CLINICAL DIAGNOSIS An Apocryphal Story

CLINICAL DIAGNOSISA woman brought her unconscious pet parrot to a vet.
An Apocryphal StoryThe vet physically examined the lifeless bird and told
Bythe woman that her pet parrot was dead.
VIKRAM KARVEThe distressed woman wailed, "Are you sure…?"
 "Yes. I am sure. Your parrot is dead…" the vet said.
When I was a small boy living in Pune in the 1960s, if"How can you be so sure…? You haven't done any
you fell ill you called your family doctor home and hetests or anything on my parrot…" the distraught
checked you up.woman said, "I don't believe you … You are just an
Every family had their own family doctor, a Generalordinary vet … I want to show him to a specialist…"
Practitioner (GP), who was like a member of theThe vet nodded his head and said, "Okay..."
family. He knew all about your medical and familyHe then turned around and left the room and returned
history and you had total faith in your family doctor anda few minutes later with a dog – a black Labrador
your family doctor and you had a mutually rewardingretriever.
relationship.As the woman looked on in amazement, the dog
After a thorough physical examination to diagnosestood on his hind legs, put his front paws on the
what was wrong, your family doctor either gave youexamination table and sniffed the parrot from top to
medicines or an injection there and then or he askedbottom. The Labrador then looked up at the vet with
someone to come over to his clinic to collectsad eyes and shook his head. The vet patted the dog
medicines which were mostly mixtures of groundon the head and the Lab went out of the room
tablets or liquid concotions prepared by thewagging its tail.
compounder and given to you in bottles with dosagesA few minutes the vet returned with a cat. The cat
indicated by stuck paper strips.jumped on the table and also delicately sniffed the
My doctor friend tells me that this approach is calledparrot from head to foot. The cat sat back on its
Clinical Diagnosis. Surfing the internet I found that clinicalhaunches, shook its head, meowed softly and the vet
diagnosis is a diagnosis based on a study of the signslifted the cat and sent it out of the room.
and symptoms of a disease (The AmericanThen the vet looked at the woman and said, "I am
Heritage® Medical Dictionary 2007) or a diagnosissorry, but as I said, your parrot is definitely dead."
made on the basis of knowledge obtained by medicalThe vet then went to his desk and wrote out his bill
history and physical examination alone, without benefitwhich he gave to the woman.
of laboratory tests or x-ray films (Mosby's MedicalThe woman, still recovering from the grief of the death
Dictionary, 8th edition, 2009, Elsevier).of her beloved pet parrot, was totally stunned with
Nowadays GPs seem to have vanished and youdisbelief when she saw the bill.
have to go to a specialist if you fall ill. And the specialist"What…!!! Two Thousand Rupees…?" the woman
sends you for a series of laboratory tests – blood,protested in bewilderment and she said, "You are
urine et al – and then studies the reports andcharging me Rupees Two Thousand just to tell me
prescribes medicines accordingly. My doctor friend tellsthat my parrot is dead…? This is ridiculous…!"
me that this is called evidence based diagnosis.The vet shrugged and said, "I am sorry but it is you
In a lighter vein let me share with you a humorouswho wanted to show your parrot to a specialist. If you
story, surely apocryphal, that my doctor friend narratedhad taken my word for it, my bill would have been just
to me on this subject.Fifty Rupees, but the Lab Report cost Rs. 950 and the
 Cat Scan a further Rs.