Health, ilness and disease Who is to decide (2)

This is in response to the article 'Bridging the disease-illness divide in medicine' by Dr K S Jacob.(Please see the previous post). The article raises an issue which occasionally confronts many doctors. Patients present to clinicians with various complaints which worry them. Usually they have a real disease which is detectable by objective methods. Sometimes it may be just a doubt whether the symptom has an ominous significance or not. At other times it may be just to seek reassurance that their symptom is of benign nature . Many patients also tend to express emotional distress in the form of bodily complaints. The job of the doctor is to evaluate the symptom and explain the nature of it to the patient in simple layman's language. If it needs some form of medical /physical /psychological treatment he is authorized to administer this by way of his training and license to practice. He may also refer the patient for further evaluation by special tests or by a specialist with better expertise. In the words of Sir William Osler the duty of the doctor is "To cure sometimes, to relieve often and to comfort always". These words still continue to be true, despite all the technological advances in curative medicine, as we are able to offer cure for only a minority of real diseases. When the venue of practice shifts to huge hospitals with profit motive, the priorities change. This escalates the costs of treatment and sometimes leads to iatrogenic complications. Kickbacks from the pharma and lab industry further complicate the situation.The medical training offered to a doctor does not make him always competent to develop the skills needed to evaluate and handle patients without any objective evidence of disease. He is trained to become a practitioner with a license to practise his profession and earn a livelihood out of it. He thinks his duty is to prescribe a pill for every ill that he comes across. Otherwise he may not get paid for his service. The time spend for educating the patient about his own body / health etc is considered a waste. There also time constraints because of huge patient load. He is not given adequate exposure in handling emotional problems or counseling regarding behavioral problems. When the venue of practice shifts to huge hospitals with profit motive, the priorities change. This escalates the costs of treatment and sometimes leads to iatrogenic complications. Kickbacks from the pharma and lab industry further complicate the situation. The whole system of giving medical training has to be revamped for this situation to change. The doctors should be trained to view themselves as counselors and educators of the public on matters relating to health and disease. There should be provision for getting timely, accurate information on one's condition and the remedies available. The system of fixing pay of doctors based on the revenue generated by them will also have to go. Many private / corporate hospitals use this method of paying doctors. Patients with subjective distress / discomfort in the absence of objective signs of disease have to be evaluated by a competent physician with adequate experience and training in bio medicine and psychosocial approaches. Majority of such patients are exploited by quacks, demigods and even by unscrupulous doctors. A recent addition to this group of exploiters are the self proclaimed nutrition and wellness therapists. They charge huge amounts and provide sham therapies which have no proven efficacy. Because these are delivered in posh, luxurious ambience by 'therapists' with good soft skills, the recipient is unaware that he is being duped.