Medicine ought to be science, or is it?

 

 Only three years ago I was seeing an appendix a week in young adolescents and kids from a sample of just over twenty seven thousand households in NW and Gauteng before that. Yes, over ninety percent were lily whites if you need to know; criminal you have to admit but all were clinically cured.

 
Less than a thousand kilometres away I have yet to see an acutely presenting appendix from a sample size ten times larger, over a time span of a year and a half and counting. Thirty years of cherished and practised clinical pathology magically dissolved into thin air, without not even a single variable to explain this.
 

Those patients that do reach the hospital present as generalised peritonitis with no clear picture as to what the original source of the surgical abdomen was. Most get confused with ruptured peptic ulcers, save for the exaggerated pyrexia and septicaemia. Add to this the renal failure complicating the presentation because of pre-treatment with herbs from the local bone throwing compatriots before coming to hospital. You as the admitting doctor have to resuscitate and stabilise before you can even attempt to diagnose. The appendix gets to be diagnosed after the exploratory laparotomy or post mortem if fortunate enough to have one done.
 

How does the clinical picture change so drastically from one region to the other? What is a student of medicine in the university of Natal expected to take home as a message from such pathological variants? When can such a student do a lily white appendix in a controlled environment with a registrar and a consultant as a guide? You get very little useful academic knowledge from abdominal washout and drains.

  
Ninety percent of what we used to operate on were not appendix abscess or anything close to the above picture. Ninety percent walked out of the hospital a day after the surgery with nothing more than three centimetres of a classical appendix scar. Ninety percent had only an appointment by the primary health care nurse with nothing more than dry flowers as a thank you note for getting rid of the major absenteeism generating rudiment as a reminder of what we’re guilty of; if lilies had to be a crime. More importantly none died and none was laparoscopic. We were happy to be named as the doctor responsible for the missing appendix, all outcomes considered. If we got a complaint it usually was because we waited too long, specifically with reproductive females when the diagnoses was not in black and white.
 

This side of the Vaal the post-operative ICU convalescence is close to a month. The scar and drains from the encounter when it eventually closes leaves little to imagination. The adhesions and the bowel obstruction presentations afterwards stay a constant reminder years into post-operative recovery period of what we could have done better.

There has to be a middle ground to this seemingly parallel dichotomies. If I had to choose one or the other though, my kids will go through the first option. If I had to modify and weed off the negatives patients need to see me first, then consult a herbalist after excluding an appendicitis, only then could I assume a lower incidence of appendicitis on regional basis.

 

If physiology and biochemistry of health health are the elements of every mix, then results are assured

Stupidity, BEE and being black are not equivalents.

Being a doctor in private should be the easiest on ones morality tax, if only money could be divorced from treating the patient in need.

Being a doctor in the HMO system I have always thought should be a little more difficult. Forcing patients to be healthy is not for the faint hearted. A carrot can and should only have a limited incentive effect before you need a stick. You can't make a meal off a bag of carrots.

Being a doctor in the state with the new changes the government made is hell. You need to care very little about your patients. Clockers, they are trying to conform us into. Shouldn't it be the other way round? The price the patient pays is totally divorced from what he gets in the state.

Historically, we always had patients as bosses in all systems. Yes, patients are bosses in the HMO as well; to keep the rates per patient low for rest of the group members you need healthy samples. The whole group is represented every time each individual consults or complicates.

Over the past few years though, we now have BEE politicians serving a different master making decisions on behalf of doctors/patient as if they had more than a median nerve to empower them to do that in the first place. The worst part is that the government seems bent on replacing every professionally qualified and intellectually interactive black with an ANC right candidate, agreeable and very little decision making power. We have seen that weeding ruthlessly continuing at parliament level right down to hospital CEOs. Herd mentality is preached across the board, unfortunately even the herd needs at the least a head.

I have always preferred a nurse for a CEO for a different reason. We need all the professionals at work and on patients rather than disciplining a cleaner.
When that CEO decides to buy you a tool that you can't use though because it was made by a connection or because it was cheaper, that defeats the purpose of patient care. You can't break burglar bars when there is fire, if only the median triggered a response before the installation. Buying a hundred blown engines will never get you on the road no matter how close to God or politically popular you may be.

When that CEO feels so insecure that medical decisions have to be sneaked in midnight to even see the daylight, the trust is broken. The patient sees a doctor and a nurse and unless consultation is made with all or at least some of the above, we're driving blindfolded.

The last such BEE and ANC flagged official I had to deal with, ended up dead due to a frontal lobe meningioma. I swear I am not related to that meningioma, nor do I have control over it. I am not that advanced. 

He died with us doctors blaming his stupidity on a normal deviation within a politically same club on a bell graph. 

If only someone could have held him down for one to examine even just the disc. 

The following year they replaced him with another, even more incompetent and my colour, black. How they can hand pick so many median nerve backed retards in a sea of so many intellectuals has always bedevilled me. We don't have to agree. Mbeki and Mugabe are black, disagreeable but still makes me proud to be classed in their subset. ANC is now a total misrepresentation of what black people are capable of.

I am afraid we getting a repeat of that now. Is it possible to be that intellectually challenged. I have decided to not be a witness of where this will end.


 If  biochemistry and physiology of and health are the elements of every mix, then results are assured