Why Diagnosis in Healthcare Has Become a Joke? A Case Study

A. The Gyaan of Good Health That Everyone Knows

Eat fresh food, think well, exercise, sleep well, go to the sun, drink water, have a work-life balance, and voila, you are immortal.

However, if life was so simple, and if staying healthy and living a healthy life was so easy, simple, and straightforward, then we wouldn’t have had a trillion-dollar healthcare industry.

Today healthcare practices “Listen to Symptoms, prescribe some tests, see some anomalies, give pills for the anomalies.” The problem is then everyone thinks that this really is that straightforward, and magic pills would solve all their problems. In this article we shall see how complex the health is and how oversimplification has added more complexities to a patient’s life than solving problems.

B. The Roseto Principle

Dr. Stewart Wolf in 1961 monitored a US village of Italian migrants called Roseto, which did not have any cardiologists, and yet did not have a single Cardiac case when the rest of the US had a Cardiovascular epidemic.

It is the joint family, happiness, hard work, several generations together, etc that keeps one disease-free, not healthcare.

C. How Marketing Reinterpreted Roseto Based on Convenience?

“Eat Mediterranean Diet” and remain disease free.

🎤 Marketing

Isn’t this so familiar?

D. Lyfas Case Study: LYCA06210172

Just observe the sheer complexity of the human mind, body, childhood, genes, social setup, gases, electrolytes, atoms, psychology, physiology, pathology, neurology, immunology, endocrinology, metabolism, and several other complex cross-codependency.
Measure the time to simply just trace one pathway.

Now that you know the interplay of physiology, psychology, pathology, vitals, different organs, and conditions, you may start understanding why the shortcut care of today fails to diagnose health problems. (Because that is not its objective in the first place, and nor it is an objective of the patients).

E. Key Problems With Today’s Diagnosis

1. Poor Economic Equilibrium

A third-graded loser with a meaningless Ph.D. get ₹1.5L 6th pay commission to read PPTs for 100 mins. An MD in emergency gets ₹80k for 24×7 duty.

💡Insight

2. But why do we have such an economic disparity?

1. Patients seek instant relief.
2. A clinician is expected to fix the messed-up life contributed by parents, family, life, habits, thoughts, and feelings in 2 minutes for ₹500.
3. 30 years of screwing by 14 people, but 2 minutes fixing for ₹500. The expectation itself is madness.
4. Both patients and the clinician know it is an eyewash. Yet, everything is feeling. Patients feel good with meds, and clinicians get money to support the family.

F. The Sham

So if you give a high-salt diet for low BP, the patient will suffer diarrhea, then will go to the hospital, then tooth pain-> Dentist, and the cycle will continue. (You get from the block)
EVERYONE GETS A PIECE OF PIE OUT OF THE ORGANS, and every single pain.

This is the circular economy of healthcare. Because no one wants an outcome, but everyone is interested in some instant relief for the current problem, and because one problem leads to another problem, when one problem is masked with a pill, it silently leads to another problem. Then there is a separate treatment for that problem, and then the next, and then when different problems form an undetachable complex correlated condition, there is a hue and cry of healthcare is minching money.

G. Why Stay in the Circular Sham and Why Can’t We Fix the System?

1. Our Body is non-linear. It needs lateral n-Dimensional brains. Such children will be 1/1000.
2. Education is training. It prevents literal and abstract connections.
3. Not many abstract brains remain abstract at the end of the system. Those who do go to research, away from reality and patients.
4. Most who serve patients are non-abstract brains, incapable of comprehending multidimensional complex models.
5. Even then most teens get into meds because:
   a) Future has potential
   b) Parents can afford
   c) Gets a seat and of course RESERVATION.
   d) Parents are doc.
6. Almost no teens when entering meds know anything about life. Can one save a life if he knows no life?

H. The Outcome of Healthcare Transitioning to the “Who Cares” System

Patients pay only for feelings. To feel good in society, 1 Cr car. To feel good internally 2 minutes, ₹2000. Cool yea?
The actual care of a few extraordinarily dedicated clinicians and nurses give their all to keep the body alive, and the corporation profitable.

Feelings are cheap, life is not. When life becomes cheap, feelings are not.
∑(Suffering)life > ∑(Money Earned)life

The biggest joke today is “healthcare is not a joke”

I. What is the actual protocol for treatment and diagnosis?

Standard Treatment Protocol

Following are the standard steps in a treatment in non-emergency, non-acute chronic patients.

1. Document: (Symptom, and comprehensive history documentation).
2. Cross check: (Several times patients lie due to shame and guilt. The information provided by the patients needs to be validated by crosschecking and cross-questioning).
3. Monitor vitals: (weight, height, blood pressure, sugar, heart rate, Spo2) to get a measurement of physiology.
4. Examine: The patient must go through a thorough physical examination where eyes, skin, tongue, nails, throat, smell, hair, scalp, and teeth are all examined for anomalies.
5. Assessment: Upon completion of documentation, crosschecking, physical examination, and vital monitoring, initial sets of probable conditions are noted down.
6. Lifestyle Advice: The patient is advised to change the lifestyle and revisit after making the changes. This is done to eliminate the effect of lifestyle into the pathology.
7. Re-examination: Once a patient completes the advised period of lifestyle changes, he needs to go through history taking, cross-checking, vitals, examination, and re-assessment.
8. Pathological Tests: Considering that lifestyle effect on the pathology is removed from the pathology, now the patient is advised to go through standard pathological tests based on the Re-examination.
9. Correlation: Pathological test results are correlated to the assessment.
10. Differential Diagnosis: Now the possible conditions are separated, and the exact conditions resulting in the current symptoms and pathology of the patient are determined.
11. Risk Assessment: Once the accurate conditions are recognized, proper immediate and long-term risks are to be assessed.
12. Intervention Plan: Based on the risks, all the possible interventions are to be identified and documented. Side effects of the treatments must be documented.
13. Education: Once all the above are documented, patients must be educated about their life, current condition, current and future risks, and possible treatment options. The patient must also be educated about possible side effects of the treatment and intervention.
14. Counseling: When the patient is conveyed about his diagnosis, he may get traumatized if any diagnosed condition is life-threatening. This trauma is known as diagnosis trauma. The patient must be provided counselling to ensure that he doesn’t suffered a diagnosis trauma.
15. Caregiver Training: The patient needs to be taken care by the family and the relatives during his recovery. Primary care provider in the family must be trained with basic medical first-aid, vital measurement, possible emergencies and their todo protocol in such emergencies.
16. Treatment: Treatment protocol with monitoring parameters must be determined. (For example CA-125 and ESR levels are good markers to check the efficacy of chemotherapy).
17. Feedback: Regular feedback needs to be taken from the patient about how he is feeling about the changes, how his body is responding, and all the feedback needs to be documented.
18. Surgery: A surgery needs to be debated by the medical team with proper documented discussion about all the possible side effects of the surgery and must be carried out only and only if the surgery is the only possible treatment line. (For instance over 80% of the stents are unnecessarily put into patients with the complaints of angina. This decrease the quality of life, as only thrice stents can be put in a patient).
19. Healing: Treatment deals with altering the current pathology through systemic changes introduced by medicines. However, any such changes also cause an inflammation in the body. The patient needs to be healed through therapeutic(for example Physiotherapy).
20. Rehabilitation: Recovering from a disease is not enough. The patient would have taken a mental, physical, and financial toll throughout the treatment. A rehabilitation must be planned to handhold the patient to his new life.

As you can see that medical treatment is a complex, multi-level, process centric protocol with stingent need for documentation, observation, feedback, monitoring, and not just symptoms and medicines.

Needless to say that each of the aforementioned steps are specialized steps that needs both technology as well as manpower. Technology and manpower are not enough, the protocol also needs infrastructure.

Diagnosis

Diagnosis is recognizing accurately the actual disease one has. A disease is a pathological change in the body due to either: aging, an external or internal injury, an infection{fungal, bacterial, viral}, bad lifestyle and habits, persistent stress to a set of organs(for example liver in alcoholism), genetic anomalies, environmental factors(like pollution), psychological factors(like worry, grief).

Several diseases have symptoms, physiology, and pathology overlap and therefore detecting them accurately needs a mechanism that is called a differential diagnosis.

Average time taken for diagnosing a Chronic Health Condition is about 4.8 years(you read it right, 4.8 years)

Average time for diagnosis

Patient Rights and Need for Patient Education

It is very important to know that law makes it mandatory for the clinical team to obtain patient consent before any treatment(other than an emergency par standard emergency medical definitions).

This consent needs to be obtained after thorough diagnosis and education to the patient and the same must also be mentioned in the prescription.

Please refer to this paper about legal need for obtaining the patient consent for treatment.

Why such a complex process? What if patient’s condition detoriates before process is completed?

Life is precious and it is nearly impossible to undo the adverse effect to a life arising from wrong diagnosis and treatment. When body makes an error, it knows the ways to fix such errors, but when human makes an error on some other bodies, such errors are hard to reverse.

Clinicians are bound by their first oath, that is:

I shall do no harm

Therefore not harming the patient is(should be) higher priority for a clinician than to treat him and to help him recover. treatment is less than 5% of the entire medical process, but has been amplified over 80% of a medical procedure today. And we already know why treatment itself has become a disease in the healthcare.

Obviously one has to be ignorant and stupid to expect such a complex clinical protocol to be implemented at ₹1500. Such expectations are merely fantasy, and health is a reality not fantasy.

I. What steps can be taken towards a possible better Healthcare for tomorrow?

In Lyfas, we do not just complain and crib about the problems. We research and think about the possible solutions. We create models and actionable plans that can be implemented today to start seeing a change. And true to what we do in Lyfas, here is our suggestions for the steps that would lead to a better healthcare system in the future.

Actionable steps to be taken for the improvement of the healthcare system

1. Identify those few born with an abstract lateral n-Dimensinal brain. They will always appear autistic.
2. Groom those children away from parents under few alive extraordinary men in healthcare.
3. Let them develop their passion through the philosophy of those men.
4. If you put those brains into the drainage called the education system, they will lose that abstraction.
5. Make them struggle for survival. They will understand life. Only life can teach life, not books. And if one has to serve and save a life, one has to learn from life. And life teaches only in hunger and fear of death, not under buildings.
6. This is how the greatest clinicians have been born. Through observation, experimentation, and poverty, people. Everyone whose books you study: From Ganog, Gray, Freud, each one of them.
7. Increasing Seats, bridging homeopaths to MD, etc doesn’t solve the problem. Because you can improve and scale the system as much as you like, but can’t give birth to abstract brains. They are born(unlike what loser HRs want you to believe:- Winners are not born, no they do).

One of the key strategies that need to be adopted is that the system needs to become process-oriented and must refuse to serve the shortcut of half-baked diagnosis(which is nothing but an instinct-driven feeling about the conditions of the patients, and giving a pill hoping for something to improve).

J. Conclusion

An Unhealthy population pulls the economy down in no time. The US is seeing it, you shall see it soon. Life plays with them, who play with them?