Humor in Medicine : “Clinical Diagnosis” vs “Evidence Based Diagnosis”
MEDICAL PRACTICE — THEN AND NOW
“Clinical Diagnosis” versus “Evidence Based Diagnosis”
Story By Vikram Karve
MEDICAL PRACTICE — THEN
THE GENERAL PRACTITIONER (GP)
When I was a small boy living in Pune in the 1950’s and 1960’s — if you felt sick and became ill — you called your “family doctor” to your home — and he checked you up.
Every family had their own “family doctor” — a General Practitioner (GP) — who was like a member of the family.
He knew all about your medical and family history and you had explicit faith in your family doctor — and you had a mutually rewarding relationship.
If you were sick — your family doctor would come home to see you.
After a thorough physical examination to diagnose what was wrong — your family doctor gave you medicines — or an injection — then and there.
Then — the GP asked someone to come over to his clinic to collect medicines — which were mostly mixtures of ground tablets — or liquid concoctions prepared by the compounder — and — these medicines were given to you in bottles with dosages indicated by stuck paper strips.
A doctor friend told me that this approach is called Clinical Diagnosis.
The same process (Clinical Diagnosis) was followed by Navy Doctors on Ships and Stone Frigates — during my early Navy Days in the 1970’s — when most Navy Doctors were GPs.
Surfing the internet — I found that:
CLINICAL DIAGNOSIS is a diagnosis based on a study of the signs and symptoms of a disease.
(The American Heritage® Medical Dictionary 2007)
CLINICAL DIAGNOSIS is a diagnosis made on the basis of knowledge obtained by medical history and physical examination alone — without benefit of laboratory tests or x-ray films.
(Mosby’s Medical Dictionary, 8th edition, 2009, Elsevier).
MEDICAL PRACTICE — NOW
EVIDENCE BASED DIAGNOSIS
Nowadays — SPECIALIZATION is the buzzword.
Yes — nowadays — General Practitioners (GPs) seem to have vanished — and — you have to go to a Specialist if you fall ill.
There no such thing as a family doctor — and — the specialist will not come and see you at home.
You have to go to his clinic or the hospital where the specialist practices and you have to wait for your turn for the specialist to see you.
Then — the specialist sends you for a series of laboratory tests — blood, urine et al.
You run around to the pathology laboratory — get the tests and investigations done — and — you report back to the specialist — who then studies the reports and prescribes medicines accordingly.
The doctor friend told me that this is called Evidence Based Diagnosis.
In a lighter vein let me share with you a humorous story — surely apocryphal — that a doctor friend narrated to me on this subject.
CLINICAL DIAGNOSIS versus EVIDENCE BASED DIAGNOSIS
The Story of THE PET and THE VET
A woman brought her unconscious pet parrot to a Veterinary Doctor (Vet).
The Vet physically examined the lifeless bird and told the woman that her pet parrot was dead.
The distressed woman wailed to the Vet:
“Are you sure my parrot is dead…?”
“Yes. I am sure. Your parrot is dead…” the Vet said.
“How can you be so sure that my parrot is dead…? You did not do any tests or investigations on my parrot…” the distraught woman said.
“Madam. There is no need for any tests. I am sure that your parrot is dead…” the Vet said.
“I don’t believe you. You are just an ordinary Vet. I want to show my parrot to some good “Specialists”. I want “Specialist Opinion”…” the woman demanded.
The Vet observed that the lady was adamant on her demand.
So — the Vet nodded his head to the lady.
“Okay…” the Vet said to the adamant lady.
The Vet then turned around and left the room.
The Vet returned a few minutes later with a Dog — a black Labrador retriever.
As the woman looked on in amazement — the Dog stood on his hind legs.
Then the Labrador Dog put his front paws on the examination table — and the Dog sniffed the Parrot from top to bottom.
The Labrador Dog then looked up at the Vet with sad eyes and shook his head.
The Vet patted the Labrador Dog on the head.
The Dog went out of the room wagging his tail.
The Vet again left the room.
A few minutes the Vet returned with a Cat.
The Cat jumped on the table.
The the Cat delicately sniffed the Parrot from head to foot.
The Cat sat back on its haunches — shook its head and meowed softly.
The Vet lifted the Cat — and he sent the Cat out of the room.
Then — the Vet gave the woman a sad look and spoke to her.
“I am sorry — but as I said earlier — your parrot is definitely dead…” the Vet said to the woman.
The Vet then went to his desk — and he wrote out his bill — and he gave the bill the woman.
The woman — still recovering from the grief of the death of her beloved pet parrot — was totally stunned with disbelief when she saw the bill.
“What…!!! 2000…? Two Thousand Rupees…?” the woman protested in bewilderment.
“Yes. The bill is 2000 Rupees…” the Vet said nonchalantly.
The woman was furious.
She shouted at the Vet:
“You are charging me 2000 Rupees just to tell me that my Parrot is dead…?
This is ridiculous..!!!”
The woman looked angrily at the Vet.
The Vet shrugged.
Then — the Vet explained to the woman:
“I am sorry — but it is you who wanted to show your Parrot to “Specialists”.
If you had taken my word for it — my bill would have been just 50 Rupees.
But — you were not satisfied with the diagnosis of an ordinary Vet like me — and — you insisted that I refer your Parrot to Specialists and get some Tests done.
So — I got a “Specialist” Labrador (Lab) Dog to examine your Parrot — and — the “Lab” Report cost 950 Rupees.
Then — I got a “Specialist” Cat to Scan your Parrot — and — the “Cat” Scan cost 1000 Rupees.
That is a total of 1950 Rupees for the “Lab Report” and “Cat Scan”.
And — along with my Consultation Fees of 50 Rupees — the grand total amount is 2000 Rupees…”
Since it was the lady who had insisted on “Specialists” (and “Specialist Opinion”) — she had no choice but to pay up.
So — Dear Reader:
If you are not satisfied with your GP (and his “Clinical Diagnosis”) — and — if you want “Specialists” (and “Evidence Based Diagnosis”) — well — you will have to pay a heavy price for it.
However — even if you want to consult a GP first — you may not find one nearby — at least in cities — and you will have no choice but to go to a Specialist.
MORAL OF THE STORY
Long back — when I joined the Navy — our health was looked after by General Practitioners (GPs) — who were very competent doctors.
But even in the Defence Services — the trend of specialization started taking root.
If you want good health-care — what the country requires are good GPs — but — we tend to be producing more and more specialists — many of whom seem to do the job GPs are supposed to do.
Also — during the COVID Pandemic since March 2020 — due to Lockdowns and the inability of patients to physically visit their doctors due to COVID Protocols — a new trend of online medical consultation started — and dependence on evidence based medicine (emphasis on testing etc) increased further.
It will be interesting to observe if things will be back to “Square 1” — now that the situation has returned to normal.
Do you first go to a GP…?
Or — do you go directly to medical specialists…?
“LAB” REPORT and “CAT” SCAN
Whenever you are tempted to go to a specialist for a minor ailment — do remember this story of the “Lab” Report and “Cat” Scan.
This story is about doctors — but the “moral of the story” is equally applicable universally in all professions.
Copyright © Vikram Karve
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© vikram karve., all rights reserved.
- This is a fictional spoof, satire, pure fiction, just for fun and humor, no offence is meant to anyone, so take it with a pinch of salt and have a laugh.
- All Stories in this Blog are a work of fiction. Events, Places, Settings and Incidents narrated in the stories are a figment of my imagination. The characters do not exist and are purely imaginary. Any resemblance to persons, living or dead, is purely coincidental.
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Copyright © Vikram Karve (All Rights Reserved)
Link to my source blog post in my Academic and Creative Writing Journal Vikram Karve: http://karvediat.blogspot.com/2018/01/the-principles-and-practice-of-medicine.html
© vikram karve., all rights reserved.
Revised Version of My Story First Posted by me Vikram Karve in this blog “Academic and Creative Writing Journal Vikram Karve” on 03 September 2010 at url: http://karvediat.blogspot.in/2010/09/clinical-diagnosis-apocryphal-story.htmland http://karvediat.blogspot.in/2012/05/pet-and-vet.html and http://karvediat.blogspot.in/2015/04/medical-practice-then-and-now-clinical.htmlandhttp://karvediat.blogspot.in/2016/06/how-to-practice-medicine.html and https://karve.wordpress.com/2021/01/03/humor-in-medicine-clinical-diagnosis-versus-evidence-based-diagnosis/ and https://karve.wordpress.com/2021/09/18/clinical-diagnosis-versus-evidence-based-diagnosis-in-a-nutshell/ and https://karve.wordpress.com/2022/06/04/humor-in-medicine/ etc
© vikram karve., all rights reserved.