A tale of two Doctors

A Tale of two doctors

I have a history of lower back pain (in medical terms – back pain due to nerve compression in L5 of the spine). The back pain can be shooting pain and can leave you bed ridden and restrict your daily movements.

I had such severe back pain in 2005. Having consulted doctors in Karur (where I was living then), I was advised to consult an orthopaedic specialist in Coimbatore. This Orthopedic specialist was well-known and very successful surgeon having his own Ortho specialty hospital in Coimbatore. 

Getting appointment with a famous doctor is a herculean task. Through my office contacts, I was able to get an appointment with him. I met him on the date and he heard me out to understand the pain, where the pain was originating and just felt my back. Any famous specialist, will have a large contingent of junior doctors following him. It resembled the scene from “Baasha” a super-hit tamil movie, where Rajnikant walks with about 10 guys following him everywhere!!

“You have a nerve compression in your lower back. We need to take an MRI. You get it done and meet me again.” I replied “Ok Doctor. But is it a serious issue, anything to worry?”. “Don’t worry. Let us see the MRI and decide the course of treatment.”

When you hear words like MRI, CT Scan, ECG, you get worried. Later in my corporate life, having associated with corporate hospitals, I understood that it is normal to get these investigations done, since corporate healthcare is a commercial business today. The corporate hospitals and the leading consultants in these hospitals are forced to write investigations as numbers count for their performance. 

As one consultant used to say – “We can always over-investigate, but we should never over-treat the patient...”

In healthcare today, there is no black or white – there is only grey….!!

With the MRI reports, I went back to the specialist. He saw the MRI report, with the junior doctors surrounding him to hear his comments. He explained “Can you see the inflammation of nerves resulting in the space of the hole in L5 which is not sufficient for the nerves to go through it? It is touching the bone and hence your severe pain. Don’t worry, it can be treated by a minor laser surgery which will ensure that the hole in the L5 of the spine is made slightly bigger and you will be fine.” 

I was surprised and more worried when the specialist mentioned the word “surgery”. I respected the Specialist’s knowledge and asked, “Doctor, is there any other option without surgery?”

“See you are a professional and want a pain-free lifestyle, because you are busy in your work. Hence it is the best option for you”, replied the doctor in a convincing manner.

“What will be the cost and how long do I need to stay in the hospital?” I asked him, thinking about the effect on office work and other logistic issues.

“Do you have insurance or planning to pay for the treatment?” was his immediate question.

“Let me check on my insurance. If not, I will plan to pay for the treatment”, I said.

”The laser surgery will be package cost of Rs.60,000. In addition, will be other medical and pharmacy costs of about 30,000 to 40,000. It is just a day procedure. You will be on physiotherapy for three days. So the maximum stay will be 4-5 days in the hospital”, the doctor said and concluded this commercial dialogue.

I was confused but with no choice, I said,” I will plan to get admitted next week”.

I spoke to my wife, parents and also my siblings in USA. The reaction of my siblings was very vehement. Both of them had one very strong point – you have to take a second opinion, because you are ‘touching’ the spine in a surgery, however minor it may be.

The decision was to take second opinion from another Ortho Specialist in Chennai. My brother through his friend got the appointment with a leading Ortho Specialist in Chennai.

The D-day came for the appointment and with my continuing pain, went to his hospital.

I was awed by the crowd at the hospital. There were atleast 100 patients waiting in the evening to see him. I met the front office, and he said I need to wait for about 4 hours to see the doctor.

I picked up a conversation with a regular patient. After talking on various topics, I asked him, how is this doctor and what is his background?

“Sir, he is a leading Ortho Specialist and was Head of department of Orthopaedics in the Govt. Medical College and Hospital, Chennai”. He sees patients in the morning for 2 hours and 4 hours in the evening. The evening consultation goes upto 10-10.30 p.m. He does surgeries also in this hospital and sees accident cases also”. It surprised me that this patient had so much of information.

My long wait ended when I was called inside the consulting room. It was the same view – the Specialist surrounded by 8 junior doctors here.

The Specialist heard me out, and then made me lie down on the bed for review and inquired about the area of pain. After listening to me, he dictated to his junior, who studiously took the notes and the treatment. I was worried that there will be a MRI asked to be done again. I was ready to show the earlier MRI report, which was not even a week old. But surprisingly, the junior asked one X-ray to be done of the lumbar back region. I was directed to the X-ray room and got it done.

After sometime, I was called again into the consulting room. By that time, the Specialist examined the X-ray. He turned to me and said, “There is an inflammation of your nerve, which is touching the bone and causing pain. I advise you to do physiotherapy with heat treatment on your back. I will give tablets to control your pain. Your pain should reduce with your physiotherapy. Let me review after two weeks.”

My inquisitiveness made me ask him, “Doctor, you have not seen the MRI report. Another Specialist in Coimbatore had advised me laser surgery as treatment. Do you want to see the MRI report?”

“If you had come to me earlier, I would not have asked for MRI in the first place. It is not required”, quipped the Doctor.

“But Doctor, the other Specialist had suggested surgery. But you are not even talking about it. Why?”

“You need to understand, I am a Physician first and surgeon later”. Nature ensures that with correct physiotherapy, the inflammation will reduce and the nerve will come back to the original position”, the Specialist replied, a bit irritated by my questioning. I said “thanks” and walked out.

Very relieved about the advice, I got into an auto from the hospital to proceed to home. The auto driver said, “Sir, are you coming out from this hospital after meeting the Chief Doctor?”

I said “Yes.”

“Sir, This doctor is more than a doctor, a very good human being. Sir he does surgeries for poor without any fees. And he is a very good doctor.”

Back in Karur, during one of the physiotherapy sessions, that physiotherapist enquired “How is your pain now?” I said “much reduced and much better.” Then our conversation went back about the Specialist in Chennai, who saved my spine from a certain surgery.

When I mentioned the Specialist name to the physiotherapist, he said “Sir, this Specialist, has also authored and published books for medical students. You ask any student their reference book for Orthopaedics, and you will hear his name as the author.”

Even today, those words of the Specialist resonate whenever I think of the back pain I went through those days – “I am a Physician first and surgeon later…..”

-       Venkatesh