36 Being smart

The Old Lion and the Clever Fox: An old enfeebled lion was confined to a cave. He got his meal by pretending to be sick, coaxing other animals to attend on him and devouring them at an opportune moment. Many unsuspecting animals had lost their lives this way. One day, a clever fox called on the lion. He stood outside the cave and exchanged pleasantries. "Why don't you come in and look me up?", asked the lion. "I better not do that," replied the fox, "for I notice a lot of foot prints going into the cave but none that come out," and walked away.

Seema was pregnant. She wished to register with a nursing home to monitor her progress and conduct the delivery. She went to Acme Nursing Home. At the reception, the public relations officer (PRO) was most cordial. "Obstetric monitoring and delivery? Madam, you have come to the right place." he told her while handing over a brochure of the hospital that listed its facilities and statistics. He asked her, "Madam. When can I fix an appointment with the doctor?” "Not so fast," Seema thought to herself and browsed through the obstetric statistics. She smiled wryly and got up to leave the place. The PRO explored, "Anything wrong, Madam?"

Seema waved the brochure and replied, "Yes. I think so. During the last year, you have admitted about one thousand obstetric cases and I see that you have done more than nine hundred caesarean sections. I want a hospital which promotes normal delivery," and walked out. 107

Comments

The rate of delivery by caesarean section is very high in private hospitals. My student reports that, in a small nursing home where he had worked for six months, caesarean section was the norm and "normal delivery" was an exception. Unnecessary surgery is neither confined to India nor to Obstetrics. In an audit, three quarters of appendices removed in Germany were found normal.

As a survival guide to avoid unnecessary surgery, Dr R Mendelson (1981) mentions the following don'ts in his book 'Malpractice':

Don't assume that the operation is necessary. Don't assume that the surgery will make you feel better. Don't assume that the surgeon cannot make mistakes. Don't assume that all the treatment choices have been considered. Don't be deceived by a well-polished air of confidence.

Being smart in analysis

When you feel ill and go for medical opinion, ask yourself the following six questions:

1 Does the medical diagnosis seem to fit in to your view of the situation (illness)? 2 If there is a wide gap between the diagnosis offered and your feeling of illness, does the health professional convincingly explain the apparent disease-illness mismatch? 3 What are the various treatment options? 4 What are the risks, benefit and cost of each option? Can I afford the costs? Can I accept the risks? 5 What is the natural history of the disease? Will it recur? Will it subside on its own? 6 Is the treatment for symptom control, containing damage, cure or rehabilitation?

108

When in doubt, get a second opinion, preferably from a non-profit service sector.

Being a smart care seeker

How to be smartin seeking health care? Here are six suggestions:

 Be friendly. You are, in fact, a "co-producer" and an equally responsible partner in your own health care and recovery.  Get the names of health care workers and professionals who take care of you.  Get bills for all payments made.  Collect a copy of the case file. You have the right to possess a copy, if not the original records.  Collect all the test reports and images. Some images and tissue samples need processing time. Remember to collect them later.  Try to develop rapport with trustworthy providers. There are plenty of them too!

To put yourself in the right frame of mind, remember that you are the employer and the professional is an employee(Fulder S, 1991).

109