My Tryst with Medical Inadvertence
By Vikash R. Keshri
My parents live in a district town in Bihar, approximately 225 kilometers east of the capital, Patna. Retired from government services, both of them are generally happy and content with life, barring some physical discomfort common in the geriatric age group. As a rule of thumb, I ensure to arrange and oversee routine medical treatment required for them. I generally call them to my place in Patna and facilitate treatment using my medico network. But, during an emergency or sudden requirement, they eventually have to rely on the private providers at their place. During the last six years, at least in three such instances, we had some very weird experiences. Ironically, all such experiences were encountered with genuine and well-qualified medical specialists. I am sharing these stories here not to complain, but to raise genuine questions and discussion.
An acute Pancreatitis which never was
On a gloomy Friday morning in 2015, I received a call from my mother who sounded worried due to my father’s aggravated symptoms of severe acidity and pain abdomen. I advised them to immediately consult a physician. They could finally be seen by a physician (MD-Medicine) after a couple of hours. The physician examined the patient, recorded an electrocardiogram (ECG), and then prescribed a battery of tests including USG- whole abdomen. In the meantime, he prescribed some antacid and antiemetic drugs. The next day, all hematological report and report of USG was available and the family consulted the doctor again. while my father’s condition kept gradually deteriorating. The USG report concluded the diagnosis as a feature suggestive of Acute Pancreatitis and Mild Splenomegaly. The physician zeroed on this and prescribed medications recommended for cases of acute pancreatitis. Four days passed, but my father’s symptoms kept deteriorating gradually. Finally, after four days of hopeless optimism, I decided to travel to my native town with a plan to bring my parents to Patna and arranged an appointment with a gastroenterologist in a large corporate hospital on the next day. On the fifth day after the onset of symptoms, finally, we met a gastroenterologist who after examining my father advised to continue the same medicines but prescribed a repeat USG at this hospital. I was visibly dismayed but decided to follow the protocol. The USG was conducted the next day and the report ruled out pancreatitis or splenomegaly and found pleural effusion. Following this, we were asked to consult a chest physician who after examining my father advised admission and HR-CT scan of the chest and also advised immediate consultation with a cardiologist in the Cardiac Care Unit (CCU). We rushed to CCU, where the cardiologist on duty examined the patient and conducted an ECG and echocardiography. He immediately informed me about the severity of the condition, informing me that my father had suffered a massive myocardial infarction last Friday (seven days back), the day of onset of symptoms. He said that the ECG on the first day showed early signs and a repeat ECG after sometimes could have clinched the diagnosis. We were informed about the patient being in heart failure with ejection fraction being is as low as 20%. He said he will admit the patient in CCU with high-risk consent and will observe for improvement for the next 48 hours. If the patient improves, then they will do further management. Fortunately, my father responded well to treatment, three days later he underwent angioplasty and six days later he was discharged with the stent in his coronary artery. He is doing fine for the last five years, especially considering his age.
I thought of suing the radiologist for such gross negligence, but my parents discouraged me. To date, I do not know the exact reason for such casual misdiagnosis. The most probable explanation ever suggested to me was the probability of exchange of report on the computer with other patient’s reports being printed against my father’s name, just guessing as I do not know the answer, neither I ever asked the concerned doctor.
Trapped to infuse haematinics
In 2020, amidst the COVID pandemic, my septuagenarian father often had anxiety about landing up in a medical emergency and failing to access proper treatment due to movement restrictions. He often complained of weakness and dizziness in the morning. I advised him to go for some basic hematological tests and thyroid profiles. The hemograms showed hemoglobin (Hb) to be 10 gm%, blood sugar was normal. I advised him to wait for the thyroid report, considering his previous history of ignoring mild hypothyroidism. But he was anxious and decided to visit a physician nearby. The physician just discussed history from a distance and didn’t conduct any physical examination due to COVID fear. He also ordered repeat hemograms from his lab, where Hb was reported to be 7%. The physician advised stopping all routine post angioplasty medicines, replacing them with a new set of medicines, and also advised infusion of iron. The staff at his clinic started forcing my mother to infuse a 5000 Rs. iron warning about the patient being serious. My mother said she will come later for this and called me for the suggestion. Based on history, my judgment was not pointing towards a 7 gm% Hb, so I suggested going for another Hemogram from a more reputed and trusted lab before taking the final call. Clinically, my father was stable. The next day the Hb was reported to be 11 gm%. Meanwhile, the thyroid function test report suggested mild hypothyroidism. In consultation with my endocrinologist friend, He has prescribed a thyroid supplement, he is doing much better now.
Although, there are high chances for laboratory variation for Hb estimation, the aggressive persuasion by the staffs at physician’s clinics was highly suspicious. Moreover, the focus on 5000 Rs. caused suspicion. I am not sure but if this was the case of luring for unnecessary treatment for petty gain? But, the sequence of events is quite convincing.
Cleaning the dirt/infection
In the mid-2010s, my mother started complaining of dizziness and heaviness in the head on regular basis, she informed me about her problem. I immediately asked her to meet a Physician (MD-Medicine) in his private clinic. The physician found her BP to be hypertensive range. As per protocol, he advised certain routine investigations such as haemogram, lipid profile, liver, kidney function test, and ultrasonography (USG) whole abdomen, etc. Fortunately, all test reports were found to be within the normal range. The physician then prescribed some medicines, reassured her, and asked her to see him again after 5 days. After returning home, she called me to narrate the proceedings. I enquired about the medicines she was prescribed and got confused about learning that along with antihypertensive (BP controlling drug), she was also given cefixime (a high order antibiotic), multivitamin syrups, and pantoprazole. I checked with many physicians to understand the rationale of such polypharmacy, none justified this. Thereafter, I suggested my mother politely ask the doctor about the rationale for prescribing antibiotics and multivitamin syrup during her next meeting. She was reluctant and argued with me for suggesting so. I tried convincing but my parents were non-negotiable on this suggestion. Finally, I gave up, but to my surprise, my mother called me 5 days later to inform me that she asked the physician about the reasons for prescribing antibiotics and multivitamins. She said the doctor convinced that multivitamin will provide you strength and help counter dizziness and antibiotic was prescribed just to clean any dirt/infection in the body. I kept quiet, as I had nothing to say.
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Disclaimer:
I am a medical doctor and a proud member of the medical fraternity. I have the highest respect for all members of my fraternity who often provide services in difficult circumstances. The ongoing pandemic has reiterated and convincingly demonstrated this. This story is based on my real-life experiences and all the facts mentioned here are true to the best of my knowledge. The aim of writing this story is not to complain but rather to raise some genuine concerns and questions about the way medicine is being practiced by a few members of the community.