The Bhutanese Leading the way.
A 35-year old woman had pain in her leg and was operated on in the Thimphu Hospital.
A few days later, her back swelled up so she had to undergo a second surgery. Her body started to dysfunction after that and she had a problem going to the bathroom. This kept her bed-ridden for three months.
One of her relatives said traditional medicine and hot spring soaks eased the pain to some extent.
Now, though she is relatively fine, she has to visit the toilet at specific times.
Similarly, another patient suffering from high blood pressure (diabetic patient) consulted a doctor who prescribed a medicine which made her body swell. Her legs became double the normal size.
Panicked, she consulted the same doctor again who was shocked and prescribed a new medicine. But even those did not work and her family had to take her to Siliguri, India since she could not even walk.
The Indian doctor scolded them for their carelessness and said they were lucky adding that had they been late by a few more days she would have been paralyzed or not even survived.
In another case, a patient who had been diagnosed with stomach ulcer had been taking medication and avoiding certain food for a long time. But the pain persisted so she went for a second check-up but this time after the ultrasound a gallstone was detected.
Her daughter said her mother was sick since she was little and only recently after the correct diagnosis and medication is she well. “I still can’t forget the nights of suffering she went through.”
However, a psychiatrist at Thimphu hospital, Dr Damber Kumar Nirola said wrong diagnosis is not uncommon to any particular country or hospital.
He pointed out that there are several reasons behind wrong diagnosis like a patient misleading a doctor by citing wrong symptoms. For instance, many patients who have psychiatric illnesses believe they have physical symptoms and never talk about their emotions which may lead to missed diagnosis.
Hiding certain information such as saying that a person does not drink alcohol and over flooding of hospitals with patients are a few factors that may cause a doctor to examine a patient in an incomplete manner.
Asked if it is the doctor’s fault, too he said it was, partially.
But when there is a never ending queue of patients, and shortage of doctors it leads to fatigue for the examiner, he added.
“A thorough examination takes as much as half an hour and sometimes we have to see more than 50 to 60 patients.”
Or sometimes, the doctor’s range of knowledge may be limited or in updated.
The Director of Department of Medical Service under Health Ministry, Dr. Ugen Dophu said that 95% of the diagnosis is a result of verbal questioning and cursory examination of the patient and only 5% through lab and other diagnostic tests.
To prevent wrong diagnosis, the only option available right now is to limit the number of patients a doctor sees in a day, said Dr Damber K Nirola.
The Special Consultancy Service in Jigme Dorji Wangchuk National Referral Hospital from 4 to 7pm keeps the number of patients at a maximum of 12 and they are mandated to at least 15 minutes of examination.
To keep a doctor updated with the latest skills, it is mandatory for him or her to do Continuing Medical Education (CME).
According to Dr Ugen Dophu problems of this nature will be addressed once a medical college is established in Bhutan.
“We are going to have a separate subject on how to behave, communicate with the patient and try to understand him,” he said adding that such things were not taught in medical colleges in big universities.
If medical equipment or the reagents used in tests do not meet certain standards, it can also lead to wrong diagnoses.
“A good history, a good clinical examination, and a good investigation” were cited by Dr Damber K Nirola as prerequisites for correct diagnosis.
“Most importantly history of medicines taken is very important.”
As far as possible stick to the same doctor as he or she will know the patient’s medical history, he added.
Wrong diagnoses ails common people more and many goes unnoticed or unheard to Crematorium. Ministry of Health has sufficiently siphoned millions and millions of resources in travels and tours by high level officers, bought fake goods at very very high price (3or more times the original price), claimed bills for the items not supplied, supplied equipments thats not at all required in the hospital and let it to rust. They dont train enough people to practice medicine and those trained they pull up in administration and management position (hoping to be secretary). And now they say they lack doctors and equipments to test and diagnose the diseases… Its shameful on MoH’s part and pity that poor fellow villagers and oldies and babies are often a victim.
The claim that Dr Damber Kumar Nirola is making to defend the medical practitioners is wrong and in itself misleading. There is no where in the world a doctor blames a patient for wrong diagnosis. Like he said, “Patients misleading a doctor by citing wrong symptoms” is blunder he said to the media. Patients are not sure of what the problem is within, so they cannot specify what their actual problem is. How can a patient say that my liver is paining wen he/she has no idea of where the liver is? But a patient with some ache in the abdomen will not try to evade and say that he has a headache. They come with a hope that the doctors will help them. Another reason for patients not being able to open up is due to the commanding communication of the doctors. Patients open up and disclose their personal problems with those doctors who are caring and show genuine concern for the patient. Dr. Nirola, you are a psychiatrist and if you are competent enough, at-least don’t mar the professional ethics of a psychiatrists by saying that psycho-somatic symptoms are not correctly revealed by the patients. If patients have underlying psychiatric illness, that itself shows how handicapped they are to understand what is going wrong in their body. You can’t expect a patient with somatoform illness to reveal every thing until doctors develop a congenial atmosphere. These people are not to be medicated or experimented with surgical blunders. They are to be dealt by a Psychiatrist or a health Psychologist but not like one as Dr. Nirola who blames patients for their wrong diagnosis. The role of a patient is to heed to the physician’s advice and enhance medical compliance. We can’t expect them to come to the hospital and say, they have psychiatric problems. Hahaha.. what kind of defense do our doctors use to hide their ignorance. Wake up, this was the cheapest self defense.
Well good comments. The problem with all of us and more so with these so called doctors who give importance to the title rather than the skills and wisdom is that we are never open, we think what we have learned in our universities is everything and there is never a need to know more. Especially we don’t have the courage to learn from people who we think are less educated than us. We need a paradigm shift in taking accountability and responsibility.
Its not a patients fault. As my experience i had a disiese before and i was suffering with the same symptoms. When i visited psychiatrist/doctor i asked for a recheck up then doctor said that no need to check up. I requested againg then doctor said in a harsh word “no need for check up”, so is it a manner for a doctor to behave with a patient,how rude is this. All the humane being are same all have anger. If doctors behave in a good manner and have patience talking to patient so they can say what is problem of them. When a patient go to hospital they give a medicine and they dont checkup nicely. And after patient become serious the do checkup and by the time it become late for patient to cure the disease. And now a days because of the special consulation from 4 to 7pm, doctor dont check nicely in the day time and they check nicely at the special consulation timing. In the special consulation timing we have to pay and as we pay and thed get money they do things at time.In a day time when we check up or do any test, it takes a day or more to get a report and if we do test in a special consulation timing we get a report much faster than doing a test in a usual time. I heard this from one of the patient parents. Is it not true ????????????