Disease in diagnosis

The quality of medical care in the port city is getting a bad name in recent times, leading to immense patient sufferings. And the diagnostic centres are partly to blame.

Healthcare is characterised by the treatment of the patient by taking into account the clinical reports, rather than just the symptoms of a disease. Getting the right diagnosis is a key aspect as it helps doctors decide on subsequent steps.

Bakteyar Hossen Saimon from Noapara village of Raozan upazila in Chittagong thought the worst was behind after his mother's gall bladder removal at Delta Hospital in Chittagong in the first week of June.

But a few days after the procedure, a diagnostic report showed the presence of malignancy (adenocarcinoma) that had spread and that she would require chemotherapy to heal.

“We were absolutely devastated by the news. Thinking about what to do next, I decided to go to Christian Medical College (CMC) at Vellore, India for a second opinion.”

Zipping through the visa procedure, they flew out the very next week. “To our surprise, the medical report of the Department of Hepato Pancreato Biliary Surgery of CMC showed no evidence of cancer.”

Mitu Chakraborty, 42, a resident of Akbar Shah in Chittagong, shares a similar narrative. She had heard of varying blood work results from her acquaintances before and so she gave blood samples at Popular Diagnostic and Nuclear Medicine and Allied Science on September 5.

Her confusion knew no bounds when she got two diverse results – the report of Nuclear Medicine and Allied Science showed her thyroid-stimulating hormone (TSH) level at 3.89 and Popular Diagnostic at 12.72.

Three days later, she gave a blood sample at Sensive Diagnostic, and the result showed her TSH at 7.44.

The head mistress at South Mosjiddha Government Primary School of Sitakunda Upazila is now apprehensive about further tests in the port city and has decided to go abroad for treatment as well.

In another incident, Farid Ahmed, a resident of Changragona union of Rangunia Upazila, said his wife was diagnosed with a tumour in her gall bladder through assessment at the Centre for Nuclear Medicine and Ultrasound in the first week of March 2016.

 “My wife broke down in tears at the doctor's chambers after hearing the test results. However, a second assessment just after three days at Metro Diagnostic Centre showed no tumour.”

 “We are now even more uncertain of what to do next.”

One of the factors behind misdiagnosis could be the use of expired reagents in carrying out the tests, Chittagong Civil Surgeon Abdul Aziz Siddiqi told The Daily Star. A reagent is a substance or mixture that is used for chemical analysis or other reactions at laboratories.

RAB frequently conducts drives into these labs and fines them for using expired reagents. But the labs just pay the fines and its business as usual, added Siddiqi.

“We formed a three member probe body to examine into the varying test results of Mitu Chakraborty and will take steps accordingly.”

On why diagnostic reports vary at different centres, Dr Zillur Rahman, head of the pathology department of Chittagong Medical College, said test results may vary depending on the method, quality of reagents, skills of the technicians and the way the reagents are being preserved.

Hospitals and labs get frequent deliveries of fresh reagents, but some dishonest technicians make do with expired and diluted reagents and sell the new reagents outside, he added.

“Many a labs may even procure low quality materials for diagnosis, as those are cheaper. And lastly, the skills of the technicians in conducting the tests and preserving the reagents is a determining factor as well,” he said.

What do the diagnostic centres have to say?

Abu Masud Hanif, assistant manager of Popular Diagnostic Centre, defended their report when Chakraborty returned to confront them about her TSH level, accompanied by journalists. “We diagnosed her again and found the same result as before. We can say that our report is one hundred percent right.”

Dr Tapan Poddar, in-charge of the pathology department at Delta Hospital, said a number of patients do not follow the right procedures before going through the medical tests. “Sometimes, patients come in after having a meal, while he or she was asked to take the test in a fasted state. This makes it difficult to make the right diagnosis.”

On the case of Mitu Chakraborty, Dr Moinul Islam Mahmud, director of Sensive Diagnostic Centre, said the Civil Surgeon Office formed a committee to look into the reports.

“As the matter is under investigation, I prefer to not make a comment. The findings will reveal everything. But I can say that we use the best equipment and use cutting edge technology to ensure accurate readings.”

The committee found no irregularities while investigating Popular Diagnostic Centre and Sensive Diagnostic Centre, sources said. It was still probing Institute of Nuclear Medicine.

Robiul Haque, director of Institute of Nuclear Medicine, could not be reached over the phone despite several attempts.