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COST EFFECTIVENESS/YIELD/MEDICAL ECONOMICS
Scarcity Amidst Plenty in Pathology Laboratories - 2003
OP Kapoor
As a physician, I find it extremely difficult to practise in India, even in a city like Mumbai, where hundreds of pathology laboratories and about half a dozen very big laboratories are available for help. Inspite of this, I face some problems, which remain unresolved.
My grievances are:
1. In case of fever, I require at least 2-3 blo
od cultures. Though some laboratories have started sending their technicians to the patient’s house to collect the blood samples, most of them do not collect enough quantity of blood required to grow scanty organisms (ideally, it should be 15-20 ml of blood). Often the previous doctor has prescribed some antibiotics, due to which the organisms are so few in the blood that they can be grown only from the bone marrow culture.
Unfortunately, hardly any laboratory does bone marrow culture. Lately, I have developed my own contacts to get this test done. But I wonder, what must be happening to thousands of family physicians who have private practice in a city like Mumbai, and have access to big laboratories where all the unusual tests like serum ceruloplasmin levels, total viral load counts, etc can be done, yet this simple investigation, which is required in every alternate patient, cannot be done.
2. Secondly, I find that ‘chronic prostatitis’ is quite common in private practice. So often, I would like to have an examination of the prostatic secretion (smear and culture). I find that, hardly any laboratory is doing this test, as a prostatic massage is required to be carried out.
3. My third grievance is about all respiratory patients, where I want reports of arterial blood gases. I have a Pulse Oximeter in my private practice. In my opinion, all the family physicians should possess this useful investigatory tool or else you should be lucky to have a pathologist available, who can do an arterial puncture and arterial blood gases (ABG). As yet, no pathology laboratory has technicians or doctors, who can do arterial puncture and ABG.
EPISTAXIS : NOT TO BE OVERLOOKED IN BLEEDING IN CIRRHOSIS
In patients with haematemesis without an identifiable cause at gastroscopy, the mouth and nasopharynx should be examined carefully to exclude a bleeding point.
BMJ, February, 2003;326:440.
( Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008)
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