“I am not sure what it is.”
I utter these words whenever I encounter a medical puzzle I cannot solve.
“This is beyond my competence,” I reply to the WhatsApp messages flooding my phone at all hours.
My patients hate it. They do not visit a clinic to buy hesitation. They want a physician who is firm, decisive, and unflinching. They want a man who can glance at a grimacing patient, make a spot diagnosis, and declare—before anyone blinks—whether an aching abdomen is a ticking appendix requiring a midnight knife or something that can be managed with a quiet dose of rest.
They want to be told, without a shadow of a doubt, that a 70% blockage in a coronary artery is “making the heart thirsty” and requires an immediate, expensive stent.
For generations, Indian patients have preferred doctors who take charge of their destiny. Participatory decision-making—the delicate ritual of laying out the facts and letting the patient choose—is an imported Western luxury. Who wants to weigh the pros and cons? Who wants to hear about relative risks, side effects, and margin of error? Nobody wants to be told that a CT scan for a simple tension headache, an MRI for a tired back, or a routine mammogram in a healthy forty-year-old might do more harm than good—triggering a cascade of unnecessary tests, crippling bills, and sleepless nights.
They demand a quick verdict. A lump must be cut out. A blocked artery must be plumbed. A fever must be malaria—no matter what the microscope or the rapid test strips say.
When I was a young resident at Government Medical College, Nagpur, in the late 1970s, an old saying echoed through the wards: “If Dr. B.S. Chaubey says you have a brain tumor, you have no option but to die of a brain tumor.”
Dr. Chaubey was a legend in Central India—a brilliant physician, certainly, but a fallible human being nonetheless. Yet the faith in him was absolute, blind, and impervious to evidence.
Skepticism was—and remains—an unwelcome intruder. To pause and think: I could be wrong. My biases are clouding my judgment. I am closing the diagnostic doors too soon. This drug showed promise in San Francisco, but it might accomplish little for a farmer in Sevagram, so let me save him the expense and the side effects.
Try explaining that nuance to a family sitting across your desk. Watch their eyes fill with silent dread as they wonder why the doctor they trusted with their lives seems so shaky, so utterly unsure.
Naturally, they leave. They head to the doctors whose success stories belong to local folklore—the ones lauded in newspaper columns and featured on television screens. Failures are quietly swept under the carpet. In our profession, no one boasts of restraint. No one wants to be remembered as the physician who hesitated.
And so, young, impressionable doctors watch and learn. They mimic their senior role models, brushing aside ECGs, X-rays, and lab reports with effortless contempt. “I trust my clinical wisdom,” the grand posture dictates. “I do not care what the data says.”
It reminds me of Dhirubhai Mehta, the late president of the Kasturba Health Society, which manages our hospital at MGIMS. Whenever a heated debate broke out, he would chuckle and say: “Do not confuse me with facts. My mind is already made up!”
He was joking, of course. But the tragedy is that our patients aren’t. They genuinely want heroes—and we are all too happy to play the part, right up until the moment the illusion shatters.
Dear Dr. Kalantri,
Very well written. I trained at a time when CT scans had just arrived and ultrasound was still a luxury. My professor used to start anti-tubercular treatment in every patient with an intracranial space-occupying lesion. His rationale was that nearly 60% of such lesions were tuberculomas, while the chances of cure in most other conditions were limited.
Today, even patients from lower socioeconomic backgrounds are often satisfied if you honestly tell them that their condition requires expertise beyond what you can provide. Many return, sometimes years later, to thank you for referring them to the right specialist. A few may leave dissatisfied, but most accept the advice.
In every field of medicine, it is not always possible to make a spot-on diagnosis. It is more important to give the right advice than to make the patient temporarily happy.