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| Sunday, 24 July 2005 |
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Consumer Ombudsman by National Consumer Watch Inappropriate medical investigations This week too Consumer Watch focuses its attention on medical practices and their impact on the public. Last week we referred in some detail to the question of the vital need for the early formulation and implementation of a National Medicinal Drug Policy. Our readers will realise how the implementation of such a policy will bring early and substantial relief to a public, burdened by the ever increasing cost of living. Reduction For the aged and long suffering patients, and families with children of school-going age the reduction in the cost of medicine will surely be a boon. One has only to walk into any government hospital or even a private hospital to see the many hundreds of patients crowding these establishments seeking medical assistance. Our attention to this matter was focused by a letter written by a member of the medical profession who has referred to an article in a recent issue of the British Medical Journal contributed by a British paediatric consultant. This consultant has referred to the outcome of unnecessary and inappropriate investigations done on patients by specialists. He says, and I quote, 'Ulysses fought in the Trojan war but afterwards took 10 years, with many dangerous and pointless adventures before he got back, to where he started. This is now called the Ulysses Syndrome!'. The point of this classical allusion to a by-gone day is that patients who have got caught to this syndrome find they are caught in a web of further investigations, referrals and sometimes treatment incurring great financial loss and setting in motion a very anxious time before finally being recognised as healthy, which they were in the first place! Thus the Ulysses syndrome is a side effect of unnecessary and inappropriate investigations or wrong interpretation of results. Many decades ago Doctors would have prescribed various tests where the number of special tests was not many. With the advances in medicine and diagnostic skills there is a much greater choice of investigations and of course a much higher cost of such investigation to be incurred by the patient. Specialist Does this also not impose a much higher degree of responsibility and judgment by the Consultant before they order a whole range of reports and tests? If all these tests are really necessary, no patient can reasonably complain. But if the specialist can devote but a minute or less on a patient (with many other patients waiting outside the consultation room to consult him before he rushes off to the next series of consultations in another equally crowded private hospital) then one begins to entertain doubts whether all the tests ordered were really necessary. It is really a question of one's conscience and sense of responsibility. From the patient's point of view however, his purse is so much the leaner, and his time ill spent to go through all the prescribed tests, to be a victim of the Ulysses Syndrome. Needless to say the specialist requires all the information he reasonably needs for a proper diagnosis. No one complains of that. But for a British consultant to have contributed the article in question to the BMJ, and that too in the very home of State sponsored medicine like the U.K., means that the problem of unnecessary investigations must be widespread. From the doctor's point of view medical negligence is a frightening possibility. Insurance against a claim for damages for negligence is a way out, but of course this adds to the element of costs for the Cost of Insurance will eventually get passed on to the patient. Nor can the burden of proof in a case where a doctor is sued for negligence be lightly discharged. The plaintiff will have to prove that the defendant(the doctor) owed a duty of care to the plaintiff(the patient), that there was a breach of the duty on the part of the defendant, and further that it was the breach of that duty that actually caused or materially contributed to the reasonably foreseeable damage complained of. The second and third elements noted above are not easily discharged as the decided court cases both in SL and abroad show. In any event, if the fear of a possible allegation of negligence is what causes doctors to recommend tests and reports, both wanted and unwanted, out of an abundance of caution, then the unwanted tests would yet be unjustified. A specialist or Consultant is presumed to have the skills which would enable him to identify those tests which are essential, without in any way jeopardising his professional integrity. The very fact that even in the UK as the article in the B. M.J. referred to at the outset, shows, the tendency appears to engage in a prolonged voyage of discovery, Ulysses-like. Widespread That this practice is sufficiently widespread as to evoke the censure and opprobrium of conscientious medical men is the reasonable conclusion we can come to from the very fact that a Consultant in the UK thought of writing that article. What of the local scene? Though the adventurous unnecessary and costly Ulysses Syndrome was not unknown to patients, because of their faith and confidence in the doctor of their choice, hardly anyone would dare question the decision of the doctor, even if they are knowledgeable enough to do so. Yet shortly after the initial letter in the press by Dr.Terence Perera, Consumer Watch was interested to see a letter also to the Press from an informed member of the Public who relates his own experience. To quote his letter to the Editor, he says, referring to Dr.Terence Perera's letter, how true this is!. He relates his experience thus. "I experienced this recently when tests were ordered for a patient I went with to a certain private hospital; the tests included X-rays and a full blood report, none of which was paid much attention to by the Doctor who ordered them." Investigation Here is the crux of the problem. Were the tests ordered for a proper and full investigation of the case? Was it done routinely without the need for such tests?. If the latter was the case, one finds it difficult to find justification for it. Look at this problem further. This writer goes on to say he knows a family doctor practicing near Colombo who installed an X-Ray machine in his clinic and found it was impossible to cover the costs of running the machine unless he kept on ordering X-Rays unnecessarily. This he found ethically repulsive and sold off the X-Ray machine. In some cases it is found that at least 40 CT Scans have to be done daily to maintain the financial viability of a machine. Not only would such unnecessary investigations add to the patient's costs but needless to say it will also add to the patient's anxiety and mental strain. What do the public do with this Trojan horse? To suggest that patients avoid Doctors who recommend such unnecessary tests presupposes many matters such as, that the patient knows this unethical practice of a particular Doctor. * If that particular Doctor is recommended, who is the patient who will want to avoid him because he is a keen admirer of the classical Ulysses?. * Who is the patient who will be so regardless of his own health and well- being and will deliberately disregard medical advice? * If it is a family General Practitioner who has recommended that particular Consultant, are you going to discard the advice of your General Physician? (who in the first place should have known the Ulysses like proclivities of the Consultant, and therefore if the G.P. was conscientious he should not have recommended the particular specialist). Indeed it would appear that the poor anxiety ridden patient is caught in a veritable rat trap out of which there is no escape but to rely on the good sense of the members of a noble profession. Consumer Watch would like to hear of the experiences and even more, meaningful suggestions of our readers on this matter. We are at 143 A, Vajira Road, Colombo 5. |
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