Saturday, September 08, 2012

Doctor vs Doctor

There is a lot of controversy today about the use of alternative medicine , or AYUSH. Western medicine practitioners ( MBBSs and MDs) are very unhappy about the fact that alternative medicine practitioners such as homeopaths are encroaching into their territory . While ayurveda and homeopathy are well-established forms of treatment, their argument is that only someone who is trained in modern medicine is entitled to call himself a doctor. Unani doctors should call themselves Hakims; Ayurved doctors should call themselves Vaids and homeopaths should call themselves Homeopaths.

The one thing Western medicine doctors are extremely good at is making a diagnosis. This is because of the use of imaging technology and advanced lab testing, which allows us to pinpoint lesions with accuracy. Thus, if you are not sure what your diagnosis is; or want to make sure that your symptoms are not the result of a serious disease, then a western medicine doctor is your best choice.  One of the reasons why MBBS doctors are so unhappy is that it takes them five and half years to learn which tests to order and how to interpret them. When homeopaths and vaids and hakims start ordering these same tests, they feel they are encroaching on their turf.

This practice can actually be dangerous. Because these alternative medicine doctors are not taught how to order these tests or how to interpret them, they tend to overtest and overtreat.  Even worse, they start practicing a form of bastardized medicine , where they try to pick the best of all possible worlds by ordering tests and CT scans , and then using treatments from their own specialty. I'm sure Hahnemann would turn in his grave if he found out that homeopaths are ordering MRIs in order to treat their patients. This is not something he would approve of , and it goes completely against the philosophy of homeopathic medicine .

It's best for doctors to be consistent . It’s not fair on the patient when doctors claim to have expertise in a certain area, when in reality they do not. While some alternative medicine doctors enjoy bad mouthing Western medicines by claiming they cause side effects,  many of them will prescribe powerful antibiotics left , right and center as a quick fix for treating fevers . While antibiotics are remarkably effective when used carefully , when they are misused, they create problems such as the spread of antibiotic resistant bugs. This is one of the reasons why it's important to police which doctor is allowed to prescribe what medicines.

In real life , regulating this becomes practically impossible ; and while Western medicine doctors may cry foul, the truth is that alternative medicine doctors are willing to practice under conditions which a lot of MBBS doctors will refuse to – for example , in remote villages and in slums, where patients can afford to pay just a pittance . They do have a valuable to play – and we need to accept this and learn to coexist.

It's important to let patients choose for themselves, and it’s safe to assume that patients have enough intelligence to be able to make the right decisions for themselves. Each of the systems has pros and cons and a lot of it really depends on the patient's philosophy ; and how aggressive he wants to be in his medical treatment . There are lots of people who prefer the conservative , slow approach of alternative medicine, while there are others who want a quick fix , and will prefer surgical solutions. The good news is that now patients have a choice   -  it's up to them to pick and choose intelligently . Of course, this can get tricky because patients may be unsure what to do . Often doctors who allegiance to one system will bad mouth and criticize doctors of other systems, because they are seen to be competitors !

Rather than criticize each other , we need to learn to play to our strengths , so that we can provide care for our patients in a way which is cost-effective and good for them. No one system has a monopoly on knowledge and we need to become respectful of other systems, so we can learn from each other.

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