I have my origin in the big town of Bellary, now a city. Life used to be simple back then. We went to a nearby school. We used to be vaccinated regularly too. When we were sick, mostly my grandfather used to give medicines and we would be alright. Taata was a medical practitioner and treated people with Homeopathic and Ayurvedic medicines.
I have professed my interest in the Medical field elsewhere on this blog. This interest probably came from seeing my grandfather treating his patients day in and day out. The medicines were usually kept secret from the patients, the reason being that many of the ingredients that went to form the medicines were used almost daily in the kitchen. (I knew them, since I was the privileged helper.) The aura of mystery, and more importantly, total belief in the doctor and the medicines probably helped recovery. From simple diseases like gastritis and menstrual cramps to scorpion bites and jaundice - I have seen him restore the health of many people. And when he was baffled or was unwell himself, he went to another doctor, Ananth, who visited weekly. This was my earliest experience with healthcare - simple, fairly dependable and very affordable. Taata and Dr.Ananth did not prescribe any fees for their services. They accepted whatever the patient gave. My grandmother recounts instances where my taata himself gave some money to the patient, because he/she was so poor. His technique was also simple. He used to feel the pulse of the patient. That information along with the symptoms were, almost always, enough to give him an idea of what ailed the person. Dr.V.S.Ramachandran, in his ‘Phantoms in the Brain’, recounts of an instance when his professor told him to observe the nails of the patient. A change in the angle between the nail bed and the finger would always mean the onset of malignant lung cancer. This simple, noninvasive diagnosis could be made far before more serious symptoms appeared. Diseases like typhoid and Rubella can, apparently, be diagnosed by their characteristic smells, and Parkinson’s by the gait of the patient.
Things ceased to be this simple in the medical field, long ago. Gone are the days when doctors used to feel the pulse of the patient routinely. A doctor is always seen with a stethoscope, one of the first and most useful medical instruments. What with the heart monitors and EKGs and oxygen monitors and a zillion other instruments available today, reading pulses and diagnosing illnesses by smelling or hearing a person walk, is an art that might well be preserved by doctors stranded in remote islands.
Heart monitors and oxygen monitors are just the beginning. We now have electronic instruments for measuring almost any bodily function. Good old steam inhalation now has electronic measurement of temperature, and pressure and what not. (A humorous aside - my son then about four years old, a gadget-freak, looked at the nebulizing unit at a hospital and said with a wide smile "Amma, I want to be a doctor who can uset that machine"). We have ventilators and pacemakers that were unheard of in older times. While it is indeed heartening that we have now reined in technology to be on our side in our fight against disease, it is really disturbing that in this fight, we subject our bodies to great torture and never learn to let go.
In the olden days, certain illnesses were just accepted. When my granddad had a stroke, he took some strength-giving medicines but did not get his blood pressure checked or take beta blockers. My grandmother says proudly that she has never undergone any tests - just took an injection (she forgets which) while pregnant with my Father, that's all. Now, at 86, she is fairly healthy and fairly strong for her age.
Things have changed for our generation. We are more aware, healthier but also very scared. I suppose that scare can actually be justified. Take iodine, for example. The deficiency of iodine causes some irreversible problems. When iodine is lacking in a child's / pregnant lady's diet, there are high chances that that child will develop mental retardation. Goitre is a well-known illness, also caused by iodine deficiency. To prevent these diseases, salt companies started adding iodine to salt. This has gone on for a while now, resulting in another side-effect, that of a non-functioning thyroid. Unfortunately, this can also be rather dangerous if undetected, as thyroxin is required for each and every function in the body. An under-working thyroid might be the cause of an enlarged heart or obesity or just any condition we can think of. Now, if the solution is as simple as getting a blood test done and taking thyroxin everyday, why not do it? Why rely on your intuition only, when you have a foolproof, if only more invasive and expensive method to diagnose a problematic thyroid? Removing iodine from salt is definitely not an answer, so the mandatory checking of thyroxin levels is.
That was just one example. Many doctors now recommend taking the HbA1C test, instead of / in addition to the traditional fasting + post-prandial blood sugar test. For people over thirty five, annual treadmill tests are mandatory. Multivitamins and multiminerals are prescribed regularly. After a certain age, Aspirin in your prescription is considered normal. But wait, this is for well-adult check-ups; taking those tests do not demand much of our time and energy, and one should not have any complaints. However, suppose one goes to the hospital with high blood pressure and is unfortunate enough to get admitted (it is a damned-if-you-do-damned-if-you-don’t-do situation, really), he/she is started immediately on medicines like Atorvastatin and Sorbitrate, even when they are quite unnecessary (and are likely to cause complications).
But the most unwanted involvement of medicine has to be in the childbirth area. Three of my cousins were born at home, two delivered by my grandmother. They are hale and healthy and doing very well. A fourth cousin was delivered (at the insistence of my uncle's family) at a hospital. He is doing fine, too. The point is that being born at home was not bad for my cousins. These days, as soon as one gets pregnant, they start thinking about c-sections and epidurals. (I am ashamed to say that I did, too). Heck, even for 'normal' deliveries, episiotomy is routine here in India. As are oxytocin shots. While these are established as safe, they take away the feeling that birth is a natural process.
Gawande, in one of his articles titled ‘...Insurance Imbroglio...”, talks about a hospital where the nurses regularly went on house-visits to check on the child asthma patients admitted to their hospital, and thus reduced the readmission percentage considerably. This left many of the hospital beds empty and reduced the hospital profits! As Gawande says, it is not easy to work out a mutually beneficial (beneficial to both doctors and patients) solution.
So what is the solution? According to a recent poll, the top issue for Americans is healthcare. What they mean by healthcare is obviously high quality diagnosis and treatment that's also affordable. Unfortunately with medicine becoming another corporate industry, this looks difficult to accomplish.
