The Rashomon effect is a term derived from the Japanese classic film Rashomon (1950), directed by the legendary filmmaker Akira Kurosawa. In the film, a single event—the murder of a samurai—is recounted from multiple viewpoints: the samurai’s wife, a woodcutter, a bandit, and even the spirit of the samurai himself. Each account diverges, portraying vastly different versions of reality. Kurosawa’s masterpiece reveals the subjectivity of human perception, showing how people can interpret the same incident differently based on their perspectives, biases, and experiences.

The Rashomon effect, originally identified in the film, now manifests in various areas, including healthcare. Notably, multiple-specialist consultations exemplify this phenomenon, where patients, doctors, care providers, and other stakeholders hold distinct perspectives on the same health issue. This subjectivity leads to divergent interpretations, impacting decision-making and treatment choices, particularly in critical conditions such as coronary artery disease. Enhanced communication and collaborative approaches are vital to resolving these challenges.

When a patient consults cardiologists, neurologists, orthopedists, and others, the Rashomon effect often appears in how each specialist perceives, interprets, and recommends treatment for the patient’s symptoms. This is where the crucial role of a general physician comes in—providing a balanced, holistic view of the patient’s health before diving into specialized care.

The Medical Rashomon: A Patient’s Journey

Consider the story of Mr. Ramesh Singh, a middle-aged office worker from Delhi, who began experiencing persistent fatigue, occasional chest discomfort, knee pain, and frequent headaches. Aware of the importance of general medicine, he first visited Dr. Sharma, his trusted family physician.

Dr. Sharma listened attentively to Mr. Singh’s various complaints and took a detailed history. With his broad knowledge of general medicine, he conducted a preliminary physical examination and ordered a few basic investigations. While some results appeared borderline, Dr. Sharma was careful not to jump to conclusions. He understood that Mr. Singh’s symptoms could stem from multiple causes.

“Your symptoms could have several explanations, Ramesh,” Dr. Sharma explained. “It’s important to approach this systematically. I’ll refer you to a few specialists to get their opinions, but I’ll coordinate the process. You can come back to me after each visit so that we can piece together the findings.”

This is the invaluable role of the general physician—a role that is, unfortunately, on the verge of extinction in India due to a growing craze for super-specialization in medical education. General physicians act as the gatekeepers of health, offering a holistic view that many specialists, with their focused expertise, might overlook.

Chapter 1: The Cardiologist’s Perspective

Mr. Singh’s first visit was to Dr. Rao, a seasoned cardiologist. Dr. Rao listened intently as Mr. Singh described his symptoms, occasionally nodding as he made notes. The cardiologist ordered an ECG, an echocardiogram, and a treadmill stress test, suspecting coronary artery disease. When some of the results suggested minor irregularities, Dr. Rao interpreted Mr. Singh’s symptoms as early signs of heart disease.

“You need to manage your stress levels, eat a heart-healthy diet, and start on these medications,” Dr. Rao advised. “We need to prevent this from developing into a more severe cardiac issue.”

Chapter 2: The Orthopedist’s Diagnosis

Next, Mr. Singh visited Dr. Mehra, an orthopedist, as his knee pain had started affecting his mobility. Dr. Mehra, examining the knee with an X-ray and physical assessments, identified early osteoarthritis.

“This pain is due to the wear and tear of your knee joint,” Dr. Mehra explained. “A combination of physiotherapy, supplements, and lifestyle modifications should help. We might need to consider further interventions if it worsens.”

Chapter 3: The Neurologist’s Assessment

The headaches and fatigue led Mr. Singh to consult Dr. Bhattacharya, a neurologist. After an MRI and several neurological tests, Dr. Bhattacharya found subtle signs that suggested potential early migraine or tension-type headaches.

“These headaches could be due to stress or vascular changes in the brain,” Dr. Bhattacharya noted. “Avoiding triggers, stress management, and certain medications can help manage this condition.”

Each specialist viewed Mr. Singh’s symptoms through their own lens, offering distinct opinions and treatment plans. This exemplifies the Rashomon effect in medicine, where each expert’s interpretation is shaped by their specific domain.

A Fragmented Diagnosis: The Rashomon Effect in Medicine

In each consultation, Mr. Singh received distinct advice, reflecting the expertise and focus of the respective specialists. The cardiologist, orthopedist, neurologist, and gastroenterologist all looked at Mr. Singh through the lens of their specialities, leading to diverse interpretations and treatment plans. Like the characters in Kurosawa’s Rashomon, each doctor viewed the same symptoms through different perspectives, influenced by their training, experiences, and biases.

This multiplicity of viewpoints illustrates the Rashomon effect in medicine. Each specialist’s narrative was shaped by their specific domain, resulting in a fragmented picture of Mr. Singh’s overall health. While each doctor offered potentially valuable insights, the lack of a unified perspective complicated Mr. Singh’s path to effective disease management.

The General Physician’s Reconciliation

After meeting the specialists, Mr. Singh got puzzled and he returned to Dr. Sharma. With all the reports and recommendations in hand, Dr. Sharma pieced together the fragmented narratives. He recognized that stress was a common factor influencing Mr. Singh’s cardiac symptoms, headaches, digestive issues, and even the exacerbation of his knee pain.

“Each specialist’s insights are valid,” Dr. Sharma explained, “but they’ve looked at your symptoms through their specific lenses. The key is to find an integrated approach that addresses these interconnected issues. Let’s focus on lifestyle changes to reduce stress, work on a balanced diet, manage your joint pain, and consider medications cautiously.”

Dr. Sharma’s balanced viewpoint, shaped by his holistic training, enabled him to develop a unified treatment plan tailored to Mr. Singh’s overall health. This is the essence of the general physician’s role—coordinating care among specialists and ensuring the patient’s well-being as a whole, rather than as isolated parts.

Navigating the Rashomon Effect in Healthcare

In situations like Mr. Singh’s, patients often struggle to reconcile differing medical opinions. The story of Mr. Singh illustrates why consulting a general physician before approaching specialists is vital. General physicians serve as the patient’s primary advocates, synthesizing different medical perspectives and guiding patients through the complexities of healthcare. Without this coordination, patients can end up lost in a maze of conflicting medical advice.

Unfortunately, the current trend in India’s medical education and healthcare industry places more emphasis on super-specialization, causing general practitioners to dwindle. This is a cause for concern, as the value of holistic, patient-centered care cannot be overstated.

Conclusion: Reviving the General Physician’s Role Amidst the Rashomon Effect

The Rashomon effect underscores the complexity of the human experience and the multifaceted nature of truth. In healthcare, it reminds us that patient management often requires looking beyond isolated symptoms and specialized viewpoints to appreciate the whole person. For Mr. Singh, like many others navigating the healthcare maze, finding harmony among the various medical narratives is key to achieving holistic well-being.

While specialist opinions are crucial, the role of a general physician is indispensable. Acting as a bridge between specialists, general physicians ensure that patients like Mr. Singh receive comprehensive care rather than a fragmented approach.

In a healthcare landscape increasingly dominated by super-specialists, the general physician’s role is more important than ever. Patients are encouraged to consult a good general physician first, who can guide them through the maze of medical opinions and provide a cohesive path to health and well-being. Let us not let the role of these essential practitioners fade into oblivion in the pursuit of specialized expertise.