Wednesday, April 22, 2015


     I am now in practice of medicine for long time . I was talking to a student yesterday , when I told him that I would like to have better doctors in the future, as when I will need them , I want to be confident about their ability to diagnose and treat any condition. I am some what disappointed in today.s medicine. This does not mean that every one is not good or does not know medicine.But it reflects MY opinion about the current state of MEDICAL PRACTICE. No one gets paid to THINK ,and so gets paid to DO tests or it is easier to order tests. This may have to do with medical malpractice fear or demand by patients or any other reason. But result is same. Now many business entities are taking over medical practices and it is going to get worse as these Businessman do not know medicine and are in to medicine to MAKE MONEY . But what I am writing today is something little different . When I have a difficult case , I would refer him or her to centers like Mayo Clinic or Shands hospital or some other local or out of state reputed center.But when they can't help the patient any more than what I can do , then what?Let me tell you couple of stories.
     I saw this patient with possible unresolved pneumonia .He was about 42 years of age and had a history of brain tumor and surgery for it done .He also needed a shunt to drain the fluid from around the brain ,as otherwise the pressure build up around the brain will be detrimental. He was worked up by me and as it turned out he had scar tissues in the lungs . He was also obese and had some pressure built up in lung circuit, call pulmonary hypertension. I started him on oxygen and then the therapy for pulmonary hypertension. Till last October -November , there was no specific treatment for the scarring in the lungs .I had tried some steroids and it did not help I tried to get him for lung transplant .But due to various reasons he was rejected He did OK for couple of years and then started getting worse. I did put him on new therapy for fibrosis . But he continued to get worse. He was seen by one center in past and they could not do anything more. So I called other center, to see if they could do any thing. They agreed to see him. But over period of 3 months he continued to get worse and his need for oxygen continued to get bigger. After extensive concussion he was sent to Hospice and he died.I knew that I could not do anything more and I also knew that Mayo could not have done anything more. But then that is my question. What do you do when there is no further road. It is easies for doctors and probably for patients , when the diagnosis is cancer, as every one KNOWS and ACCEPTS the inevitability of the death with that diagnosis.But  when we have other diagnosis , and we can 't help and on one can answer or help, then that is what I was calling the DEAD END ROAD. The only good part is that many a times the problems are not fatal like chronic cough, and the best thing thing of all is ,it boosts my confidence ,when these patients come back with no major change in their treatment.
     So it brings me to one of my favorite statements , Medical knowledge is vast and incomplete.

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