Posts Tagged ‘conservative management’

It is often said optimism is key to success . From the patient’s and physician’s  perspective   it is the willpower that has saved many lives. Positive minded patients  do not die without fighting. We  know self belief can do wonders in medical  care  !

If  self  belief is  the ultimate healer ,   trusting the   doctor  and  the hospital  are  equally important  . Patients believe in  doctors and doctors believe in science . Science is not sacred .It is man-made   .Those men  who create  science  need not be  holy  either !

Can  we  trust modern medicine in the current form  ?

I am afraid the answer is  too tilted towards  . . . “No”   I am not a pessimist  in the strict sense  . However ,   the future   looks bleak  in most places  ! unless some strong remedial measures are under taken.

Statistics   suggest , patients  are  rapidly losing   the belief   in their physicians   ,  considering the track record of our  health care management in recent  times . Global trends in the last 5 decades indicate the health care delivery system has gradually  been  hijacked from the Govt to the private hands.

It is  quiet a shocking  revelation ,   the private  sector  health care  has done  more damage  than  the state   driven health care . How  foolish   our expectation  can  be !   For fulfilling the millennium  goal ( Health for all )  most  countries  have  handed  over the  baton  to the  greedy corporates .

How on earth , one can expect  the   private / corporate  sector  to provide  equitable health   for all  . It  would be wealth for all  those involved in  this flawed medical care  system  at the cost of  poor !

Read this book  . . .To understand the nuances of how our health care industry is bulldozing  , like an army tank into the population  and  most of us  is a victim or a partner to this .

Click here  for  the  Book review

From The Hindu January 2011

Final message

Entry of capitalism into health sector is probably the worst  infliction   man kind  has suffered , than all those deadly viruses and bacteria   over a last few centuries !

Medical science is a phenomenal  gift  created , nurtured and grown by the sixth sense of our ancestors .Their only aim was to provide relief to the sufferings.  Now their dreams,  vision and goals lie  shattered .

No hospital  has a  specialty called  “humane care”  , while  many  have  a separate  department   to  do a  neuro  metabolic imaging    for a  depressed  man with Alzheimer  disease   in his nineties   and  a  Bio – Robot  driven    fuzzy logic  lab   to  predict cardiac  events  in a soon to die rich man . Absolute waste of resources !

There is  no doubt , we have become a  sort of  salves to  science  . . . (Irrational science to be precise ! ) It is a man-made monster.  Even a most conservative person  (including the author )  could    be causing  some damage as we  are forced to follow  the unruly scientific publications .  Probably  . . .yes . . . we can’t eliminate  it   but   identify  futility of modern science try to get  rid of it . !


A related article

Those were the days   . . .  When doctors practiced medicine  . . .and much more  . . .

A  wonderful  piece of writing   by Dr Susikaran  Thangasamy from the open pages of  India’s national newspaper

‘The Hindu” http://www.thehindu.com/opinion/open-page/article1137935.ece

What is the remedy ?

First of all , every one should answer this question to their conscience

What ails  our health care  system  today ?

Do not be part of it . . .  solutions  will come automatically !

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                                            The science of medicine has evolved over 2000 years since the stone age days.It has  currently reached  a glorious era with  cutting edge  scientifc  technology .Today  one can map the entire human genetic blue print and intervene in the  disease  even before they manifest .One can   keep dying people alive for years with multi organ transplantation. Modern medicine has taught us  how human sufferings can be prevented and life can be prolonged (with or without purpose !)

The term conservative management  conveys two different

meanings for medical professionals.


For other group of physicians




                             Ever since the days of  application of leech over the  head for treating migraine and a crude knife abdominotomy for emergency exit of babies from  pregnant mothers in distress  , healer’s   mind has always  perceived “something  has to be done  urgently when some body suffers”  this sort of  reaction is probably  inherited  and is related to  the primitive flight or fight response .

This may be true in  some of the emergencies but it is untrue in many of the non emergencies.

                                          Unfortunately ,  our mind  finds it difficult   to differentiate  between these  situations . With constant exposure to dramatic medical breakthroughs , modern day physician is made to believe   “Some thing  is always  better than nothing  when illness strikes. Human body is a wonderful machine which has it’s own service station ! in the form autoregulation  and the meticulous  homeostatic mechanisms. Only if the disease process overwhelms,  it needs intervention.( Typical example:In the routine viral fever , you don’t adminster Acyclovir or other antiviral  for all of them !

                                        The problem with early aggressive approach is,  it fails to give an oppurtunity  for the body’s natural defence forces  to respond. Further , we will  never ever know how the administered treatment is going to fare vis a viz the natural response.( With due respects to RCTs).   While the field of medicine   has  so much  evolved , our thought process,  especially  the  aspect of clinical  reasoning  has always been lagging behind .It is now considered  as inferior or even unscientific  treatment  if  some one follows a conservative approach to a problem even if  it  provides   same outcome of that of an invasive or aggressive approach ( The classical example is PCI for chronic stable angina The COURAGE study).

The other major issue is the hazards of unwarrnted  invesitigations , drugs and procedures

Classical example:No one knows how much morbidity or mortality the routine Swan ganz catheter  caused when it was rampantly used for over two decades to monitor central venous pressure .It is estimated  that in modern medicine  there are at least  few  drugs or devices  in each speciality waiting  for the same fate  as that of  the swan ganz catheter.

No body knows when it will be exposed .Our EBM will take it’s own time . . .Till that time humanity need to suffer.

This thinking is not new  The concept  “First do no harm is over 2000 years old”


Questions in search of answers

 Does law of conservation of energy applicable to human body and medicine  ? 

 Can we defy death with modern medicine ?

Final message

  • Conservative management is still  a great medical concept  in many situations  and one should not allow it to die  by the whims and fancies of the modern scientific forces.
  • Whatever you do on the patent’s body  do it ,  only if it is going to helpful for him /her. If you are unsure  Whether a given  treatment  is going to help or not ask this question to an expert .
  • The widely prevailing  dogma  of aggression is always better than  non aggression  has absolutely no evidence.
  • So approach a clinical issue disease by disease ,  individual by individual.
  • Now , in this era  high tech  medicine  ,  It is lot more tougher to choose a conservative path as the pressure to do more and more  looms  larger ! It is easier to follow the crowd  than a path of your own .
  • Always remember it needs a  stronger  mind to  act according to our conscience !

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