Why some Doctors discriminate against patients?

He,let us call him Mr M, is 30 years old,single working in a Bank in one of India's big Cities.His native place is near my clinic and I know him for last 6 years. I know him because he is positive for Hepatitis B Virus.

I remember him coming to me in distress as the technician in the Blood Bank had rejected his donated blood and asked him to see a Physician.He was told he is having jaundice.
I understood what the technician meant.Such rejection meant the blood is positive for either Hepatitis B or Hepatitis C Virus.

I ordered a whole series of tests on his blood. Results showed he was harbouring Hepatitis B Virus in his blood,but all the other tests were negative.

Both Hepatitis B and C are transmitted by inoculation of infected blood and blood products or body fluids.Unprotected sex, unhygienic medical procedures and unsafe blood can cause transmission.Once the virus enters the body it lives and replicates in the Liver causing hepatitis which may or may not produce jaundice.In most patients the immune system kills the virus completely and the person becomes negative to the test for virus.
But in a minority of patients the virus persists in the Liver and blood in a dormant form.Such a person is called a carrier in whom the virus will not produce any problem but can potentially transmit it to others. Our Mr M was such a carrier.Later in life [may be after 10 or 20 years] in a small percentage of carriers,the virus may again become active producing severe permanent Liver damage and even Liver cancer.So Mr M will have to undergo periodic lab tests to assess the activity of the virus.

While I explained all this his face revealed a depressed mood.
'I never had any unprotected sex doctor.Also never received blood donation'.
Any major medical procedures or injections? I asked.
'I had a few shots for various reasons.Also few dental procedures'.

If he was speaking the truth, probably we the health care personnel might have carelessly passed the virus in to his blood.I stopped that discussion there.

From then on he had came to me every year doing a series of lab tests confirming that the virus is there but not doing any harm to him.

Today Mr M was before me again.After reviewing the lab tests I gave him a smile saying everything is all right except that he is continuing as a carrier. I asked him about plans for marriage.
'Family is after me, pushing for marriage',M said.'But I do not want to hide my carrier state'.

'You can immunise your future wife with vaccine.Then you need not worry about transmitting the virus', I reassured him.

'Will anybody willingly come for an arranged marriage with a Hep B carrier?' M asked.
'Then love somebody,that may solve your problem', I replied.He gave me a shy smile.

'I have another problem doctor',he hesitantly said.
'Tell me' I encouraged him.
'I need some dental procedure done.I went to 3 different dentists in the City where I work.When I revealed my Hep B positive status they became very hesitant in doing the procedure.They came with excuses like we do not have separate instruments,or we do not want to take a risk of transmission of virus to other patients etc..'M said.' I do not want anybody else to suffer like me,that's why I am revealing my Hep B positive status'he added.

I was ashamed but not shocked.
I have seen this behaviour many times in doctors[both dentists and other doctors] when confronted with Hep B or more often with HIV.These docs will do the procedure gleefully and pocket the fees if Mr M was not so truthful.And they are doing countless procedures on un tested or untruthful positive patients day in and day out.If the Universally accepted precautions are properly taken all procedures are safe.Why these doctors discriminate like this? Are they not confident about the safety measures they are taking in their clinics?
More over in case of M, he must have got the virus from an unsafe injection or procedure.So health professionals are even more to be held responsible.
I immediately send him to a Dentist friend, with a letter in such strong words that he will not even think about rejecting Mr M. I hope he will get the required treatment and will not ever be rejected again for being truthful.

Craze for Specialist Consultation

Recently, I had an interesting experience. A-25-year old guy working in a Software Company in Banglore came to me with complaints of lack of appetite, giddiness, nausea and headache of a week duration. He had seen a doctor there in Banglore but the medicines prescribed did not help him.
Just looking at his eyes made me realise he was jaundiced. I examined him fully and came to a conclusion that he was having jaundice probably due to acute viral hepatitis. Before ordering a panel of tests to find out the exact cause of jaundice, I asked him to show me the Banglore doctor's prescription. He gave it to me little reluctantly. To my utter surprise, the doctor he had seen is a senior consultant in Neurosurgery at a posh hospital. The doctor had not spotted jaundice, may be because at that time [6 days ago] it was not as evident as it is now. He had given him anti vertigo and anti vomiting tablets.
I was curious.Why you went to a neurosurgeon? He said his friends told him it was better to see a top most consultant of Neuroscience as they all felt the problem was in Brain. Still why a surgeon? You could have gone to the neuro-physician? The reply shocked me.Only the neurosurgeon in that hospital had an American degree.
This craze for specialist consultation [after self diagnosis] is growing among the upper and middle income groups in India. Most often this leads to delayed diagnosis and delayed treatment. Many doctors also encourage this for selfish motives. The patient with headache go to a neurologist first and the one with chest pain will always go to the cardiologist first. The concerned specialist first rules out all the illnesses that he can treat by a panel of investigations. If all are negative, then only the patient is referred elsewhere.

With tons of medical information available on the Internet, many patients believe that they can diagnose themselves. They also believe that they can chose the specialist they want to consult. Many decides which medicines they will take and which they would not. Is this trend of patient emancipation beneficial to the society? Many believe so but I am not so sure.


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