Thursday, March 17, 2011

Our concept of disease entities

There is no sharp line between health and disease. (See a previous post in this blog “The concept of health and disease” please). Deviations from what we consider as “normal” that are detrimental to the individual are labeled as illnesses or diseases. The ways in which a person’s condition deviates from normality take innumerable forms and shapes. Every patient’s disease is in fact unique. There are similarities and differences between diseases of different individuals. Because we think that similar diseases may progress in similar ways and respond to our intervention in similar ways we try to group them into one disease entity and give it a name. There are grades of similarity between the individuals in the same disease entity. We might see patients whose diseases fit very well with the classical description of that entity and patients whose diseases differ from the classical description to various degrees. There are no sharp lines of separation between disease entities. Some diseases may not fit well into any of the artificial entities that we create or fall in the boundary between two entities or more.  We then either force them into one of the entities that we consider the nearest possible or include them into more than one entity or create a new entity with a different name to accommodate them.
These facts explain at least partly the differences between doctors about the diagnosis of a patient’s disease and why in many instances a patient’s disease does not behave in the way we expect it to.
Much of the controversy in medical discussions is about language rather than fact. It is semantics. Nevertheless it is important because language dictates our acquisition of knowledge. It is the language, the names, that makes it possible for us to learn about diseases and to get the help of the book or the literature to guide our prediction of prognosis and our management. It is not an ideal situation but that is the case with almost everything in life.

Wednesday, March 9, 2011

MS & Ph.D debates in our universities

Two phenomena are commonly observed during MS and PhD debates in our universities.
  1. The student usually prepares a food and drink party in front of or beside the debate room to celebrate, with friends and relatives, his distinguished success before the start of the debate!! The psychological pressure of this on the examiners needs no comment.
  2. Most of these debates end with granting the candidate an (excellent) grade! One candidate became furious because he was given a (very good) grade!!
Isn’t it time to stop these shameful practices to give our postgraduate degrees some recognition and respect?  

Friday, March 4, 2011

Judging doctors’ competence!

People frequently judge doctors by the progress of the patient following their intervention. If the patient improves the doctor is competent. If the patient does not improve or deteriorates the doctor is incompetent.
Many illnesses especially acute ones like viral infections are self limiting and not affected significantly by treatment. The condition starts and gradually worsens over days until it reaches a climax, then it starts to improve until it recovers. If the patient sees a doctor in the beginning of the illness he is likely to deteriorate in the following days irrespective of what the doctor does. The doctor may be blamed for the deterioration. If he then sees another doctor when he is at the climax of his illness he will start improving irrespective of what the doctor does. The improvement may then be attributed to the second doctor. The same thing applies to many chronic illnesses because they have a fluctuant course with spontaneous exacerbations and remissions. Justice is rare in this world. It is a sad fact of life.