Thursday, 24 April 2014

An Experience in diagnosing Tuberculosis Correctly (and some lessons learnt) by Amit. (Disclaimer: Hospital Guide Foundation provides a neutral platform for Patients/attendants & Doctors to express their opinions/experiences. These views are of the writer.)




Its an unfortunate truth that its increasingly difficult to trust the advice of doctors, in a time when most public hospitals suffer from long queues and sordid treatment conditions, while private hospitals and doctors let their commercial interests come in the way of honest and ethical practices. I’d like to share my story of having to go to 4 different doctors to settle on a diagnosis, with the hope that it will help you with your own experiences going ahead.


Background: My wife was running a very mild fever (called low grade fever) for a while, and felt frequently fatigued.


Consultation 1: After a few weeks of this, we went to a general physician at a private hospital in Bangalore. He conducted a battery of standard tests around malaria, typhoid etc, all of which turned out negative. At which point, the doctor told us that she should “eat healthy and have coconut water”, and that we should get back in touch if any more symptoms develop. As it turns out, this was a very irresponsible piece of advice.


Consultation 2: We had to travel to Delhi shortly afterwards, and decided to seek a second opinion. I asked around in my family and decided to meet a senior internal medicine expert at a leading private hospital. We are grateful that this doctor asked my wife to measure her weight, from which we realized that she had lost about 5 KGs in last few months. He asked us to run Tuberculosis (TB) tests (Montoux, TB Gold, Chest X-Ray and Chest CT scan). Montoux and TB Gold turned out to be positive, though both have less than 100% reliability. What we did not appreciate was that the doctor was very insistent that we do the tests at his hospital.. where it costs 40% higher than good third party diagnostic centres (we ended up going to Mahajan Labs who have terrific medical infrastructure). This doctor also asked for another expensive test (Hains first line test) that we later discovered was not needed at this stage.


Consultation 3: A little cynical after the experiences so far, we went to another private doctor who confirmed the prognosis as lung Tuberculosis. He also strongly suggested another test (again insisting we do it in his hospital.. to our amusement even telling which room number we should go to “right away”), which was also uncalled for (Bronchoscopy). This is an expensive test (Rs. 20,000), and he wanted to follow it up with yet another invasive procedure (costing yet another Rs. 20,000)!


Consultation 4: A little tired of the experiences in private hospitals, we finally did our own research and found out about the national institute of tuberculosis and respiratory diseases delhi. This is a super-specialty government run hospital. We went without any appointments and were able to meet a senior doctor (a Chief Medical Officer). To our surprise, the doctor asked us certain diagnostic questions that no one had asked yet (e.g. did she take TB medication ever in her life, and whether she has any joint pains etc.). He also looked carefully at all test results, and also checked her for nodules in the neck(for non-pulmonary TB). He also told us that bronchoscopy is not needed because it can also be unconclusive, and other tests are sufficient confirmation.


In the end, the advice from the TB institute doctor proved to be the most balanced. My lessons (and takeways from others) from this experience:


  • Private hospital doctors are almost always cumpulsively inclined to recommend expensive tests. They may be good doctors, but they will invariably try and make you spend as much as they can.
  • Public sector hospitals are not fun to visit, and it can be difficult to even get an appointment. However, their motivations are not commercial and so they will advice from an neutral perspective.
  • One must go to at least 2-3 doctors (more if needed) especially in serious illnesses.
  • Most importantly, you are in charge of your own treatment. Read up on the internet, compare notes, ask questions to doctors, consult friends and family… do everything with a logical and balanced mind to drive the process yourself.

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