On wrong diagnosis, wrong medication and unnecessary surgery

(for a facebook group)

These things do occur. But I think the issue is complex and there is the danger of oversimplifying the problem.
1. First, we do not know the magnitude of the problem. Except for personal experience and stories from other people, there’s no evidence of how big the problem is in Nagaland. A statement like, ‘Naga doctors often give wrong medicines’ do not hold water. A person who has had two bad experiences at the doctor’s chamber may be enough for him to make such a sweeping statement. But for each complaint, we do not know if there are a thousand cases rightly diagnosed and rightly treated. To make allegations without solid evidence won’t be right.
2. Are all such complaints truly/proven cases of medical negligence or are there gaps in communication and understanding? There will be cases where patients lodge no complaint. But how many doctors are charged of negligence, proven guilty and debarred from practice in Nagaland?
3. Lack of facilities for investigation (laboratory, radiology) constrains doctors in diagnosing diseases and their management.
4. Medical Science is not like mathematics where 1+1=2. Doctors make cost benefit analysis, bargain, and negotiate with human beings who have choices and emotions. For every headache, one cannot order a CT scan. Sometimes, the diagnosis may be more costly than the treatment. Right medicine for the rightly diagnosed disease may not work either due to poor patient compliance or body resistance to the medicine, or for other reasons.
5. Doctors are human beings and there may be different ways/styles of approaching a sickness without going off track. Some may want to boast saying, ‘your previous doctor should have done this/that’. I worked in Delhi and yes, Indians sure can show that they know better. When you visit a second doctor, the course of disease might have been changed. Also patients influence the practice of medicine. There are people who think that doctors who give more medicines are good doctors.

Having said that, doctors also need to constantly update their skills; their clinical skills but also communication skills. And we need to have respect for fellow human beings as persons and not simply as machines to be fixed. The power relation between a doctor and patient can be as unequal as a slave-master relation. In a clinical setting, the doctor can be manipulative, Mr.-know-it-all, and cold as ice. It may not be difficult for a surgeon to open an abdomen and justify later, the only intention being to thicken one’s wallet/purse. Personal link to a pharmaceutical company, diagnostic lab, or a private nursing home can turn people in white coats into vultures, making money out of others’ misery.

On the whole, there is a need for change at multiple levels. Strengthen legislation and measures to check malpractice. Provide better diagnostic facilities. Carry out research. Follow standard treatment protocol and codes of conduct. Hold CMEs to update knowledge, and trainings to upgrade skills. Go for second/third opinion. etc.