The Secrets of Modern Medicine Revealed
Nabin Sapkota, MD
Dedicated to all my patients and their loved ones
A journey into the secret world of modern medical practice as seen from the eye of the doctor
MedTale Publishing
Omaha, Nebraska
Specializing in books of general interest related to medicine
Smashwords Edition
Copyright 2010 Nabin Sapkota
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Disclaimer: The information presented in this book and the website is meant to give general readers an interesting inside information about how modern medicine is practiced. All ideas expressed are the author’s opinion and should not be, in any way, taken as medical advice. You should consult with your own doctor if you need any specific advice about your medical problems.
Library of Congress Control Number: 2010903954
ISBN: 978-0-9826965-1-4
Table of Contents
Chapter 2: How does the doctor find out what is wrong with you?
Well, basically, you tell him.
Chapter 3: Why does the doctor always ask me so many irrelevant questions?
Chapter 4: My test was normal. I do not have the disease, do I?
Well, not that simple.
Chapter 5: Why would anyone lie to the doctor?
Chapter 6: My niece is a nurse.
I do not go to my doctor without her. She can really explain things to my doctor. She is my greatest asset.
Chapter 7: What can the doctor find out just by listening with the stethoscope?
Chapter 8: My friend just died from ovarian cancer.
Why do they not test every woman for ovarian cancer just like they do for breast cancer?
Chapter 9: You must be a genius to survive medical school, right?
Chapter 10: Half of what they teach in medical school is wrong. Can you believe it?
Chapter 11: Does faith matter?
Chapter 12: Should not all the doctors treat the same disease same way?
Chapter 13: I really fainted. They cannot find anything wrong with me.
I am really worried.
Don’t worry, you are lucky. I would be worried if they found the reason for your fainting.
Chapter 14: I do not really want to go to teaching hospitals.
I do not want to be seen by student doctors.
Chapter 15: I have been taking this medicine for a long time.
I do not feel any better at all, should I stop?
Chapter 16: An interesting case
There is so much mystic, magic and miracle associated with the profession of medicine that it is every father’s dream to see his child grow up to become a doctor — a person with the power to heal and save lives. Most future doctors are initially drawn to pursue a career in this noble profession with this vision of the healer in mind. They all want to become this great person who, with the knowledge and power gained from the medical school, is able to save lives and make a person smile by taking away the pain and suffering. But the road that leads to the ultimate destiny of becoming the healer is long and complex. The bars are high and the threshold to even commit to pursue this profession is so high that you need a very high degree of determination to pursue the path. Those who are lucky enough to get high grades, impressive resume and excellent source of financing get into medical school after a lot of hard work.
After they finally get into medical school, something changes. They slowly start to lose the glamorous vision of medical career and start to struggle with the day-to-day technicalities of their course material. With today’s advanced medical technology, their learning material becomes so much detailed in scientific description that they even tend to forget that the main objective of their study is to help humans. They become so obsessed with the details of bones, muscles, blood and body chemicals that they start looking at human body as something of a materialistic object that can be described in terms of the components that it is made up of. By the time they are done with the first half of their course, they have acquired extensive knowledge about how human body works and how each organ functions. It seems to them as if the whole person suddenly disappears and is replaced by an assembly of working parts, each with a distinct function.
Later on when they actually start seeing real patients, they will be reminded of the ultimate objective of their study. But, by that time, they have been so bugged down with the details of factual knowledge and scientific explanations that they no longer see, feel or perceive the romantic, magical, mystic or divine nature of their profession. By this time the words “human suffering”, “touching”, “protecting”, the same words that drew them to pursue this profession, seem awkwardly foreign and meaningless to them. Instead, they are now mainly concerned with “diagnosis”, “disease process”, “surgical procedure” and “drug interaction”. Now, they do not speak of healing, but talk about tissue regeneration instead. Now, they do not talk about relieving human suffering but talk about pain control and anesthesia. They do not talk about sadness or misery but talk about depression instead. Now they do not talk about magical touch but talk about detailed physical exam, x-rays and CAT scans.
When they actually start their medical practice after years of training, they eventually realize that they are dealing with human beings with emotions, expectations, wants, needs and curiosity. But they quickly adapt to this new discovery and develop two different types of languages and communication skills — first one to deal with other physicians or health care providers and a second one to deal with patients and their family. They try their best to explain the findings, disease process and treatment modalities to the patients in so called layman terms. But they feel that there is always a limit as to how much they can explain in this way and how much really needs to be explained.
The impact of medical profession is very profound on the society. Even a simple advice from the doctor has a long lasting impression on any family. We have all grown up with the familiar words:“Remember, what the doctor told you?” This profession is so highly regarded and rewarded by our society, yet so little is known about the “inside information” on how medicine is actually practiced. Yes, anyone knows what doctors' office look like, what hospitals look like and how x-rays are done. But very few know how medical practice actually works. They do not understand what actually goes through the minds of the doctors and nurses when they are evaluating a patient. They do not understand how doctors eventually arrive at the diagnosis and treatment plans that they make every day. They do not understand how much doctors can rely on the blood tests and x-rays and how much they cannot. They do not understand how much influence the age, gender, occupation, personal habits and family background of a patient can have on the diagnosis the doctor considers.
From the explanation so far, it appears as if there are two very different worlds of medicine that do not coincide with each other: One seen from the eyes of a doctor, and one seen from the eyes of everyone else. This book is an attempt to show a regular person the world of medicine as seen from the eyes of the doctor. Books of this nature are very difficult to find for a few reasons. First of all, most doctors have already forgotten how they felt (or how everyone else feels) about medical profession before they went into it. Second, they find it a waste of time trying to explain the reason behind the medical decision. They feel that, without the scientific medical knowledge, any detailed explanation would be incomprehensible and therefore useless. Thirdly, by revealing the doubts, uncertainties and imperfections of the medical science, they fear losing the confidence of their patients. This is why all medical advice tends to be in an authoritative and overly factual tone with conscious skipping of the uncertainties and doubts. Most of the medical books that are written for the general readers so far only offer some form of medical advice or opinion. The few books that attempt to give the readers a doctor's view of medicine are mostly personal stories rather than factual information.
This book is different in that it does not give you any medical advice but tells you how modern clinical medicine works. It explains to you in a simple factual manner how doctors process the information obtained from your blood tests and what goes through the doctors’ mind when they ask you a particular question. It tells you what the doctor is listening for when he puts the stethoscope in your chest. It gives you interesting facts about what doctors learn in medical school and what they learn outside the medical school. It tells you how medical students and doctors at different stages of their training interact with each other and how that might influence your hospital experience. It explains to you about why they do screening tests for certain diseases and not for others. It explains to you what it means when the media reports the findings of a new drug research. In summary, it gives you the little secrets that are taken for granted in the medical profession but would be very surprising and exciting to the outsiders.
I, myself, had all these doubts before I decided to write this book. I happened to remember and cherish my memory and my feeling towards medical profession before I went into it. But, I too was immersed in the technical details of the medical world during my medical school and during my clinical training. When I started my medical practice, I tried to be more passionate and looked directly into the patient’s eyes and started seeing the human being in front of me. I tried to find out not only about how her organs are working, but also about how she is feeling about seeing the doctor and being in the hospital. Slowly, this refreshed my memory; I started to remember how I felt about medicine and doctors before I became one of them. After I realized there are two different worlds of medicine, I attempted to show the doctor’s world of medicine to the patients, but again held myself back as I had doubts that they would understand it. I, too, had doubts that these revelations would make me less authoritative. Subsequently, I realized that, the hospital or the doctor's office was not the best place to explain these secrets of the medical world to the people of non-medical background. I then started to answer questions of friends and family over dinner conversations and discovered how interested and excited people were to hear about these “little secrets” of the medical world. I realized that after knowing these secrets, they did not have any doubts or any less respect for their doctors. Instead, they were able to better understand why their doctors behave the way they do. After knowing about the imperfections and limitations of modern medicine, they had more respect for their doctors knowing how many things the doctor has to consider before making a particular decision. These experiences aroused a very strong desire in me, a desire to build a bridge — a bridge between the two very different worlds of medicines.
I strongly feel that there is a need for this bridge between these two different worlds of medicine and I am confident that this bridge can be built and maintained. I invite you, the intelligent reader, to cross this bridge with me. You are welcome to this world which has been kept as a secret from you — a world of medicine as seen from the eye of the doctor. You can now explore the methods, weakness, strength, excitement, joys and sorrows of modern medicine.
Chapter 2: How does the doctor find out what is wrong with you?
Well, basically, you tell him.
That is right. Even with the availability of sophisticated blood tests , highly advanced imaging with CT scan, MRI and nuclear scans, very advanced medical equipment and endoscopic procedures, the most important piece of information the doctor needs to make a diagnosis is what you tell him. This part of your medical evaluation is called the “history taking” and this is the single most important piece of information that leads to the correct diagnosis. This part of the medical evaluation also demands a high degree of skill and patience on the part of the doctor as well as the patient.
The patient is in pain. She is in agony. She wants to be treated fast. She wants to get that x-ray done right away. She wants to get that antibiotic started right away. She is in no mood to go over what happened and what she was doing when the pain started. But the doctor has to know everything; he just needs all the answers. He keeps asking all these seemingly stupid questions. He wants to know how many cigarettes the patient smoked. He even wants to know what meal the patient had and what time the last meal was. He also wants to know if the patient had any beer or wine with the meal. He does not stop at that. He even wants to know how many beers she had with the meal. He is also asking if the patient has lost any weight recently. The patient is getting impatient. She is tired of answering all these questions. She wonders why she is being interrogated instead of being helped.
This is a very common scenario in an emergency department or at a hospital bed. The patient can get very frustrated and angry with all these questions. Not only the patient, it can also be very frustrating for the inexperienced clinician or a student doctor, and sometimes even to an experienced doctor. There are certain methods and certain techniques of this process called history taking.
Although most of my patients continue to answer my questions as I keep asking them, I can see the surprise, agony, anxiety and sometimes frustration in their eyes as to why they have to answer all these details. I almost wish at one of those times that they would stop me and ask me why I wanted to know all the details. I always wish I could take some time to explain why I needed to ask them so many details about their personal life as a part of the medical evaluation. But then I realize that when someone is sick and suffering, that is not the best time to explain about the reasoning and goals of this process called “comprehensive history taking”. I will try to explain it here to all of you when you have the curiosity and time to read my book.
Symptoms of a disease and their relation to the disease that causes the particular symptom seem very straight forward. We hear about them all the time. We have commercials from the pharmaceutical companies on TV explaining what symptoms are caused by what disease and they want you to ask your doctor about a particular medicine. You also have programs on TV and radio stations where you listen to health care professionals talk about the symptoms to look for when you are worried about a particular disease. You hear about a certain disease and it's symptoms during public information campaign organized by different groups. Interestingly, whenever any celebrity or public figure is diagnosed with any disease or condition, you keep hearing about that disease in details on the media for weeks or sometimes for months. The common theme in all these sources of information tends to be the same. They have one disease, and then they have 3 or 4 symptoms, the name of the medicine to treat the disease, or the name of the surgical procedure to correct that condition. Subsequently, these medical terms become household names.
When you hear about different diseases, different symptoms and different treatments over some period of time, your brain starts to process the information in a particular manner and you tend to form a pattern about diseases and symptoms. It will then seem to you that there are a set of symptoms a patient can have and there are a set of diseases that are represented by one or more of the symptoms. It would then seem logical that you should make a simple table with 2 columns and put the names of the diseases on the left side and the names of the symptoms on the other side and match them. If you can correctly match the set of the symptoms with a particular disease, you have the knowledge to be able to suggest the diagnosis based on the symptoms the patient is having. In fact, this is the most common perception of disease and diagnosis that is present not only in the general population but also in the majority of Para-medical and other entry level health profession.
If we extend these concepts further it seems logical that someone should program the above mentioned facts into computer software. If you create a computer algorithm where you could match the symptoms to the diseases, you could be solving a lot of problems. For example, you could enter the symptoms you are having into the system and it could match your symptoms to a particular disease and suggest a diagnosis. Then you could also have a second algorithm where the computer could match the recently diagnosed disease with the best available treatment option and now you have a treatment plan. Maybe, this is exactly what we need to do to bring down the cost of medicine: replace doctors with computers!