"Sir, Please come fast your patient Mr K is gasping...."
By the time I reached the ICU the electrocardiographic monitor was showing a flat line. The Cardiologist was there and also the Urologist and a few others.They all were trying their best to revive the patient.I was summoned to talk to the relatives sitting outside. They gave me the hard job.
Yes it was a hard job.Mr K was my patient for a long time. He was suffering from Coronary Artery Disease and Chronic Obstructive Pulmonary Disease. He was in and out of ICU many times. But for the last few years he was doing fairly well.No Hospitalisation for 26 months. He was cheerful and pleasant Along with his Cardiac and Lung diseases he was also suffering from benign Prostatic enlargement. The Prostate was large enough to obstruct free flow of urine from the Urinary Bladder. He thus was able to pass Urine only through a permanent Catheter put inside his Bladder. 2 years ago he was evaluated for Prostatic surgery [so that he can pass Urine normally] but the procedure was deferred in view of his poor Lungs and Heart.
Seeing him come to my Out Patient Department every month with this urinary catheter I was tempted to rethink about Prostatic surgery. As his general condition seems to have improved during last few months,I had hope that the Prostate surgery could be done now. I referred him to Urologist. He did a complete evaluation and told me if I and the Cardiologist could give a certificate of fitness for surgery he will go ahead with the procedure. The Cardiologist gave a guarded certificate saying there is mild risk of complications including death due to the pre existing illness.I also gave such an opinion.
Some of the relatives were not willing for surgery.But his son was ready.He asked me again and again about the risks.I explained everything and said even though there is a risk it is negligible and you can give the consent. The patient was ready to comply with his son's and my decision. Finally all gave consent and surgery was fixed.
Today was the surgery day. All went all right till a few minutes ago when he suddenly suffered a cardiac arrest in the post operative ward. The attempts to revive was failing in front of my face.
What can I tell them? They believed in me and hoped the urinary catheter will go away and their father will be happy. But now the father is no more. Will they feel that I am responsible for his death.
I went out to see the anxious relatives. In a hushed tone I told them what all had happened. I told them that everything possible was done but unfortunately we could not save him.
Are their faces showing anger at me?
No only stunned disbelief.
I explained that his lungs and Heart suddenly gave away and even if it did not happen now it might have happened some days later. They took it well and there were no accusations.
But still I continue to ask the question again and again.
Was I responsible for his death? May be yes in an indirect way.
Showing posts with label Doctor-Patient relationship. Show all posts
Showing posts with label Doctor-Patient relationship. Show all posts
Friday, June 12, 2009
Sunday, March 22, 2009
Am I reassuring too much?
A patient always like to hear reassuring words from their Doctor.
A doctor is also happy to see the smile of relief on patient's face.
I reassure my patients a lot.But some times I ask myself
Am I reassuring too much?
The other day in my practise it was a day of reassurance.
First patient was a 29 year old woman,in the last few weeks of Pregnancy.She was diagnosed to have Gestational Diabetes.She is working in one of our Metros and was under the care of a specialised Gestational Diabetic Clinic there. Now she has come home for delivery and wanted me to look after her Diabetes.
She was on Insulin, 3 injections per day and was monitoring her blood sugar every day 2 to 3 times at home with her glucometer. She was given a long list of dos and dont's and a detailed diet chart.She was following everything perfectly.
After reading her reports I looked in her face.She seemed to be distressed. I asked her what was troubling her. She said her blood sugar is fluctuating very much and is afraid her baby will be harmed. She also said instead of gaining, she was loosing little bit of weight and is worried about.
The blood sugars were fluctuating but with in a narrow range and was well acceptable. When ever a small rise in blood sugar happens she is much worried that she reduces food intake. Some of the diet restrictions told to her from her speciality clinic was extreme and had not much scientific basis. Her mother is also confused about what food her daughter should be given. All the home grown wisdom of what to give and what not to give for a pregnant daughter was set aside and they were religiously following the diet chart.
I smiled at her and said " You are worrying too much. Your blood sugars are excellent and I am sure you will have a healthy baby and a normal delivery. Yes, you should regularly check your sugars but eat more liberally. Tell me what you really like to eat and I will tell you what quantity and how often you can eat your favourite dish."
That reassurance visibly made her happy. By next visit she started gaining weight and more importantly was at ease. I hope she will deliver normally a healthy child.
Next patient was a retired Government Clerk. He came to me few weeks ago with features of Cirrhosis Liver,probably due to alcoholism. He was send to a Gastroenterologist for detailed evaluation and was found to have severe Liver disease. He has come back with the reports.
"Is it really bad doctor?"
"Your Liver is affected by your drinking".
"I stopped the day I first came to you. Will the Liver function improve?"
"If you do not drink again you will definitely improve, don't worry", I said looking in to his eyes.
That was really not the truth.The reports showed he have irreversible liver damage and his liver function may deteriorate over several months to years. But his symptoms will temporarily improve with medicines. That's why I could confidently reassure him.
My answer I am sure made him feel better.
Third patient was a 64 year old Rheumatoid Arthritis patient. Her knee joints were so much destroyed that she needs Total knee replacement for both knees. Her family was not very well off . I had discussed it with her son and the family was not very keen to find the money for the surgery.
"Will I be able to walk properly and climb steps doctor?" She usually ask me.
" Let us see. You are showing some improvement.So if you continue the treatment......let us see."
In my mind I was sure she will not be able to walk properly. I had hinted to her once about surgery which she refused immediately citing old age. Also the family may not be able to afford it. So she will most probably go on like that using a walking stick, moving very slowly,swaying her body to either side till her death.
But each time she leaves my room, she is satisfied with my reassurance.
Am I reassuring too much?
Some times I do, hiding the gravity of the illness so that the patient is not too much upset. Some time I reassure prematurely before arriving at the diagnosis to avoid unnecessary mental tension.
Making the patient fully aware of the situation may help in avoiding future surprises.It may also help in compliance with therapy. So should I change my method?
I am confident I did do the correct thing in all three instances.
As the great TB physician Dr Edward Trudeau said
"To cure sometimes, to relieve often, to comfort always,"
should be the motto of each Physician.
A doctor is also happy to see the smile of relief on patient's face.
I reassure my patients a lot.But some times I ask myself
Am I reassuring too much?
The other day in my practise it was a day of reassurance.
First patient was a 29 year old woman,in the last few weeks of Pregnancy.She was diagnosed to have Gestational Diabetes.She is working in one of our Metros and was under the care of a specialised Gestational Diabetic Clinic there. Now she has come home for delivery and wanted me to look after her Diabetes.
She was on Insulin, 3 injections per day and was monitoring her blood sugar every day 2 to 3 times at home with her glucometer. She was given a long list of dos and dont's and a detailed diet chart.She was following everything perfectly.
After reading her reports I looked in her face.She seemed to be distressed. I asked her what was troubling her. She said her blood sugar is fluctuating very much and is afraid her baby will be harmed. She also said instead of gaining, she was loosing little bit of weight and is worried about.
The blood sugars were fluctuating but with in a narrow range and was well acceptable. When ever a small rise in blood sugar happens she is much worried that she reduces food intake. Some of the diet restrictions told to her from her speciality clinic was extreme and had not much scientific basis. Her mother is also confused about what food her daughter should be given. All the home grown wisdom of what to give and what not to give for a pregnant daughter was set aside and they were religiously following the diet chart.
I smiled at her and said " You are worrying too much. Your blood sugars are excellent and I am sure you will have a healthy baby and a normal delivery. Yes, you should regularly check your sugars but eat more liberally. Tell me what you really like to eat and I will tell you what quantity and how often you can eat your favourite dish."
That reassurance visibly made her happy. By next visit she started gaining weight and more importantly was at ease. I hope she will deliver normally a healthy child.
Next patient was a retired Government Clerk. He came to me few weeks ago with features of Cirrhosis Liver,probably due to alcoholism. He was send to a Gastroenterologist for detailed evaluation and was found to have severe Liver disease. He has come back with the reports.
"Is it really bad doctor?"
"Your Liver is affected by your drinking".
"I stopped the day I first came to you. Will the Liver function improve?"
"If you do not drink again you will definitely improve, don't worry", I said looking in to his eyes.
That was really not the truth.The reports showed he have irreversible liver damage and his liver function may deteriorate over several months to years. But his symptoms will temporarily improve with medicines. That's why I could confidently reassure him.
My answer I am sure made him feel better.
Third patient was a 64 year old Rheumatoid Arthritis patient. Her knee joints were so much destroyed that she needs Total knee replacement for both knees. Her family was not very well off . I had discussed it with her son and the family was not very keen to find the money for the surgery.
"Will I be able to walk properly and climb steps doctor?" She usually ask me.
" Let us see. You are showing some improvement.So if you continue the treatment......let us see."
In my mind I was sure she will not be able to walk properly. I had hinted to her once about surgery which she refused immediately citing old age. Also the family may not be able to afford it. So she will most probably go on like that using a walking stick, moving very slowly,swaying her body to either side till her death.
But each time she leaves my room, she is satisfied with my reassurance.
Am I reassuring too much?
Some times I do, hiding the gravity of the illness so that the patient is not too much upset. Some time I reassure prematurely before arriving at the diagnosis to avoid unnecessary mental tension.
Making the patient fully aware of the situation may help in avoiding future surprises.It may also help in compliance with therapy. So should I change my method?
I am confident I did do the correct thing in all three instances.
As the great TB physician Dr Edward Trudeau said
"To cure sometimes, to relieve often, to comfort always,"
should be the motto of each Physician.
Tuesday, December 16, 2008
Cost of gaining height
You may recall that few months ago I had posted about a man who looked like a boy.He was 23 years old but had the features only of 12 years of age.His height was 123 cms and his body feature were like a small boy.He was a case of Pituitary Dwarfism. Let me tell you what happened since.
The hormone tests proved that he is having a deficiency of Growth Hormone and Male sex hormone called Testosterone.Then I took a series of Radio graphs[Xray films] to see whether his growing ends of bones had fused.In normal males it will fuse anytime between 18 and 21 years.He is 23 now,so chances are it might have fused.But fortunately the radio graphs showed it had not fused.
That meant there is a chance that he may gain in height if given injections of Growth Hormone.That was good news,but the bad news was the injections are expensive. 15 day course of injections will cost around 8000 Rupees.He may have to take such injections for several months.
The family was very poor.The patient's father was a manual labourer and have to support a large family.My first thought was not to burden them by telling them about costly injections.As he was already 23 the chances of gaining much height is very less.The hormones injected may cause the growth plate of the bones to fuse thereby preventing further gain in height.
Bur not telling their options was unethical.So I gave a long explanation which his father listened with rapt attention. From the vacant look I could realise that he did not understand much.
He put everything on my head. Saru parayunathu pole cheyyam.[Will do whatever sir say]
Now I have the added responsibility of deciding for that family.
So I decided.Let us try the medicines for 2 months and see.You tell me when you have the money ready for 15 days medicines.I will order it and give it to you directly.We can save some money by doing that.He agreed.
After a week he called me and said the money for 15 days of injections is ready.I ordered the medicine and company couriered it in my address.I taught the father how to take the injections. The money had to be send to the Company office by cheque or draft.I asked him to do that.He confessed that he do not know anything about Banks and asked me to do it for him.I did not know what to do.He just gave me the cash and left.
After 15 days he came again with his kid.There was no increase in height[ as it may take few more weeks to get the effect].Cash was ready and I handed over the medicine.
After the end of next 15 day period he called and said there is a cash shortage.They were planning to sell a piece of land,but was not able to get a good price.I asked him to come to see me with his son.
I measured the height.There was an increase of 2 cm.All of us were happy to see the increase.
He asked me for few days time to get the cash ready. I told him that a gap in therapy was not good.
Should I volunteer to give him a loan? If he asked for a loan what should I do? I was wondering.
But he did not ask for a loan.He assured me he will get the money in few days.
I know that the father was struggling hard to get money for the injection for his son. Few more months of injections may further increase his height by few centimetres. But at what cost?
The hormone tests proved that he is having a deficiency of Growth Hormone and Male sex hormone called Testosterone.Then I took a series of Radio graphs[Xray films] to see whether his growing ends of bones had fused.In normal males it will fuse anytime between 18 and 21 years.He is 23 now,so chances are it might have fused.But fortunately the radio graphs showed it had not fused.
That meant there is a chance that he may gain in height if given injections of Growth Hormone.That was good news,but the bad news was the injections are expensive. 15 day course of injections will cost around 8000 Rupees.He may have to take such injections for several months.
The family was very poor.The patient's father was a manual labourer and have to support a large family.My first thought was not to burden them by telling them about costly injections.As he was already 23 the chances of gaining much height is very less.The hormones injected may cause the growth plate of the bones to fuse thereby preventing further gain in height.
Bur not telling their options was unethical.So I gave a long explanation which his father listened with rapt attention. From the vacant look I could realise that he did not understand much.
He put everything on my head. Saru parayunathu pole cheyyam.[Will do whatever sir say]
Now I have the added responsibility of deciding for that family.
So I decided.Let us try the medicines for 2 months and see.You tell me when you have the money ready for 15 days medicines.I will order it and give it to you directly.We can save some money by doing that.He agreed.
After a week he called me and said the money for 15 days of injections is ready.I ordered the medicine and company couriered it in my address.I taught the father how to take the injections. The money had to be send to the Company office by cheque or draft.I asked him to do that.He confessed that he do not know anything about Banks and asked me to do it for him.I did not know what to do.He just gave me the cash and left.
After 15 days he came again with his kid.There was no increase in height[ as it may take few more weeks to get the effect].Cash was ready and I handed over the medicine.
After the end of next 15 day period he called and said there is a cash shortage.They were planning to sell a piece of land,but was not able to get a good price.I asked him to come to see me with his son.
I measured the height.There was an increase of 2 cm.All of us were happy to see the increase.
He asked me for few days time to get the cash ready. I told him that a gap in therapy was not good.
Should I volunteer to give him a loan? If he asked for a loan what should I do? I was wondering.
But he did not ask for a loan.He assured me he will get the money in few days.
I know that the father was struggling hard to get money for the injection for his son. Few more months of injections may further increase his height by few centimetres. But at what cost?
Wednesday, December 3, 2008
Non medical reason for referring a patient-Part 2
You may recall my post few days ago on the above subject. Let me continue the story.
The patient a woman of 42 years was brought to my hospital next day morning. My physical examination and the blood results revealed that she is having Dengue fever with a decrease in Platelets, the cell that helps in clot formation when the blood vessel is injured. Apart from vomiting and mild fever she was doing well.
I reminded the relatives about what I told them the day before. I said to them that Dengue fever can be life threatening.
'Next few days are critical. Even if you take her elsewhere the management will be the same. Now you decide.If you like to stay I will try my best to make the patient all right'.
The decision was quick.'We have faith in you doctor'.
I was happy to see their faith in me.It is my experience that if you explain everything about the Patient's condition in simple terms looking in the eye the faith of the patient and the relatives increases.
With in 2 days of supportive therapy her Platelet count improved and she became asymptomatic. I discharged her from the hospital on the fourth day.The family was very happy and thankful.I saved them a lot of money and hardships.
Many patients are referred to a higher centre with out sufficient reasons.Nowadays doctors try to play it safe.
I took a calculated risk here.I admitted a patient to my small hospital with a probable life threatening illness who was referred to a big City Hospital by another Physician.The risk paid off and here we had a happy ending. That may not be the result in all cases.
The patient a woman of 42 years was brought to my hospital next day morning. My physical examination and the blood results revealed that she is having Dengue fever with a decrease in Platelets, the cell that helps in clot formation when the blood vessel is injured. Apart from vomiting and mild fever she was doing well.
I reminded the relatives about what I told them the day before. I said to them that Dengue fever can be life threatening.
'Next few days are critical. Even if you take her elsewhere the management will be the same. Now you decide.If you like to stay I will try my best to make the patient all right'.
The decision was quick.'We have faith in you doctor'.
I was happy to see their faith in me.It is my experience that if you explain everything about the Patient's condition in simple terms looking in the eye the faith of the patient and the relatives increases.
With in 2 days of supportive therapy her Platelet count improved and she became asymptomatic. I discharged her from the hospital on the fourth day.The family was very happy and thankful.I saved them a lot of money and hardships.
Many patients are referred to a higher centre with out sufficient reasons.Nowadays doctors try to play it safe.
I took a calculated risk here.I admitted a patient to my small hospital with a probable life threatening illness who was referred to a big City Hospital by another Physician.The risk paid off and here we had a happy ending. That may not be the result in all cases.
Friday, October 24, 2008
How I got interested in HIV/AIDS?
In the late 1990s, I was working in a small [Government] Taluk Hopsital. HIV 'Positive' persons I saw in my practise were few and I was happy to refer them to higher centres.
Then I got transferred to a busy District Headquarters Hospital in 2001. There I could not escape dealing with 'positive' persons.
Every week the infectious disease ward will see a new 'positive' patient coming to die.
Most of them by then might have spend a fortune on magical remedies. The most infamous among them was the medicines of Fair Pharma from Kochi. For more detailed information about how one Majeed cheated poor patients and build the costliest house in Kerala click here. Now fortunately the 'medicine' is banned in Kerala by the Court after a longstanding legal battle with 'Positive' people and PUCL.
The patients in my hospital were given symptomatic treatment and left to die. Some come and die alone while the more lucky ones have a wife or mother to be with them during their last days.
I was depressed seeing all these deaths.
What can I do for them? I asked myself.
I had no experience in treating HIV/AIDS patients. In the medical college where I studied in early and mid 1990s, 'positive' persons were rarely seen. I knew a lot from the text books but practical knowledge was nil.
Those days the Government was giving lot of training in HIV/AIDS for doctors and other health care workers, but it was only about prevention.
HIV/AIDS is a death sentence. So train yourself and others how not to get it.
This was the message of such trainings. Nobody mentioned treatment. We were not trained to cope with these dying 'positive' patients.
In the developed world by the year 2000, more than 10 drugs were available effective in treating HIV/AIDS. Few were available in India too at that time. They were expensive and somewhat toxic but still they worked. And they were cheaper than the Fake medicines of Fair Pharma.
More over, HIV/AIDS patients need treatment for opportunistic infections that attack them as their immunity is low.
So when a 'positive' patient is sick, first we have to find out which opportunistic organism or organisms have infected him/her. Then give the proper treatment so that he/she becomes better. Later, ART [anti retro viral therapy] was started. Some time in severely sick patient we may have to start both treatments together.
Training myself in HIV/AIDS management, I started treating these patients in earnest. I procured medicines from drug companies directly and thus was able to give it to patients much below market rates. The stigma of buying such medicines from Drug Store was circumvented as I myself provided the medicines.
The results were dramatic. Patients in death bed about to say their final prayers were able to look after themselves with in months. Those who sticked on to the medication schedule for more than a year began working and earn for themselves.
I lost many patients too, but I tried my level best. Some came to me at a very late stage. Many could not continue the medicines because of the high cost of ART. Many by then had become social outcasts and committed suicide.
I urged other Physicians to take up the challenge of HIV. I conducted lectures in the IMA[Indian Medical Association]. I told them that it was ,we the modern medicine doctors, who are making the 'positive' persons go to Quacks like Majeed [Fair Pharma]. As we are not ready to take care of them, they are helpless. Unscrupulous persons squeeze out the last penny from them giving false hopes.
That made some difference. Few of my colleagues started taking up such cases.
By 2003-2004, things started changing in a positive direction for 'positives'. ART drugs became cheaper. India became one of the biggest manufacturer and exporter of cheap generic HIV drugs. Govt of India started giving ART drugs free of cost at selected centres. Kerala Government followed suit.
The emphasis in training of health care workers shifted from prevention to treatment. From a 'death sentence' HIV/AIDS became projected as a chronic manageable disease needing lifelong medication like Diabetes.
Now a 'Positive' person comes to my clinic every other day. Most of them are old patients coming for follow up. A newly detected 'positive' person is seen once or twice a month. Most of them are taking the free ART drugs from Medical Colleges. Some who can afford [and is afraid of perceived stigma at Govt centres] take medicines from me.
Deaths occur but only rarely.
I cherish the sight of happy faces and healthy bodies of all those positive persons. That sight make my life meaningful.
Then I got transferred to a busy District Headquarters Hospital in 2001. There I could not escape dealing with 'positive' persons.
Every week the infectious disease ward will see a new 'positive' patient coming to die.
Most of them by then might have spend a fortune on magical remedies. The most infamous among them was the medicines of Fair Pharma from Kochi. For more detailed information about how one Majeed cheated poor patients and build the costliest house in Kerala click here. Now fortunately the 'medicine' is banned in Kerala by the Court after a longstanding legal battle with 'Positive' people and PUCL.
The patients in my hospital were given symptomatic treatment and left to die. Some come and die alone while the more lucky ones have a wife or mother to be with them during their last days.
I was depressed seeing all these deaths.
What can I do for them? I asked myself.
I had no experience in treating HIV/AIDS patients. In the medical college where I studied in early and mid 1990s, 'positive' persons were rarely seen. I knew a lot from the text books but practical knowledge was nil.
Those days the Government was giving lot of training in HIV/AIDS for doctors and other health care workers, but it was only about prevention.
HIV/AIDS is a death sentence. So train yourself and others how not to get it.
This was the message of such trainings. Nobody mentioned treatment. We were not trained to cope with these dying 'positive' patients.
In the developed world by the year 2000, more than 10 drugs were available effective in treating HIV/AIDS. Few were available in India too at that time. They were expensive and somewhat toxic but still they worked. And they were cheaper than the Fake medicines of Fair Pharma.
More over, HIV/AIDS patients need treatment for opportunistic infections that attack them as their immunity is low.
So when a 'positive' patient is sick, first we have to find out which opportunistic organism or organisms have infected him/her. Then give the proper treatment so that he/she becomes better. Later, ART [anti retro viral therapy] was started. Some time in severely sick patient we may have to start both treatments together.
Training myself in HIV/AIDS management, I started treating these patients in earnest. I procured medicines from drug companies directly and thus was able to give it to patients much below market rates. The stigma of buying such medicines from Drug Store was circumvented as I myself provided the medicines.
The results were dramatic. Patients in death bed about to say their final prayers were able to look after themselves with in months. Those who sticked on to the medication schedule for more than a year began working and earn for themselves.
I lost many patients too, but I tried my level best. Some came to me at a very late stage. Many could not continue the medicines because of the high cost of ART. Many by then had become social outcasts and committed suicide.
I urged other Physicians to take up the challenge of HIV. I conducted lectures in the IMA[Indian Medical Association]. I told them that it was ,we the modern medicine doctors, who are making the 'positive' persons go to Quacks like Majeed [Fair Pharma]. As we are not ready to take care of them, they are helpless. Unscrupulous persons squeeze out the last penny from them giving false hopes.
That made some difference. Few of my colleagues started taking up such cases.
By 2003-2004, things started changing in a positive direction for 'positives'. ART drugs became cheaper. India became one of the biggest manufacturer and exporter of cheap generic HIV drugs. Govt of India started giving ART drugs free of cost at selected centres. Kerala Government followed suit.
The emphasis in training of health care workers shifted from prevention to treatment. From a 'death sentence' HIV/AIDS became projected as a chronic manageable disease needing lifelong medication like Diabetes.
Now a 'Positive' person comes to my clinic every other day. Most of them are old patients coming for follow up. A newly detected 'positive' person is seen once or twice a month. Most of them are taking the free ART drugs from Medical Colleges. Some who can afford [and is afraid of perceived stigma at Govt centres] take medicines from me.
Deaths occur but only rarely.
I cherish the sight of happy faces and healthy bodies of all those positive persons. That sight make my life meaningful.
Tuesday, September 23, 2008
Obstinate Patient?
The other day I had a tough time with one of my patient.
She was 54 years of age.She was diagnosed Type 2 Diabetes 5 years ago. Her blood sugar was under fair control with a tablet taken in the morning before breakfast. But for the last 3 months it was high in the mid 300s. I wanted to increase the dosage of her medicine.I told her it will be better to take half a tablet before dinner also.
But her response surprised me.She refused to take medicine in the evening.
'Why'? I asked.
' I am taking an Ayurvedic herbal powder as medicine for Diabetes in the evening' I cant stop that.
I got irritated.May be I was in an irritable mood.
'You first decide on the system of medicine you want to follow.If you want to follow modern medicine you obey my instructions' I shouted.[ I never shouts but my voice was raised].
She was taken back by my raised voice.
'I have been taking that powder for last 3 years'. She pleaded.
'So what?' 'It is not reducing your Blood sugar.So better stop'. My voice was still raised.
She pleaded again but I held on to my tough stand.
Her eyes were red and tears appeared. I did not know what to do for some time.
Then I relented. 'You take your powder in the evening 2 hours before the tablet'.
'If both are taken in the evening will there be any interaction?" She was worried.
I said there wont be any problem. She was relieved and I was able to defuse a difficult situation.
May be I should have proposed that compromise formula earlier.I should not have raised my voice.Some days I may become too irritable.
She was 54 years of age.She was diagnosed Type 2 Diabetes 5 years ago. Her blood sugar was under fair control with a tablet taken in the morning before breakfast. But for the last 3 months it was high in the mid 300s. I wanted to increase the dosage of her medicine.I told her it will be better to take half a tablet before dinner also.
But her response surprised me.She refused to take medicine in the evening.
'Why'? I asked.
' I am taking an Ayurvedic herbal powder as medicine for Diabetes in the evening' I cant stop that.
I got irritated.May be I was in an irritable mood.
'You first decide on the system of medicine you want to follow.If you want to follow modern medicine you obey my instructions' I shouted.[ I never shouts but my voice was raised].
She was taken back by my raised voice.
'I have been taking that powder for last 3 years'. She pleaded.
'So what?' 'It is not reducing your Blood sugar.So better stop'. My voice was still raised.
She pleaded again but I held on to my tough stand.
Her eyes were red and tears appeared. I did not know what to do for some time.
Then I relented. 'You take your powder in the evening 2 hours before the tablet'.
'If both are taken in the evening will there be any interaction?" She was worried.
I said there wont be any problem. She was relieved and I was able to defuse a difficult situation.
May be I should have proposed that compromise formula earlier.I should not have raised my voice.Some days I may become too irritable.
Monday, September 1, 2008
A mood elevating patient
It was Monday,the beginning of a busy week. My mood as I entered my consulting room was not good.May be the morning blues.Or depressed thinking about a week full of work ahead.
First 2 patients came in and went out.My mood remained the same.
Then walked in[or literally carried in by his son] a retired school teacher.He is above 80. He is a regular patient of mine for last 4 years.He is suffering from Type 2 Diabetes,Benign prostatic enlargement,Osteoarthritis etc etc. Regularly he becomes sick when I am out of station. This time it happened again. He tried to contact me for a trivial cold. He could not as I was away for a week.This made him restless.His sleep was reduced.Then he started running a temperature.The son took him to another doc the next day. Medicines were prescribed.The symptoms were reduced but he was not satisfied.
He held my hand and told me he is so happy seeing me. He said he do not feel good.There is no appetite or sleep. He was afraid he will die before I came back.The son remarked that the illness actually started when his Dad heard I am out of station and now he will become all right soon.
I examined him and then reassured him that he is only having a mild cold.I also told him I won't go anywhere next 2 months. He did not leave my hand for a long time.
The faith and love that the old man had for me made me happy and I began smiling again.My blues were forgotten.
First 2 patients came in and went out.My mood remained the same.
Then walked in[or literally carried in by his son] a retired school teacher.He is above 80. He is a regular patient of mine for last 4 years.He is suffering from Type 2 Diabetes,Benign prostatic enlargement,Osteoarthritis etc etc. Regularly he becomes sick when I am out of station. This time it happened again. He tried to contact me for a trivial cold. He could not as I was away for a week.This made him restless.His sleep was reduced.Then he started running a temperature.The son took him to another doc the next day. Medicines were prescribed.The symptoms were reduced but he was not satisfied.
He held my hand and told me he is so happy seeing me. He said he do not feel good.There is no appetite or sleep. He was afraid he will die before I came back.The son remarked that the illness actually started when his Dad heard I am out of station and now he will become all right soon.
I examined him and then reassured him that he is only having a mild cold.I also told him I won't go anywhere next 2 months. He did not leave my hand for a long time.
The faith and love that the old man had for me made me happy and I began smiling again.My blues were forgotten.
Saturday, August 30, 2008
A strange interview
It happened some time ago. She is a 31 yr old Type 1 Diabetic patient of mine. She called me up one day saying a guy will come to see me asking about her health condition. He is her prospective bride groom. The families contacted through a matrimonial ad. He had met her and her family. Now he wants to know how healthy she is.
In India most of the time it is the family/parents who search and find partners for their sons and daughters.[Things are changing but slowly] The parents of my Type 1 patient were in search of a bridegroom for some years now. She had called me before also, saying a guy or his parents may come and ask about her. But nobody had come to me yet.She had a stable and well paying Govt job and this had attracted many suitors.Still her T1 status might have dissuaded her prospective grooms. As far as I know she had said no to one or two suitors too.
He called me 2 or 3 times on phone before fixing a suitable time to see me. He was a serious looking guy, little bald may be around 35 years. He introduced himself and mentioned the name of my patient[his proposed bride].
We were silent for sometime.Then I started interviewing him.He is only having a temporary job in a Company,but his family had some agricultural land and according to him are financially stable.
He did not knew how to start his questions.I helped him by asking what he want to know.
How serious is her Diabetes?
Will she need Insulin through out her life?
Can she become pregnant and deliver children?
Will the children inherit her Diabetes?
Some how I thought this Guy is nice and dependable. I wanted my patient to get a good partner.So the picture of her health status that I presented to him was very positive.
Yes, she needs Insulin through out her life.Her body is not producing Insulin,a hormone essential for Sugar metabolism. We are injecting it so that she can live normally.
She have no other defect.
She can become and pregnant deliver normal children.
Finally I also added that she is having the best blood sugar control among my Type 1 patients.
I had a feeling that he was satisfied and happy. She came the next day and wanted to know everything.I told her in detail.Then she asked me 'How you feel about him?' I said I felt he is nice and dependable. She looked at my face intently and I gave her a reassuring smile.
In India most of the time it is the family/parents who search and find partners for their sons and daughters.[Things are changing but slowly] The parents of my Type 1 patient were in search of a bridegroom for some years now. She had called me before also, saying a guy or his parents may come and ask about her. But nobody had come to me yet.She had a stable and well paying Govt job and this had attracted many suitors.Still her T1 status might have dissuaded her prospective grooms. As far as I know she had said no to one or two suitors too.
He called me 2 or 3 times on phone before fixing a suitable time to see me. He was a serious looking guy, little bald may be around 35 years. He introduced himself and mentioned the name of my patient[his proposed bride].
We were silent for sometime.Then I started interviewing him.He is only having a temporary job in a Company,but his family had some agricultural land and according to him are financially stable.
He did not knew how to start his questions.I helped him by asking what he want to know.
How serious is her Diabetes?
Will she need Insulin through out her life?
Can she become pregnant and deliver children?
Will the children inherit her Diabetes?
Some how I thought this Guy is nice and dependable. I wanted my patient to get a good partner.So the picture of her health status that I presented to him was very positive.
Yes, she needs Insulin through out her life.Her body is not producing Insulin,a hormone essential for Sugar metabolism. We are injecting it so that she can live normally.
She have no other defect.
She can become and pregnant deliver normal children.
Finally I also added that she is having the best blood sugar control among my Type 1 patients.
I had a feeling that he was satisfied and happy. She came the next day and wanted to know everything.I told her in detail.Then she asked me 'How you feel about him?' I said I felt he is nice and dependable. She looked at my face intently and I gave her a reassuring smile.
Friday, August 15, 2008
Patient loyalty
Some patients are very loyal to their doctor. They hate seeing another doctor. They will believe only if their favourite doctor tells them, but their loyalty land them into trouble sometimes.
A patient of mine, a 50-year-old diabetic, developed sweating and mild chest pain. As I was away for a day, he consulted another doctor. An Electrocardiogram (ECG/EKG) was done and the doctor found some changes suggestive of early heart attack. The patient was asked to get admitted in an Intensive care Unit. Not believing the doctor, the patient waited for a day to see me. That night the patient became worse and he died on way to Hospital.
Being a one man practise, many a time it is difficult for me to arrange substitute medical care when I am out of station. Though I tell them to see the nearest available doctor in case of emergency, many are reluctant. When I come back from a break of few days many of these loyal patients accuse me of orphaning them. Their affection make me feel good ,but at the same time the accusation make me feel guilty.
A patient of mine, a 50-year-old diabetic, developed sweating and mild chest pain. As I was away for a day, he consulted another doctor. An Electrocardiogram (ECG/EKG) was done and the doctor found some changes suggestive of early heart attack. The patient was asked to get admitted in an Intensive care Unit. Not believing the doctor, the patient waited for a day to see me. That night the patient became worse and he died on way to Hospital.
Being a one man practise, many a time it is difficult for me to arrange substitute medical care when I am out of station. Though I tell them to see the nearest available doctor in case of emergency, many are reluctant. When I come back from a break of few days many of these loyal patients accuse me of orphaning them. Their affection make me feel good ,but at the same time the accusation make me feel guilty.
Friday, August 8, 2008
Stress and Blood Sugar
She is 71 years old, a diabetic patient of mine for last 3 years. She is on 3 types of tablets to control her blood sugar. She checks her blood sugar regularly and keeps all her appointments with me, but her blood sugar fluctuates wildly. One month it will be 185mg post meal and the next month it will be 360.
She always look depressed. She never smiles at me. All my efforts to bring a smile on her gloomy face are always wasted.
She always come with her son, but she is not living with him. She lives alone in a big house with a house maid. Her son lives in the same town a few kms away.
I was curious about her fluctuating sugars. Her diet seems to be same. Her sleep is always good as she is taking a sedative. Level of activity is also the same. Then why the fluctuation?
Slowly, I realised there is a pattern to the fluctuation. She has 2 daughters. They stay some distance away in a different town. Once every 2 months she go to one of her daughter's place and stay there for 2 weeks. If she was tested immediately after her return from such a trip the blood sugars were near normal. When she stays alone, her blood sugar rises up.
Actually, she had realised it before me. She never wanted me to advise her to stay with her children.
When I asked her, 'why don't you stay with your children' her reply was immediate. 'Why can't they stay with me? At least my son should stay with me.I was brought up in an aristocratic family. I believe in staying in my own house built by my late husband. I cant go and live in my son's house'.
The son sheepishly smile all the time [I thought he must be thinking the same thing.Why should I live in a house built by my Dad?].
What can I say to this adamant lady? After a few minutes, I told her 'your children may also be like you,fiercely independent. So, better not to complain'. I suggested a longer stay at her daughter's place and then bid her goodbye.
Independence at old age if not stressful to your mind is good, but if it affects your health adversely then you should rethink.
She always look depressed. She never smiles at me. All my efforts to bring a smile on her gloomy face are always wasted.
She always come with her son, but she is not living with him. She lives alone in a big house with a house maid. Her son lives in the same town a few kms away.
I was curious about her fluctuating sugars. Her diet seems to be same. Her sleep is always good as she is taking a sedative. Level of activity is also the same. Then why the fluctuation?
Slowly, I realised there is a pattern to the fluctuation. She has 2 daughters. They stay some distance away in a different town. Once every 2 months she go to one of her daughter's place and stay there for 2 weeks. If she was tested immediately after her return from such a trip the blood sugars were near normal. When she stays alone, her blood sugar rises up.
Actually, she had realised it before me. She never wanted me to advise her to stay with her children.
When I asked her, 'why don't you stay with your children' her reply was immediate. 'Why can't they stay with me? At least my son should stay with me.I was brought up in an aristocratic family. I believe in staying in my own house built by my late husband. I cant go and live in my son's house'.
The son sheepishly smile all the time [I thought he must be thinking the same thing.Why should I live in a house built by my Dad?].
What can I say to this adamant lady? After a few minutes, I told her 'your children may also be like you,fiercely independent. So, better not to complain'. I suggested a longer stay at her daughter's place and then bid her goodbye.
Independence at old age if not stressful to your mind is good, but if it affects your health adversely then you should rethink.
Friday, August 1, 2008
Doctor,please give me your cellphone number
Doctor, please give me your cellphone number.Then in case of an emergency we can contact you directly.
I receive such request very frequently. How should I respond?
You will think that this is a reasonable request. Each and every patient should be able to contact the treating doctor directly in an emergency. You wont have any second thoughts about how I should respond. But.............
I am sure if each and every patient I treat get my cellphone number, I wont have a single minute of peaceful living. I will be deluged with calls while sleeping, eating, bathing, driving, when seeing patients in my Consultation room, while taking rounds etc etc. Sense of propriety and ethics are forgotten. The facility will be misused [as some already do who have somehow got my cell number.]
I am available in the daytime at my land phone numbers. At night in case of an emergency, the patient have to approach the hospital were I work. The staff at the hospital can contact me 24 hours a day.
For some of my patients, I give my cellphone number without hesitation. They are
1. HIV positive persons
2. Type 1 diabetes patients
I don't hesitate for HIV positive persons, because I feel with all the stigma and discrimination they face, they should at least be positively discriminated by me. They should be able to talk to me anytime they want.
Type 1 diabetes patients need constant communication with the treating doctor as they have to self manage a lot and may need physician guidance in management.
Another reason for lack of hesitation is that 'positive' persons and type 1 diabetics under my care constitute less than 1 percentage of total number of patients. So, I need not loose sleep giving away cellphone numbers to them.
Do you think of me as a selfish and uncaring doc?
I receive such request very frequently. How should I respond?
You will think that this is a reasonable request. Each and every patient should be able to contact the treating doctor directly in an emergency. You wont have any second thoughts about how I should respond. But.............
I am sure if each and every patient I treat get my cellphone number, I wont have a single minute of peaceful living. I will be deluged with calls while sleeping, eating, bathing, driving, when seeing patients in my Consultation room, while taking rounds etc etc. Sense of propriety and ethics are forgotten. The facility will be misused [as some already do who have somehow got my cell number.]
I am available in the daytime at my land phone numbers. At night in case of an emergency, the patient have to approach the hospital were I work. The staff at the hospital can contact me 24 hours a day.
For some of my patients, I give my cellphone number without hesitation. They are
1. HIV positive persons
2. Type 1 diabetes patients
I don't hesitate for HIV positive persons, because I feel with all the stigma and discrimination they face, they should at least be positively discriminated by me. They should be able to talk to me anytime they want.
Type 1 diabetes patients need constant communication with the treating doctor as they have to self manage a lot and may need physician guidance in management.
Another reason for lack of hesitation is that 'positive' persons and type 1 diabetics under my care constitute less than 1 percentage of total number of patients. So, I need not loose sleep giving away cellphone numbers to them.
Do you think of me as a selfish and uncaring doc?
Wednesday, July 23, 2008
A positive feedback
I had a pleasant phone call the other day. The caller was the brother of the patient with acute leukemia in my earlier post.
He said his brother is much better now and has been discharged from the Hematology Centre after a month of hospitalisation. Chemotherapy course have to be continued for a year.He thanked me profusely for diagnosing the condition fast and sending them to that centre. It seemed the doctor there also commented that they reached there well in time.They reached there the next morning itself. The patient is still not out of danger,but chances of survival is more.
I shared the news with the lab team and the pathologist and we all felt good. I started smiling more at my patients and took more time to answer their seemingly silly doubts.
Such positive feed backs help a lot in raising your morale.
He said his brother is much better now and has been discharged from the Hematology Centre after a month of hospitalisation. Chemotherapy course have to be continued for a year.He thanked me profusely for diagnosing the condition fast and sending them to that centre. It seemed the doctor there also commented that they reached there well in time.They reached there the next morning itself. The patient is still not out of danger,but chances of survival is more.
I shared the news with the lab team and the pathologist and we all felt good. I started smiling more at my patients and took more time to answer their seemingly silly doubts.
Such positive feed backs help a lot in raising your morale.
Saturday, July 19, 2008
A smug smile
You might have seen doctors having a smug smile on their face while they look at the investigation results. The patient sitting opposite may think that the Doc is going to tell them some good news. The patient may expect the doctor to tell that the result is negative or the illness is cured. But most often it is the opposite.
Such smile comes on a doctor's face when the diagnosis he thought of is proved by the test result. The smile becomes bigger if some other doctor or doctors had missed the diagnosis.
I also had smiled like that many times especially early in my practise.Now a days I smile only if the result meant it is a curable or treatable condition.
Today I had a reason to show my smug smile.
She is a 65-year-old woman. She was admitted one year ago for altered behaviour and drowsiness following an episode of severe gastro-enteritis [diarrhea and vomiting]. Lab tests showed her Sodium level was well below normal. This was attributed to lose of salt due to vomiting and diarrhea. She was re-hydrated with sodium containing fluids and she recovered well.
I did not see her till last week when she was admitted for extreme tiredness,lack of appetite and vomiting. Her son told me that after last year's admission, she was not keeping good health. She needed frequent hospitalisation for various ailments.
When I examined her, she looked pale and swollen up. She was not listening to me properly and was very lethargic. Her sodium was again low, but other routine tests were normal. I did a Thyroid function study suspecting low level of hormone production from thyroid gland. The result showed I was right, but surprisingly her thyroid stimulating hormone which is produced by the pituitary gland was also low. This meant she is having Central Hypothyroidism and there is something wrong in the pituitary gland. When I did a series of other hormonal tests to evaluate pituitary function the results were equivocal[not helpful to reach a diagnosis].
So finally I ordered an MRI Scan of the pituitary gland.It was while reading that MRI Scan report that I broke into a smug smile.It showed an empty sella meaning pituitary gland is not visualised as it had shrunk in size.
As there is no tumour or injury visible in MRI, it meant that this is not a life threatening problem. She needs only replacement of hormones that is deficient. So I could smile liberally.
I gave the prescription for hormone replacement tablets. I also gave a reference letter to an Endocrinologist in the near by City so that a second expert opinion can be taken.
Many times I have got excited at the possibility of rare and exotic diagnosis.But immediately I try to curtail my excitement and try to think about it in the patients view point.
For this cute old lady the smile meant good news but for many others the news wont be good.
Such smile comes on a doctor's face when the diagnosis he thought of is proved by the test result. The smile becomes bigger if some other doctor or doctors had missed the diagnosis.
I also had smiled like that many times especially early in my practise.Now a days I smile only if the result meant it is a curable or treatable condition.
Today I had a reason to show my smug smile.
She is a 65-year-old woman. She was admitted one year ago for altered behaviour and drowsiness following an episode of severe gastro-enteritis [diarrhea and vomiting]. Lab tests showed her Sodium level was well below normal. This was attributed to lose of salt due to vomiting and diarrhea. She was re-hydrated with sodium containing fluids and she recovered well.
I did not see her till last week when she was admitted for extreme tiredness,lack of appetite and vomiting. Her son told me that after last year's admission, she was not keeping good health. She needed frequent hospitalisation for various ailments.
When I examined her, she looked pale and swollen up. She was not listening to me properly and was very lethargic. Her sodium was again low, but other routine tests were normal. I did a Thyroid function study suspecting low level of hormone production from thyroid gland. The result showed I was right, but surprisingly her thyroid stimulating hormone which is produced by the pituitary gland was also low. This meant she is having Central Hypothyroidism and there is something wrong in the pituitary gland. When I did a series of other hormonal tests to evaluate pituitary function the results were equivocal[not helpful to reach a diagnosis].
So finally I ordered an MRI Scan of the pituitary gland.It was while reading that MRI Scan report that I broke into a smug smile.It showed an empty sella meaning pituitary gland is not visualised as it had shrunk in size.
As there is no tumour or injury visible in MRI, it meant that this is not a life threatening problem. She needs only replacement of hormones that is deficient. So I could smile liberally.
I gave the prescription for hormone replacement tablets. I also gave a reference letter to an Endocrinologist in the near by City so that a second expert opinion can be taken.
Many times I have got excited at the possibility of rare and exotic diagnosis.But immediately I try to curtail my excitement and try to think about it in the patients view point.
For this cute old lady the smile meant good news but for many others the news wont be good.
Wednesday, July 16, 2008
Why?
A 25-year-old male walked into my consultation room with a reference from a Dental surgeon. Dental surgeon wanted my opinion about the patient's excessive gum bleeding.
He was well built, handsome and looked cheerful. He told me that he got married only recently. He said that the oozing from gums started only 2 days ago. I examined him, but could not find anything grossly wrong. There was no active bleeding. To confirm that there is nothing wrong, I asked for blood counts and peripheral smear test.
I did not think about him until the pathologist called me on phone 3 hours later asking whether there was any positive findings on clinical examination. I replied negative.
Then she broke the bad news. The lab tests were suggestive of acute leukemia, that too a bad sub type. I was stunned. I did not know how I could break the news to that smiling young man.
As the patient was dizzy and still bleeding from gums, it was his brother who came for the report. Telling him was more easy for me, though still painful.Giving sometime for the harsh truth to sink in, I told him the need to get the patient immediately to a Hematology Centre. I gave the reference letter and a little hope by saying the last patient I send there few months ago was doing well.
Acute Leukemia strike suddenly. It is so dramatic that it is found in so many film scripts. Why it occurs? It has no known reasons in most of the cases.You accept it as a part of life.
But when it comes to you or to a dear and near one, the question arises.
Why me? Or as the patient's brother asked me "why him?"
I did not have an answer then or even now.
He was well built, handsome and looked cheerful. He told me that he got married only recently. He said that the oozing from gums started only 2 days ago. I examined him, but could not find anything grossly wrong. There was no active bleeding. To confirm that there is nothing wrong, I asked for blood counts and peripheral smear test.
I did not think about him until the pathologist called me on phone 3 hours later asking whether there was any positive findings on clinical examination. I replied negative.
Then she broke the bad news. The lab tests were suggestive of acute leukemia, that too a bad sub type. I was stunned. I did not know how I could break the news to that smiling young man.
As the patient was dizzy and still bleeding from gums, it was his brother who came for the report. Telling him was more easy for me, though still painful.Giving sometime for the harsh truth to sink in, I told him the need to get the patient immediately to a Hematology Centre. I gave the reference letter and a little hope by saying the last patient I send there few months ago was doing well.
Acute Leukemia strike suddenly. It is so dramatic that it is found in so many film scripts. Why it occurs? It has no known reasons in most of the cases.You accept it as a part of life.
But when it comes to you or to a dear and near one, the question arises.
Why me? Or as the patient's brother asked me "why him?"
I did not have an answer then or even now.
Sunday, July 13, 2008
Respecting the elderly
We are all taught to respect the elderly and we all do it, but are we respecting their wishes?
A 70-year-old lady sits sheepishly near me in my consulting room. Opposite to us on the other side of the table sits her son. He scolds her for her high blood sugar and cholesterol. He says that his mother does not like an old, sick woman. She eats everything disregard her condition. Son also complains that she does hard house hold work and goes out to the fields to supervise the agriculture work. All these were unnecessary as there are others to do it. The lady has a guilty smile, but denies most of the accusations of her son.
This happens very often in my clinic. The younger generation wants the elderly to live a schedurled life.They will be happy if they just sit and watch TV all the day and eat as bland and tasteless diet as possible avoiding everything. They believe that elderly should behave themselves [as old and sick]. By leading such a life, the children feel that their parents can live long and happy. As they are [most often] footing the bills for their health care, children expects obedience from their parents.
After hearing from both sides, I usually take a middle path. I advice the children that even though their parents are old and have some health problems, don't make them feel they are sick by your reprimands [like don't do this, don't do that ]. I will tell that some restrictions in food and activities are needed, but do not put them in 'house arrest'. Try to understand what they like to do and allow it in such a way that there is no harm to their health.
I tell the elderly patient not to indulge too much in unhealthy food. I tell them to be active but protect themselves from extremes of weather.
Usually as they go out of my room, the elderly have a broader smile.
A 70-year-old lady sits sheepishly near me in my consulting room. Opposite to us on the other side of the table sits her son. He scolds her for her high blood sugar and cholesterol. He says that his mother does not like an old, sick woman. She eats everything disregard her condition. Son also complains that she does hard house hold work and goes out to the fields to supervise the agriculture work. All these were unnecessary as there are others to do it. The lady has a guilty smile, but denies most of the accusations of her son.
This happens very often in my clinic. The younger generation wants the elderly to live a schedurled life.They will be happy if they just sit and watch TV all the day and eat as bland and tasteless diet as possible avoiding everything. They believe that elderly should behave themselves [as old and sick]. By leading such a life, the children feel that their parents can live long and happy. As they are [most often] footing the bills for their health care, children expects obedience from their parents.
After hearing from both sides, I usually take a middle path. I advice the children that even though their parents are old and have some health problems, don't make them feel they are sick by your reprimands [like don't do this, don't do that ]. I will tell that some restrictions in food and activities are needed, but do not put them in 'house arrest'. Try to understand what they like to do and allow it in such a way that there is no harm to their health.
I tell the elderly patient not to indulge too much in unhealthy food. I tell them to be active but protect themselves from extremes of weather.
Usually as they go out of my room, the elderly have a broader smile.
Wednesday, July 9, 2008
Patient taking money from the doctor
When you see the title I am sure you will be frowning. It is always the doctor who takes money from the patient, not the other way round.
But sometimes it can happen. Today it happened to me not once, but twice.
First it was a 50-year-old lady, an agricultural worker and a long-term patient of mine. She used to bring fresh vegetables from her kitchen garden often, and I used to waive the consultation fee. This time I had ordered a few blood tests, and she had to spend all her money for it. After consulting me, showing me her test results and getting a prescription, she wanted a loan of RS.20 for buying the bus ticket that will take her back to her home 15 kilometres away. I readily obliged, and she said goodbye promising me to return the amount when she come next time.
After an hour came a man whose face I remember only vaguely. He introduced himself as the son of a long-term patient of mine who had passed away 2 years ago. I could recollect the patient very well. He lived in another town 40 kilometres away where I worked previously. He was suffering from Chronic obstructive lung disease and was a regular visitor to my clinic.Even when I shifted my practise to my home town[where I work presently] he continued to consult me till his death.
The son of that patient wanted my help. He had come to my town [which is the District headquarters] to get a certificate from a Government office.While he was travelling in bus, his pocket got picked and he lost his wallet. He lost all the money he carried. He needed money for paying the fee for the certificate and to get back home. He said I am the only person he can ask for money in this town. Again I obliged.
For me this happens once in a while. Most of the cases are genuine and money is returned promptly, but some try to dupe me with false stories. Early in my practise I had fallen for some fake sob stories,but now I am more careful.
So remember, it is not always the doctor getting richer with the patient's money, the reverse also happen.
But sometimes it can happen. Today it happened to me not once, but twice.
First it was a 50-year-old lady, an agricultural worker and a long-term patient of mine. She used to bring fresh vegetables from her kitchen garden often, and I used to waive the consultation fee. This time I had ordered a few blood tests, and she had to spend all her money for it. After consulting me, showing me her test results and getting a prescription, she wanted a loan of RS.20 for buying the bus ticket that will take her back to her home 15 kilometres away. I readily obliged, and she said goodbye promising me to return the amount when she come next time.
After an hour came a man whose face I remember only vaguely. He introduced himself as the son of a long-term patient of mine who had passed away 2 years ago. I could recollect the patient very well. He lived in another town 40 kilometres away where I worked previously. He was suffering from Chronic obstructive lung disease and was a regular visitor to my clinic.Even when I shifted my practise to my home town[where I work presently] he continued to consult me till his death.
The son of that patient wanted my help. He had come to my town [which is the District headquarters] to get a certificate from a Government office.While he was travelling in bus, his pocket got picked and he lost his wallet. He lost all the money he carried. He needed money for paying the fee for the certificate and to get back home. He said I am the only person he can ask for money in this town. Again I obliged.
For me this happens once in a while. Most of the cases are genuine and money is returned promptly, but some try to dupe me with false stories. Early in my practise I had fallen for some fake sob stories,but now I am more careful.
So remember, it is not always the doctor getting richer with the patient's money, the reverse also happen.
Sunday, July 6, 2008
How to greet a patient?
We doctors meet large number of patients everyday. How should a doctor greet a patient?
Different doctors greet patients differently. It may depend on many things. How busy a doctor is may be one of the important factor. Also, the local custom play a role.
How do I greet my patients? I never open the door for my patients. Either the nurse ushers them in or they come in by their own. I will be sitting at my desk and nodding my head with a smile. Then I will start the interview asking How are you? or what happened? or what is the problem?
If I am too busy, I may be taking down some notes of the previous patient or attending a telephone call in between patients. Then, I may look at the patient's face only after he/she is seated. May be it is rude but.....
How your doctor greet you? How would you like to be greeted by your doctor? Comments and suggestions are welcome
Different doctors greet patients differently. It may depend on many things. How busy a doctor is may be one of the important factor. Also, the local custom play a role.
How do I greet my patients? I never open the door for my patients. Either the nurse ushers them in or they come in by their own. I will be sitting at my desk and nodding my head with a smile. Then I will start the interview asking How are you? or what happened? or what is the problem?
If I am too busy, I may be taking down some notes of the previous patient or attending a telephone call in between patients. Then, I may look at the patient's face only after he/she is seated. May be it is rude but.....
How your doctor greet you? How would you like to be greeted by your doctor? Comments and suggestions are welcome
Wednesday, June 11, 2008
Quitting Smoking
''Smoking cessation (stop smoking) represents the single most important step that smokers can take to enhance the length and quality of their lives."
I take pride in my ability to make my patients quit smoking.In last 10 years I might have helped hundreds of my patients quit smoking.
First I tell them that there is a long Que of diseases trying to get into the body of a smoker.Who will come first I don't know. It is a race. Either heart attack or Lung Cancer or mouth cancer or chronic obstructive lung disease or one of the umpteen other diseases and cancers will win the race but others will soon follow.
Then the patient will respond by saying "I will reduce smoking".
"That is of no use. That wont save you from those diseases " will be my warning.
Then the patient will say "I will reduce first and stop completely within a short period".
My reply will be "In my experience it is difficult to stop smoking like that. The best method is to stop suddenly. I am sure you will be able to stop suddenly when you are in ICU but it is wiser to stop it before reaching the ICU". The patient will be usually convinced.
Then in the patient's file under that day's date, in bold capital letters I will write STOPPED SMOKING TODAY and show the patient what I had written. This works most of the time.
For very heavy smokers quitting suddenly may not be that easy, but still with some mental strength most people can quit suddenly.
These are the immediate and long term benefits of quitting smoking from cancer.org
20 minutes after quitting: Your heart rate and blood pressure drops.
12 hours after quitting: The carbon monoxide level in your blood drops to normal
2 weeks to 3 months after quitting: Your circulation improves and your lung function increases.
1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.
1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's
5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.
10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease.
15 years after quitting: The risk of coronary heart disease is that of a non-smoker's
Kicking the tobacco habit offers some benefits that you'll notice right away and some that will develop over time. These rewards can improve your day-to-day life a great deal.
your breath smells better
stained teeth get whiter
bad smelling clothes and hair go away
your yellow fingers and fingernails disappear
food tastes better
your sense of smell returns to normal
everyday activities no longer leave you out of breath (for example, climbing stairs or light housework).
I take pride in my ability to make my patients quit smoking.In last 10 years I might have helped hundreds of my patients quit smoking.
First I tell them that there is a long Que of diseases trying to get into the body of a smoker.Who will come first I don't know. It is a race. Either heart attack or Lung Cancer or mouth cancer or chronic obstructive lung disease or one of the umpteen other diseases and cancers will win the race but others will soon follow.
Then the patient will respond by saying "I will reduce smoking".
"That is of no use. That wont save you from those diseases " will be my warning.
Then the patient will say "I will reduce first and stop completely within a short period".
My reply will be "In my experience it is difficult to stop smoking like that. The best method is to stop suddenly. I am sure you will be able to stop suddenly when you are in ICU but it is wiser to stop it before reaching the ICU". The patient will be usually convinced.
Then in the patient's file under that day's date, in bold capital letters I will write STOPPED SMOKING TODAY and show the patient what I had written. This works most of the time.
For very heavy smokers quitting suddenly may not be that easy, but still with some mental strength most people can quit suddenly.
These are the immediate and long term benefits of quitting smoking from cancer.org
20 minutes after quitting: Your heart rate and blood pressure drops.
12 hours after quitting: The carbon monoxide level in your blood drops to normal
2 weeks to 3 months after quitting: Your circulation improves and your lung function increases.
1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.
1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's
5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.
10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease.
15 years after quitting: The risk of coronary heart disease is that of a non-smoker's
Kicking the tobacco habit offers some benefits that you'll notice right away and some that will develop over time. These rewards can improve your day-to-day life a great deal.
your breath smells better
stained teeth get whiter
bad smelling clothes and hair go away
your yellow fingers and fingernails disappear
food tastes better
your sense of smell returns to normal
everyday activities no longer leave you out of breath (for example, climbing stairs or light housework).
Thursday, May 15, 2008
Did I think too much about mind?
When you correctly identify a patient as having psychological cause for his/her illness there is a trap in which you can fall into.It happened to me once.
A 60 year old lady was constantly coming to me with symptoms like tummy pain,tendency to pass motion immediately after taking food,bloating sensation etc.My clinical examination and investigations including endoscopy were negative.I labelled her as a case of functional bowel disease due to psychological reasons.My treatment with that diagnosis was successful and she was happy.She came to me less frequently and later stopped all medicines.After 2 years she came to me again with almost similar complaints.I treated her in the same way as before.The response to treatment was not that good but I continued to reassure her .Only after 2 months did i realise that there is something wrong.An endoscopy showed a stomach cancer.Surgical removal was done and chemotherapy started.Unfortunately she succumbed to the disease.
Did I think too much about her mind instead of her body? May be yes.
A 60 year old lady was constantly coming to me with symptoms like tummy pain,tendency to pass motion immediately after taking food,bloating sensation etc.My clinical examination and investigations including endoscopy were negative.I labelled her as a case of functional bowel disease due to psychological reasons.My treatment with that diagnosis was successful and she was happy.She came to me less frequently and later stopped all medicines.After 2 years she came to me again with almost similar complaints.I treated her in the same way as before.The response to treatment was not that good but I continued to reassure her .Only after 2 months did i realise that there is something wrong.An endoscopy showed a stomach cancer.Surgical removal was done and chemotherapy started.Unfortunately she succumbed to the disease.
Did I think too much about her mind instead of her body? May be yes.
Tuesday, May 13, 2008
Mind and Body again
An injured mind can down our body defense mechanisms. And this in turn can even cause mortality.A close relatives or friend's death can produce so much trauma to the mind that it can trigger an illness which can take the life out of the body.So often you might have heard that the spouse getting sick and dying immediately after the partner's death.
Recently an 80 plus man, a widower and a patient of mine for many years , who fought and won against many illnesses succumbed to trivial infection immediately after his last son moved out of his house thus making him feel lonely.
The emotional support you get from your loved ones is as important as any medicine or an expert doctor's care.
Recently an 80 plus man, a widower and a patient of mine for many years , who fought and won against many illnesses succumbed to trivial infection immediately after his last son moved out of his house thus making him feel lonely.
The emotional support you get from your loved ones is as important as any medicine or an expert doctor's care.
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