Where Has That Family Doctor Gone?

(With due apologies to all the doctors in my own family as well as those who are good friends - no offence, please.  Kindly take this as the usual random read for 5 minutes and do not abandon me as a patient when I come to consult you on my vulnerable days)

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This is not a one-man-experience.  This is the distilled wisdom gained from the nightmares of various friends and relatives, without any reference to specific hospitals or specialists. Instances are galore when we have heard of people going into a big city hospital with what seems to be a minor complaint to see a doctor, urged by wives like my own dear one, who is reading this piece now. Being forced to see ten other specialists in six hours and coming out wondering what serious malaises they have developed suddenly.  Because nothing conclusive is disclosed and judgement passed by the end of the day and they have to be subjected to another battery of tests the next day. You enter the room of the General Practitioner (GP) for a solution to the nagging head/body ache you have lived with for the past two years with no major discomfort. You think you will be out in fifteen minutes with some reassuring words and a comforting prescription from the good doctor.  But the whole proceedings spin entirely out of your control - not that you had much of that to begin with - during the next thirty minutes and soon you are left wondering if your days in the world are numbered due to some serious, unidentified malignance afflicting you, with no one making you wiser.

First up, you have grown up with such mild niggles bothering various body parts all your life, you should know when it is serious enough to warrant a visit to the doctor.  Never to succumb to the badgering of that worthy who drives your life all the time. Secondly, if you have the option of visiting a doctor who practises in a small clinic of his own somewhere, be smart enough to choose that option.  And avoid like the plague, that big hospital with all the specialists in all the disciplines and all the bells and whistles, required by the medical care experts and health insurance companies.  If you ignore these warnings and enter a corporate hospital with a big brand name, then be prepared to be sucked into the following whirlwind of a routine in the next few hours.  You go the GP to get rid of the mundane muscle spasm or sprain in your leg. There is a possibility that a junior doctor, who is learning the ropes from the senior, screens you first.  Once you have answered all the questions multiple times and a fact sheet is filled up, your file is forwarded with you to the senior.  When the senior asks the same or more questions, there is a chance that he discovers that the junior goofed up somewhere and insists on having an inquisition right then and there in your presence.  All polite and seemingly harmless, of course, but nevertheless the junior goes through the extreme discomfiture of being grilled in the presence of the patient. But the overbearing senior has no qualms because he always does this in the presence of patients for that extra bit of satisfaction and fun derived.  Once this process is over and the junior is suitably chastised for assuming he is the same as the senior in terms of prowess, the problematic location in the body is examined collectively by the junior, senior, a nursing assistant and a couple of even more junior interns, apart from any paying spectators if they are interested. Nobody gives a damn if you are feeling like a worm under a microscope and would rather shove all the attention away, so you put up with that circus with you serving as an object of instruction and edification. Just as you are hoping that a prescription will be given and you could be on your way, you realise that what is transpiring is only Act 1, Scene 1 and a whole lot is yet to follow - picture abhi bhaki hai dost!

After a rapid-fire exchange amongst them, the senior tells you that you should see a Physiatrist (read the spelling carefully, there is definitely no artist hiding here, but a muscle specialist) for further examination and opinion.  Fortunately there is one just two cabins away for the convenience of sacrificial lambs like you and thus begins your grand tour of the various nooks and corners of the hospital facilities. Of course, the GP and the Physiatrist are good friends and this kind of mutual passing of the patient happens frequently for whatever reasons.  Now, the same scene which played in the GP's cabin is replayed in the Physiatrist's domain.  After fifteen minutes of talking and examination, the judgement is given that the problem is not with the muscle.  Your file grows a bit fatter with a couple of more sheets, being the contribution of the Physiatrist and you return to the GP and wait for the file also to make the same journey through official channels.  After listlessly waiting for half an hour for the busy GP to see you again, he beams looking at the file as if he has found the panacea for all your current and future ailments and declares `I knew it was not the muscle, that is why I sent you to the Physiatrist.  Now, I recommend you meet the Orthopaedic who is on the first floor'.  

The Ortho is even busier than the two previous doctors put together (it is obvious that bones are made a lot flimsier by God nowadays thereby making the ortho a flourishing line), so you wait for an hour more and watch the endless procession of  people in casts, just plain limpers, some on wheel chairs and some really serious cases brought on stretchers.  Your mind is whirring about, wondering which category you will soon be put into, without realising it is not so simple.  The ortho looks at the body part and asks you if you have an x-ray.  When the response is negative, he just brusquely nods to the nurse, who prepares a prescription to be signed him, asking for an x-ray of your leg in frontal and side views.  The radiology department is on the 5th floor and you wait for the lift to avoid straining your leg even further.  There are six lifts but all of them arrive full, you run jostling among the people to enter but for some strange reason, they depart without taking anybody in or ejecting anyone out.  After a repetition of this tamasha for the next ten minutes, you get fed up and climb the stairs.  Here is the nub. If your foot was okay to begin with and there was just a small swelling, this entire ordeal would have aggravated the problem quite a bit and provided some fodder for the ortho.  In the X-ray room, you wait for another forty five minutes because all those limpers, wheel chair occupants, stretcher dwellers and other assorted people in casts have already camped here before you, gaining seniority over you in the order. When your turn comes, you undress partially and get your legs twisted in five different ways for four exposures to x-ray.  They would examine the film and invariably find that one of them is not really the piece of art that they expect their work to be, so they will go through the rigour once again.  X-ray personnel would tell you that the films and the report will be ready in the evening and can be picked up from the reception.  When you dumbly stare at their faces and mumble that the Ortho is waiting for the films, they will hum and haw, stage a mini-conference of sorts and make a huge concession to say they will send the films and the report to the Ortho eventually (please don't try to fix a time) and you should go back to him and yes, wait longer.

The direct line from the radiology department to the Ortho's cabin would take four minutes to cover, if the lift blesses and accommodates you and ten if it does not.  But the film would not arrive for another hour and a half, as if it was transiting through the International Space Station.  Invariably, this means you would make at least one additional trip to and from the Radiology section to remind them, by now limping a bit and putting additional strain on the already doddering leg. When the film finally arrives and the Ortho takes a peek, he would shake his head dubiously such that you wonder if you require an amputation forthwith.  But that head shake was indicative of the fact that the Ortho did not see much more scope for extracting anything from you, based on the x-rays.  He declares suavely, pointing you in the direction of the x-rays on his well-lit screen, `I cannot see anything wrong with the leg in the x-ray'.  So, if you thought of jumping in joy because your ordeal has come to an end and you can go home, you should hold your horses - he grimly says `it is better if you get a scan done.  Sometimes we can see things in the scan which are not visible on x-rays'.  Interestingly, if you were carrying an MRI film and no x-ray, there is one hundred percent chance that the Ortho would feel that x-rays would be more helpful than the MRI film.  Either way, you are stuck without an immediate exit route, unless you are peeved enough to turn your back on the entire dog and pony show.

Now, Hamlet kind of decision time for you.  `To do MRI or not to do that'.  Apart from the fact that it costs a bomb, it is a very spooky experience, when you are completely cut off from the rest of the world, shoved into and incarcerated within a tomb like structure, which makes a hell of a lot of rattling noises of various types and decibel levels. Your initial apprehension as you are moved into the machine will soon grow to panic as you imagine that all the others leave you inside for incubation and go away for the day and there is no way for you to get out of the machine. And it is a thirty minute joy ride.  The left side of the remnants of your brain will initially tell you `no need, go home, they are making a sucker out of you'; followed by `what if there is some serious problem in the leg which can be identified only through MRI, so do it', thereby creating a serious conflict you need to untangle.  Not wanting to come to the hospital again, you go through the MRI, repeat the x-ray film experience and finally meet the Ortho with the MRI films.  Now his well-lit screen is fully occupied by the films and he points out various segments, explaining something which you don't get any way.  Finally, he says ` I will give you a prescription.  You see me after 10 days'.  Just like that.  It is all over.

You numbly stare at the prescription, which says `Dolo 650 1-0-1 x 5 days, Any pain relieving spray - twice a day'!! You wonder whether to laugh in relief or cry in despair.  The whole hospital experience involving 8 hours and 15,000 rupees for just that, you may wonder.  Yes, you could have done that yourself without any GP or specialist looking at the problem.  The situation would have been somewhat better if you had gone to a neighbourhood doctor practising in his own small cubicle.  He would have, at the most,  wanted an x-ray and the whole issue could have been resolved with that, hopefully.  That too, only because the Physiatrist or Ortho or other specialists are not available in the vicinity and there is no MRI available on the premises for him to refer you to.

Either way, you would go home, do hot water fomentation twice a day, take Dolo twice a day and do the spray joyfully twice a day.  Phew, what a tour of the hospital to get that pleasure!!  When I describe the whole process with a healthy dose of scepticism to my dear wife, she looks at me with sympathy and says a big hospital is better any day - no explanation offered, but to be understood.