Letters: Unhealthy practice?

This refers to Subir Roy's column "Refer a patient, earn a commission" (Value For Money, July 17). Just as the pharmaceutical companies shower the medical profession with gifts and goodies, similar benefits accrue by referring patients to select diagnostic centres for investigations essential or otherwise. Like exceptions to every rule there are highly ethical and morally scrupulous professionals who are indifferent to these blandishments. Spending time or using basic clinical skills like talking to the patient takes time. Recently a wealthy Chicago couple donated $42 million to the University of Chicago Medical Center for the creation of an institute to improve the doctor-patient relationship and improve communication skills. Medical students must pass a "clinical skills" exam assessing, among other proficiencies, how well they acknowledge patient concerns, ask about feelings and show empathy.

Awareness campaigns by the health care industry seek to transform the worried well into the worried sick. Current advanced technology assist doctors to look really hard for things to be wrong and we all know that according to Murphy's Law things will go wrong to make us more apprehensive. Thresholds for diagnosing disease have fallen in recent years and with these changes, more than half of us can be considered to have a disease. For example, the criterion for cholesterol or blood pressure has dropped many times. The epidemic of diagnosis has led to an epidemic of treatments. Unhappily more of us are being told that we are sick and only a few that we are well. Interestingly, among physicians, researchers and insurers, there is an ongoing debate as to whether regular checkups really reduce the chances of becoming seriously ill or dying of an illness.

H N Ramakrishna Bangalore

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