An experience with doctors

I have a problem called folliculitis over the past year and a half which results in random and unexpected skin infections. Although the problem is not per se very serious, it can get pretty painful, socially awkward and cause disruption to productivity. The infections occur randomly with no specific cause. Trying to get this problem properly treated has been an interesting and not fun experience. I saw a bunch of doctors over time with no resolution to the problem. Finally I had the luck to bump into a great doctor who solved the problem for me with minimal trouble (more on that below). But what was disturbing about the experience with the other doctors was how different their prescriptions were, from what actually worked finally.
I overall saw 7 doctors about this problem. The range of options suggested included:
- undergoing (expensive) antibiotic courses
- doing (expensive) blood tests to find out what was the exact nature of the infection
- using an antibiotic soap and a nose ointment
- yoga and meditation. This from a Manipal Hospital doctor who looked ill at ease and out of depth and suggested that there was nothing much that could be done.
- getting hair replacement therapy. Really. One joker of a guy was disappointed to see that I had come to him with a skin infection instead of a baldness problem. After cursorily looking at the boil and prescribing antibiotics and a blood test, he tried to sell me a hair replacement treatment course. This guy was also morbidly obese and badly dressed, hardly the kind of personality to inspire confidence.

With no progress (and taking the Manipal docs advice seriously) I let the problem lie for a while. Then, I again tried to address it during my sabbatical when I had some time. Having no way to identify a good doc, I decided to pick a few doctors and try a consultation with all of them. I got really lucky with the first doctor (Dr. Divya Appachan) but decided to go ahead and see one more, just to follow through on the original plan. Doing that provided a nice comparison, since I visited them both on the same day with exactly the same symptoms.
The two doctors were a study in contrasts:
1.) Dr. Divya Appachan spent a considerable amount of time, looking closely at each boil and asking me questions about the nature and frequency of the infections. The other doc, (call him Doctor A) took a look at one sets of boils from a safe distance and that was it. Both diagnosed it as folliculitis.
2.) Dr. Appachan explained a set of measures that I could take to manage the infections. An ointment (T-Bact) should be applied immediately as soon as a new boil shows up. The boil is likely to go away right away if that is done. In case it doesn't, it would tend to grow and a small amount of pus would form. She showed me how to poke it painlessly with a sterile needle to discharge the pus. Following that, using the same ointment should do the trick. If these measures didn't work, she said we would go to the next step of an antibiotic course. But it would be better to avoid the antibiotics. I had a bunch of questions that she listened to and patiently explained the answers to. She also suggested that the (expensive) antibiotic soap that I had been using based on earlier doc recommendations should not be needed. She did not ask me to visit again, unless I had a problem.
The treatment has worked very well so far and I'm feeling very good about it. I haven't had to visit her again.

After the quick examination above, Dr A, on the other hand, prescribed two sets of powerful antibiotic treatments simultaneously. We'll hit it from both sides he said with the enthusiasm of a child setting up a toy battle. Never mind that the battlefield in this case was my body, and the ammunition, my wallet. He asked me to come back afer a week of the treatment.

3.)Both charged the same

I guess I don't need to add further comments on the above. Its a sorry state of affairs. I think the approach of seeing several doctors before picking one is not a bad one.

New videos

Two water and sanitation movies that I edited and uploaded recently:

"Better" by Atul Gawande

I just read an excellent book "Better" by Atul Gawande. Gawande is a surgeon in the US and writes frequently and well (books, articles etc.). "Better" is a great general read, but here are two ideas from there that are simple, elegant and should be done in India too:

1.) Vaccine fund: It is well-known scientifically that most vaccines have side-effects (in the worst case, very severe) that affect a very small fraction of the people (children) who take them. Presumably, public health professionals have evaluated these incidences and concluded that the greater good is worth the unfortunate few cases. But society has some kind of obligation to those unfortunate few. In the US this is institutionalized through a small surcharge on the cost of the vaccine, the proceeds of which go to a fund for those who are adversely affected by the vaccine. Surely we should do something of this sort in India too ?

2.) A fund to cover the cost of people who suffer due to errors/negligence/bad luck etc in medical care. This is not there in the US but is there in New Zealand. It comes up in the author's discussion of the medical malpractice industry in the US. If you suffer due to error or negligence of a health care provider in the US, the only recourse you have is through the courts. This is a far from perfect system as it works currently in the US. Only a tiny fraction of people who feel they have suffered from errors or negligence go to court due to the expense and the risks. When someone is awarded damages, they tend to be very large amounts. So the system delivers justice only to a very small fraction of people who have a very strong case of severe harm caused. On the medical professional's side, this system leads to very large amounts they have to pay in premiums for their malpractice insurance. The author argues that it would be much better to have a system where there is a common fund for people who suffer due to a slipup in medical care. The system does not worry so much about finding out who is at fault, rather it tries to remedy the damage done to the patient. Through this system a lot more people benefit, though there is a cap on the amount you can get otherwise the overall cost of the system would be impossibly high.

Again something that we need in India too ?

Gawande ends with a short list of 'recommendations' for medical students for them to be better doctors. One is particular I liked:

Count Something. Regardless of what one ultimately does in medicine - or outside medicine for that matter - one should be a scientist in this world. In the simplest terms, this means one should count something. The laboratory researcher may count the number of tumor cells in a petri dish that have a particular gene defect. Likewise the clinician might count the number of patients who develop a particular complication from treatment - or just how many are actually seen on time and how many are made to wait. It doesn't really matter what you count. You don't need a research grant. The only requirement is that what you count should be interesting to you.

More on the book and Gawande at gawande.com. You can borrow this book from easylib.com in Bangalore, the library service I use.

On Gold

For some time now I've been puzzling over ... gold. I have an instinctive and visceral dislike for gold jewellery (and the buying of it!). I was trying to get at the root of it and perhaps I have.

The 'buy gold' logic is very compelling. Your wife wants it. (Well atleast my wife does and so do most of our female relatives and a lot of friends, though I'm sure nowadays a lot of women have managed to stay out of it). As a guy it makes sense because it is an investment and not a consumption expense so you're keeping your wife very happy essentially without spending any money! What a win-win !

So why do I hate it so much.

I think its because all the gold comes out at events like weddings, and women overload themselves massively with it. Gold as ornamentation works upto a certain amount of the stuff ; too much and it takes away from beauty instead of complementing or enhancing it. You are no longer a person, you are a hanger to hang all this gold off of.

The primary function of wearing lots of gold jewellery is to communicate the message: 'I have lots of money'. And that's disgusting.

PS: From Sajini, here's a CBS TV segment on the same topic.

http://youtu.be/sUr2E4dfs0Y