compressing her lungs.
Rushed to the emergency room, a tube drain was placed surgically into her chest to evacuate the blood and air. As she recovered from this mishap, more bad news came in. The biopsy was inconclusive. Another one would have to be done.
Aparna Ajanta left town for the best center in the country. Another scan-guided needle biopsy was done. The biopsy was again inconclusive.
Now she was heading towards surgery to remove and biopsy the coin lesion. The job was done cleanly by an experienced thoracic surgeon, and Ajanta recovered. The biopsy result?
Hamartoma, it said.
“What’s that?” she asked. Her doc replied that it was really not much except some abnormal tissue that was not a cancer.
If she had not known of this, she would possibly not have ever needed surgery for it.
Aparna was a Victim Of Medical Imaging Technology. VOMIT, in short.
VOMIT syndrome is now a well known complication of fruitless testing that throw up diagnoses that would often have been better left alone and unknown. This is one major reason why ‘let me find out if everything is okay in my body. Doc, I want all the tests, including the scans” is NOT a great idea. Treatment of many conditions is undertaken only because tests (like the chest x-ray in Aparna’s case) are done without indication, and doctors feel obliged to treat the newly diagnosed ‘disease’. Indeed, why do the tests if we are not going to treat what is found?
Other aspects of medical testing include:
* Poor standardisation of labs results in wrong reports that are sometimes dangerous.
Most labs are run with poor equipment. The tests are often done by unqualified technicians, and the pathologist or biochemist comes in only to sign the report. These doctors are rarely paid well enough for them to give much time at a lab. They, therefore, rush out of the lab after signing reports. Another center, same story. End of the day, some money has been made, but a bunch of useless or misleading reports are sent out.
* Labs, usually the ones not doing particularly well, give a hefty cut to the referring doctor, usually a medical specialist (internist). Of course, any one, from a general physician to a neurosurgeon, may avail of these ‘interpretation charges’ (‘IP’ in marketing jargon). Unfortunately, they might refer the patient to the highest bidding lab rather than the best one. Many doctors have their own lab, which could be another glorious example of the above prototype.
* In many Indian cities, of which Mumbai is a particularly obnoxious example, labs cheat patients, as exemplified by the Cheaterjee Labs. Look at this:
The marketing exec of the Cheaterjee Labs is telling the GP:
“Sir, we will cater to all your patients, rich or poor.
Please follow our system for the best results:
If you don’t really need the test, write out the tests in blue ink; we will just type a report and not waste our resources doing the test. In this case, we will give you 50% of the costs.
If you need us to give you a favorable report (for example, a higher blood sugar report, or a positive test for syphilis), please write in red ink. We will give you 40% of the costs of the tests.
If, however, you actually need us to give you accurate results, write in black. Your IP charges will be 30%.
Sir, here is a compliment from Mr. Cheaterjee, our Director. Please accept this set of three pens!”
Our GP is one smart cookie. He mainly treats the migrant laborers of Kurla, a Mumbai suburb. The Biharis and Bangladeshis are his patients. Illiterate, these poor, unsuspecting idiots think there is only one answer to their ailments: injections and glucose infusions.
For any problem, the GP admits them in his local hole-in-the-wall nursing home, and gives them the expected ‘treatment’. If the ‘customer’ is possessed of a little more cash, then tests are done. Now, the three-ink plan comes in handy. If the doc wants to squeeze some dough out of the patient, he can get a positive report for, say, syphilis, and then keep giving regular injections of penicillin, making a buck every week. A few such patients, and he has his sight on his next mutual funds investment.
* Most Government labs are horribly run. Exceptions are some of the good teaching hospitals in major cities.
* Most of the top private hospitals have decent facilities, but reports may vary. In case of cancers, it is the skill of the pathologist that makes the difference between right and a grievous wrong.
* Almost all healthy young patients below 40 years who need a routine surgery need NO pre-operative tests (useless, expensive, and wasteful). This international recommendation is zealously ignored by 99% of doctors.
There, I said it. Will I be a leper in the community of doctors now? Oh, I forgot, I am only a virtual one!