‘Vaidyo Narayano Bhava’ is a well quoted Sanskrit phase which places a doctor at a similar pedestal as God himself. This is indeed the only profession in which someone’s body is entrusted to the practitioner. The evolution of science and technology however has brought about a steady decline in the divinity of the doctor- patient relationship. There is no doubt that malpractices in the medical profession are equally to blame. Information technology makes it easy to attain knowledge about any disease at the click of a button today. However, the reliability of such data depends on the source which has uploaded or published it. Most information sources are good but some could be biased. To add to the problems come in the pharmaceuticals and the modern health industry with their marketing tactics that has increasingly become very commercial in India.
Due to the structure of our health system, we do not have a mechanism and culture to facilitate referrals to the appropriate specialist doctor. This is largely due to random distribution of speciality practitioners as well as incomplete knowledge about their expertise amongst the people. As people directly approach specialists, they might not always see the exact person suited to their problems. Similarly, it is too easy to get a variety of medicines and splints directly from the stores or even ‘online’ nowadays, that a lot of potentially harmful self- medication is rampant. I have listed a few of such practices relevant to disorders of the knee below:
These are the most commonly used medications worldwide. They are easily available over the counter and are also the most prescribed. These are the first line treatment given after injuries as well as in arthritis. To make matters worse, patients often move from doctor to doctor without carrying the prescription of one to another. The doctors might end up prescribing different preparations of the same or similar medications resulting in long term use. Side effects are well known and they are the leading cause of kidney failure. There are various newer preparations available, but long term safety of most of these is not established.
Joint Reparative Medications
These do not have bad side effects as the pain medications. However one must be cautious taking various combinations of such medications that are increasingly available over the counter too. Long term side effects of various such combinants are not yet conclusively established.
One must similarly beware of medications made from plant extracts that are claimed as ‘natural’. These have been found in certain cases to contain steroids that cause osteoporosis and increase risk of bone fractures in the long run. Similarly it might be quite deleterious to combine medications from different systems of medicine and patients must be cautioned against taking medicines from different practitioners simultaneously.
Knee Caps & Braces
Various such contraptions are available commercially and often bought off the counter. They are mostly OK for short term use. However habitual use is often recommended by non- specialist practitioners. This makes matters worse as continuous use of braces causes muscle wastage. This in turn makes arthritis worse.
With modern techniques of specialty surgery, the need for braces following planned operations is very rare. It is not uncommon however to find these being used. Even though they seem protective, they often delay optimal rehabilitation.
Exercises & Physiotherapy
The importance of developing the right muscles by exercise is rarely stressed upon in our setup. Even though the basic principles of exercise are age-old and find mention in older systems of medicine like Ayurveda, focus has somehow shifted to medications alone. Many Physiotherapy practitioners too encourage use of modalities for pain relief and patients are less motivated to learn techniques of muscle strengthening, which are themselves the key to solving early arthritis related symptoms and also important in making recovery after surgeries.
Blood testing, Xrays & Scans
Health screening packages have become fads in recent times. Going through routine ‘complete health packages’ does not give any insurance against the diseases screened for any future period. Similarly, the availability of investigations has driven us doctors away from clinical medical examination and spending time talking to the patient. Many a time, a number of tests are unnecessarily ordered and might lead to wrong conclusions about diseases like Gout and Rheumatoid Arthritis, resulting in over- treatment and side effects. Excess radiation can also cause cancers.
In this scenario, every educated person seeking a solution to a medical problem can at least check before hand that the specialist they are approaching is the right one for that respective need. Family doctors or general practitioners can play a very good role here, as they have the advantage of knowing the individual patient more entirely. Many of us however no longer have regular contacts with family physicians. Similarly there also exist alliances between different practitioners that can influence the pattern of referral to particular specialists. The onus thus falls on the patient. Despite all the above discussed disparities, we have a large number of great practitioners who have dedicated themselves to the best care of their patients. Our health system gives us the power to decide who will treat us, unlike the case in many developed countries with evolved health systems.
The author Dr. Yogeesh D. Kamat is a Consultant Hip & Knee Specialist Orthopaedic Surgeon. He practises exclusively in Joint Replacement, Arthroscopy and Sports Injury related to the lower limb joints and is available at KMC Hospital, Mangalore.