*The Rashomon Effect*

*The Rashomon Effect* The 40 year old gentleman was in deep distress. His wife was massaging his left shoulder in a bid to alleviate his pain. Within the last 48 hours, he has met three different Doctors (Super- Specialists to be precise) and underwent an ECG, ECHO, MRIs of shoulder and Neck bone, and a battery of blood tests. The wife's hands were overflowing with the prescriptions and the Path Lab reports. Being an IT professional, he has been suffering from Neck pain quite often. Three days ago, the pain started to gradually shift to his left shoulder and arm. The patient googled his symptoms which indicated the possibility of an imminent Heart attack. The couple had rushed to a local Doctor who performed normal blood tests and sent him to a Cardiologist. The Cardiologist thought it could still be a Myocardial ischemia and performed a 2D Echo Test. It turned out to be normal but to be on the safer side, he prescribed a low dose of blood thinners, Cholesterol medications and advised him to get an opinion from an Orthopedic Surgeon. The pain was excruciating and the Orthopedic Surgeon being a Specialist in Keyhole surgeries, suggested that it could be a tear in the shoulder tendons since the patient was diabetic. He performed an MRI of the shoulder which was equivocal. He gave the patient some more medications and suggested that he meet a Neurologist ‘just in case’ it could be a nerveous problem. After examination, the Neurologist too thought it could be Diabetes or viral Neuropathy based on the high Blood Sugar level. He advised a few tests and an MRI of the Cervical Spine. Finally, it turned out to be a Slipped disc in the Neck Bone. What we see here is a common Healthcare problem of late. *Every Super-specialist sees the patient and his symptoms, only from his specialized narrow perspective* The clinical notes, investigations and disease Management are tailored to suit the Doctor's specialization. This is what is stated as *Rashomon Effect* *Rashomon* was a famous movie directed by the celebrated Japanese Art-movie Director- *Akira Kurosawa* In this movie, *a Murder scene is described by different witnesses from their own point of view. All their views, are very different from one another. But they all believed that they are speaking the truth, because it appears True from their own individual perspective* Similarly every Medical Super-specialist has his own approach towards the patient, typically focussed on the system in which he has specialized. *Upper stomach pain is seen as Esophagitis by the Gastroenterologist, Angina by Cardiologist and as Costochondritis by the Orthopedic Surgeon* If we look at their clinical notes and examination findings, it would match their diagnosis since their mind is wearing blinkers. The Specialised mind fills the gaps based on his previous observations, specialised knowledge and myopic training. With increasing Super- specialization, the patient is not seen as a whole, but only as an affected Organ. The specialist falls prey to the *Rashomon Effect* and explains the patient's symptoms from the perspective of his own Super-specialisation. *It is difficult to avoid this in future, since practitioners of General Medicine, are on the verge of getting extinct, thanks to current trends in Medical Education in India, where there is a craze for Super-Specialists* *Please consult a good General Physician, before approaching any Super-Specialist in 5 *Rashomon Effect* ............... *Resolve Thatte's paradox* A simple doctor knows atleast something about everything. A specialist has more knowledge about less things. A super-specialist knows more and more about less and less. A super-super-specialist would know more and more and more about less and less and less things............... *Ultimate super super specialist would know everything about nothing.....*_ ==================== *_Based on mathematical corollary_*