Saturday, November 27, 2010

Two Minutes Older: Medical Illiteracy

For the last few weeks, I’ve been having several tangential and direct conversations about illness and treatment. It must be the result of belonging to a generation whose parents are growing old and ailing, or just coming through its own experiences with bearing and raising children. These illnesses range from the seasonal to the severe but what all my conversations had in common was the strange carelessness and ignorance that people displayed about anything remotely medical.

One person had been suffering from severe backaches for some time. She thought the origin was gynaecological. After several tests and consultations, no clear reasons were discovered but her doctor prescribed some medicine that she took without question. I asked her, “Is it a painkiller or a hormonal treatment kind of thing?” She didn’t know and astonishingly, didn’t think to ask her doctor. She also took those medicines only when she happened to remember and often skipped doses through having forgotten.

An older relation, in his eighties, treated his phlegmy cough with bottles of cough syrup without visiting a doctor. Though he was finally taken to one and given antibiotics, after two days of fever, and severe breathlessness, he had to be put on a ventilator. In this particular case, it was not just his own diffidence about asking for medical attention, it was also a case of being in a place where the people around him didn’t know or have access to his medical history.

One friend recounted how a torn ligament in his knee went undiagnosed by the doctors at a boarding school a couple of decades ago; another person suggested I take (without a prescription) some dietary supplement for my migraines. I have spent a fair amount of my time being appalled by both doctors and patients.

Don’t get me wrong. I sympathise deeply with the ostriches of the world – those who avoid all thought of illness in the hope that if they do, it will not afflict them. I understand why people would choose to ignore the complaints of their body, or pop a painkiller or paracetemol without bothering to find out if that’s the right line of treatment. Anything to avoid being told it could be something serious.

Anyone who has been to hospital with any degree of regularity knows that danger lurks everywhere: once you go to consult a doctor, you more or less unquestioningly acquiesce in her line of diagnosis and treatment, even if it includes a battery of obscure (and expensive) tests and medicines. Disease is as much about fear as recovery is about trust.

The writer and surgeon Kavery Nambisan recently said, while talking about a non-fiction book she is writing on healthcare, that she wasn’t against doctors prescribing tests, because sometimes they were necessary and useful but what was really scary was the disappearance of the local General Practitioner who knew one’s family, medical history and knew how to diagnose many things by observation and conversation. A GP ought to be the first line of defence against disease.

For the non-medical person, however, a successful career as an ostrich involves, oddly enough, a near-constant state of awareness. You’d think this would happen almost by osmosis, given how much the media goes on about health and that unbearable new-age word, ‘wellness’; but you’d be wrong.

I’ve discovered that apart from a small circle of confirmed hypochondriacs, most people tend to pay more attention to the beneficial effects of fruit facials than they do to tips on ways to avoid getting malaria. The hypochondriacs, on the other hand, set themselves up as resident doctors, prescribe themselves anything from antibiotics to painkillers with airy confidence and wonder why they suffer when they suffer the inevitable consequences.

There must be a happy middle ground we can occupy between total medical illiteracy and half-baked knowledge. There are community health drives that inform people about basic health issues. Some places still have their friendly neighbourhood GP – may their tribe increase - who have the time and patience to answer questions. But all this information amounts to nothing in the face of determined resistance to knowledge. Without that barricade, what else can ostriches expect but to be bitten in the fleshier parts of their anatomy?


An edited version of this appeared in today's The New Indian Express


km said...

But when that ostrich does get bitten (funny, I always think of ostriches as creatures that do the biting), does it get a tetanus shot?

Space Bar said...

km: event he biter gets bit; you know that. and, if not a tetanus shot, I'd imagine anti-venom.

Fëanor said...

medicine is a mechanised game now: see n patients/day to make your profit targets. so where's the time to understand an entire history? hence the rise in misdiagnoses. plus the medical profession, like any other, has its fair share of duds, listless types that go through the motions. time for everyone to chew neem daily - the cure for all ills.
(word verif: pee mit. hmmm.)