Sunday, April 17, 2011

The state of diagnostics in India

I had to get a blood culture done to check for the possibility of infection due to some symptoms I was having. I went to a very reputed hospital in the city and gave my sample. Along with the sample for the culture, I also gave a sample for C-Reactive Protein (CRP), which is a marker for infection/inflammation.

A couple of days later, the reports arrived. The CRP was normal but they could isolate Eschirichia Coli bacteria in the blood culture. This was strange. Usually if there is infection, the CRP should be high. They suspected that the blood sample drawn for culture might have been contaminated. A repeat sample was drawn for the culture.

Another patient I know was asked to get her blood tested for ANA infection. She gave her sample to one of the best hospitals in the city. The report came out to be positive. For some reason, the doctor wanted to confirm the diagnosis. He had the sample sent to another very good hospital. Negative! 

In my initial years with kidney disease, blood was drawn at the same time and three samples were made and sent to three different labs in the city to check the level of Blood Urea. The reports from the three labs were different and how? One showed 85 mg/dl, another 170 mg/dl and the third 240 mg/dl.

Laboratory investigations form a critical part of medical diagnosis and treatment. How can we be treated based on such flawed systems? Many decisions are taken based on the results of these tests. How can we be confident that we are getting the right treatment? And these incidents were all pertaining to top hospitals in the city. Imagine the state of the smaller diagnostic labs.

Many years back, labs would all be operated manually. There would be rigorous training to become a lab technician. There were hardly one or two labs in a city the size of Hyderabad. Dr. Nandan Singh's labs were very famous in Hyderabad. You probably had a couple more. You went to one of these. 

These days everybody and his uncle is opening a lab. Why? Labs are no longer manual. You have fancy equipment that does most of the tests. All you need to do is to mix some chemicals with the blood and put in a tube that is connected to the equipment and the machine tells you the result. In a matter of seconds. This has made the whole process so easy that anyone by reading the instructions can do this. And that's where the problem lies. Unqualified people have begun doing these investigations. They do not realize the importance of what they are doing. So they take it easy.

The test for Serum Potassium, for example, is a very sensitive test. This test requires you to add a particular reagent to the sample, drop by drop. Adding the reagent suddenly, at one shot, can ruin the sample and you lose the sample forever. Who checks whether this has been done? No supervisor would ever know if it has not been done.The Potassium value reported can be very different in this case. The consequences of this wrong report can potentially be disastrous.

It is very important, therefore for proper regulation of these labs. Stringent quality control, good technicians and strict monitoring are extremely essential. It would be criminal on the part of these hospitals and laboratories to not put these in place.


IGA Nephropathy said...

This is actually one of my biggest concerns with medicine in India. The focus on profit and cost is so high that sometimes I even wonder whether somebody actually does the tests (not that other countries have is the fact that there are no checks & balances and nobody gets caught).

Hopefully the doctors are tuned to this and look for more physical symptoms and take time to take the history but alas that also may not be true but for few ones.

Anonymous said...

This need to be a police report..