Medical practitioners often need to refer a patient from small clinics and hospital to a higher center for providing state of the art care provided by specialty hospitals armed with ultra modern Imaging , gadgets and devices.
Recently, I happened to see an elderly women with ca breast, radiculopathy, dilated cardiomyopathy, triple vessel disease , stented /by passed with 3 CABG grafts later, followed by an ICD and CRT, .Her CRT became non responsive after a failed attempted AF ablation.
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After a prolonged stay in the posh AC suit of a renowned corporate hospital the patient was feeling exhausted and weak with multiple tests and procedure.The patient found things annoying as every consultant and support staff behaved like a programmed robots with artificial smiles and compassion.
She and her family was tolerating things, but desperately required a break from 24/7 attention (which was without much progress either ) . After a mini family confabulation, they decided to request the treating consultant to refer her to a lower center for a more humane care.
From here on its fiction . . .
The doctor agreed (after Initial amusement ) and asked his secretory to write a letter which sounded something like this,
Please get permission from the hospital desk for referring this 70 year old gentlewoman to a “lower health care center” as she feels exhausted with our treatment and decided to opt for a more simplistic, supportive , compassionate and humane care that’s is devoid of claustrophobic gadgets and machines .
We also acknowledge we are neither equipped , nor has personnel and expertise to provide that sort of human care, you demand ,! We have to respect science more than individual patient needs . We are taught, paid and live for science first ! so please forgive us.
But, we respect your concern and will transfer you to a primary health center.Thank you for being with us this long , and helping us the master some cutting edge skills and helped science to grow.
By and large, the concept of tertiary health care can very well be a myth.(With few exceptions) It means mechanised care that primarily involving aggressive organ specialists who want attack the disease without mercy for the patient.
The uttering here might sound provocative , especially for the families who have benefited from cutting edge medical technology , . . .
Still , the rate of growth of irrational organ or system based tertiary care is growing in dangerous proportions , and very soon we will realise the disastrous consequences of this pathological mindset of modern medical intellect.
What we need , ? Emergency bulk supply of “right and straight” thinking “whole body specialists‘ . Who are they ? they include the Internal medicine graduates ,humble general practitioners ,family physicians and geriatricians .These genre are currently in the sidelines suffering from artificial low self-esteem (atleast In India !) Soon I expect they should emerge stronger and take control of the sagging medical profession from the clutches of pseudo scientific specialty hospitals who keep the cost of medical care Insaningly high that drains the global GDP in a meaningless manner.
Will WHO act ? Should they be conferred the veto power and tightly control when to refer a patient from a lower to higher center and vice versa !
For those of you who don’t know who is who ?
WHO stands for World Health Organisation , a united Nation organisation which is the apex medical body & guardian of human health .One of their Job functions is ,they are expected to act when there is Inappropriate health delivery and expenditure .( Unfortunately even most of the medical professionals think WHO exists for only one reason to eradicate mosquitoes and vaccinate children ).
WHO need not think they exist only to guard health of poor under privileged , they have a critical responsibility to prevent wrong therapies committed to rich and affluent as well ! and more so these unnecessary modalities spill over from rich to poor in the name of equality !
Dr.S.Venkatesan MD 
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