What is the difference between God and an orthopaedic surgeon? God doesn't think he is an orthopaedic surgeon. I suppose God's ubiquity is part of the reason. You can find God here, there and everywhere among the common people but orthopaedic surgeons are much more particular - you find them only in high-class joints. We take God for granted but orthopaedic surgeons demand an arm and a leg for their services even when the problem is a finger or a toe.

As I kept repeating to my friends and family alike, I took a break from the afternoon cricket practice with my son and his friends. At first, because I was having a swell time, I thought it was a sprain and tried hot water, ice and various unguents but when the pain refused to go away and the swelling seemed to be going up rather than down I exchanged the rub for a doctor who rubbed me the wrong way.

unique name

Realising that the top joint of the index finger on my right hand was broken and not sprained as I had previously thought, I decided to go to an orthopaedic specialist. I was in Port-of-Spain and in pain. I had travelled from Antigua the night before and my finger was hurting badly. A doctor friend had recommended a place just out of the city but I decided that there was a clinic near the Queen's Park Oval that accepted 'walk-ins' and decided to go there instead. What made up my mind was that the clinic had both 'fracture' and 'orthopaedic' in its name.

The first thing the doctor did when I went into his office and told him about the problem, was to seize the finger and squeeze it. Then he tried to twist it. I reminded him that he had X-rays. He said he would look at them later. When he did, he realised the back of the joint was fractured. He said he would not put a pin in it because of the increasing arthritic condition but would put the finger in a splint. He took out a box of plastic splints, found one that fitted me, put a bit of Velcro on it, took a phone call, gave me a prescription, agreed to give me a letter to American Airlines to postpone my flight, and sent me back to his receptionist to pay the bill.

He charged me TT$500 (approximately US$83.30) for the visit. The small plastic splint cost me TT$172 (about US$28.67). I saw it online for US$7.44 with a discount for bulk orders. When I got the doctor's letter to American Airlines I was told that it would cost TT$200 more. I spoke to two other doctors later and they were appalled. One said bluntly that all he needed to do was look at the injury and he would have taped two 'palette' sticks on it and maybe given me some pain killers if I needed them. Another told me about the importance of professional ethics. The fact was that I had spent TT$992 exclusive of the cost of the medicine - both in actual costs and the damage it did to my system.

no malpractice insurance

But first, let's think through why in the midst of a financial depression, doctors' costs are actually rising. It might be that an increasing number of people have medical insurance and can afford higher charges but doctors here don't have to pay malpractice insurance. In the Caribbean, doctors are allowed to regulate their own profession and, while a doctor might admit that a colleague made an error, I cannot recall any doctor appearing as a witness against another doctor in a malpractice suit.

Another explanation for the high charges can come from this old joke. A multimillion-dollar power plant had mysteriously ground to a halt. All efforts to restart it had failed and an expert was brought in. After studying the problem for a few minutes he took a hammer and hit one of the valves. With a rumble, the plant came back to life. Later, the expert's bill arrived for the amount of $100,000. The outraged executive in charge was angry and asked for an itemised breakdown. The consultant responded with a bill that read: 'Hitting valve with hammer $10. Knowing which valve to hit: $999,990' I suppose that is why I got hit with such a huge bill.

Perhaps I was lucky that it was only a broken finger. Suppose I had gone to him saying, "Doctor, I have no money and my leg hurts. What can I do?" I believe his answer would have been, "Limp".

Tony Deyal was last seen quoting from actual medical reports that included 'She is numb from her toes down', 'On the second day the knee was better and on the third day it had completely disappeared', 'The patient has no past history of suicides' and' exam of genitalia reveals that he is circus sized'.