The Female Buerger's Disease Patient

The Surgery Professor was taking class of under-graduate MBBS students on peripheral vascular diseases (diseases of the blood vessels/ supply to the limbs).

He started explaining about Buerger’s disease, a type of blood vessels disease. The professor told the class that Buerger’s disease is almost exclusively seen in young chronic male smokers. It is extremely rare to see any female suffering from this disease.

The class was curious to know the reason for same as smoking though uncommon is not extremely rare in females.

The professor explained that it may be related to some genetic or hormonal factor but exact reason in not known. He then continued his lecture on the other aspects of this disease.

When the professor came to treatment part, he told the class that raising the heel of the foot wear of the patient is helpful in providing relief in pain in calf region in these patients. Raising the heel decreases the work of the calf muscles, thus alleviating the pain in calf region.

Suddenly Dr. Dev (fictional name) exclaimed, ‘Sir, now I know the reason for females not suffering from Buerger’s disease. They already wear foot wear with high heels.’

(Based on true incident)
— ND

© Author. All rights reserved. 


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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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Just Some Tonic Please

Dr. Dev (fictional name) was working as junior resident in the Department of Surgery, AIIMS, New Delhi.

A staff nurse working in ward asked him to write some ‘tonic’ for anemia (decrease in red blood cells or hemoglobin) for her. She had noticed that she had become pale in last few days.

The over-worked, tired, Dr. Dev wrote some haematinic and forget about it. After a week, the nurse again asked Dr. Dev to write some more haematinics. Since the nurse asked him informally while Dr. Dev was busy working in the ward, he did not had the time or the inclination to go for  detailed consultation and evaluation of the nurse’s anemia. The staff nurse also just wanted some prescription for her anemia and was not interested in a proper consultation for her anemia.

Few days later, when Dr. Dev came to the ward in the morning, he found the same nurse admitted in the post-operative section of ward, with a Ryle’s tube in nose and intravenous drip lines in both arm.

On inquiring he found that the nurse had severe bleeding in her stools at night and was admitted to the emergency department. To stop the bleeding she had to undergo emergency operation, on which she was found to be suffering from tuberculosis of small intestine (Small Bowel).

This intestinal tuberculosis was the cause for the anemia which the staff nurse was suffering from. If the nurse had come for proper consultation for her anemia, the consultation would have included a history, physical examination and investigations (tests) to determine the cause for her anemia. Intestinal tuberculosis, though very difficult to diagnose without an operation, might have been suspected and she might have received anti-tuberculosis drugs early along with the medicines for anemia.

Beware of the patient asking some friendly advice. They are usually friends, family members, colleagues, chance acquaintances or just some patient wanting to save on consultation charges.

Usually due to feeling of shyness in discussing their medical problems in detail with a doctor who is their friend, relative or colleague, they direct the doctor to just prescribe him/her minimum symptomatic treatment. This may lead inadequate or wrong diagnosis or treatment for which the doctor may be held responsible, even though the fault lies with patient.

When faced with such situation, the doctor should politely but firmly ask the person seeking friendly advice to come for a formal consultation for proper evaluation and treatment of their conditions. Short term prescription of drugs, if done at all, should be conditional to their agreeing for this formal consultation.

In no condition should the doctor prescribe drugs repeatedly without proper consultations.

You may ruffle few feathers in short term but ultimately will find this firm approach beneficial for both the doctor’s and their friends’ and relatives’ welfare.

 (Based on true incident)

— ND
© Author. All rights reserved.

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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 
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The Economical Charges

Dr. Dev (fictional name) was visiting his friend Dr. Akshay Kalekar (fictional name), the famous ENT surgeon. We had read his smart way to cut cost in his day to day practice in ‘The Tongue Depressor’ http://agnipathdoctors.blogspot.com/2015/05/practice-tips-tongue-depressor.html

While Dr. Dev was sitting in his consultation chamber, a patient came to show his problem. Dr Akshay examined the patient, made his diagnosis and asked to see his previous treatment papers.

After examining his previous papers, Dr. Akshay explained to the patient, that he requires operation to treat his condition.

The patient agreed to undergo operation, as his previous doctor has also advised operation as part of treatment. He asked Dr. Akshay his professional charges for the operation.

‘It will be Rs. 12,000’ replied Dr. Akshay.

Dr. Dev was surprised because Dr. Akshay normally charges just Rs. 10,000 for that procedure. He keenly waited to see the patient’s reaction to hearing the charges.

Much to his further surprise, the patient happily agreed to the charges without even requesting to give him discount or reduction in the charges.

As soon as the patient had left the consultation chamber, Dr. Dev curiously inquired, ‘Dr. Akshay, why did you tell the patient your charges will be Rs. 12,000 for the operation, when you routinely charge just Rs. 10,000 for same?’ ‘And, more importantly why did the patient so readily agreed to the charges without demanding for some discount as patients usually do?’

‘Well Dr. Dev’ replied Dr. Akshay, ‘your surprise is justified.’ ‘I do charge Rs 10,000 for this operation. But while going through patient’s previous treatment record I found that he had consulted Dr. R. S. Sharma (fictional name), senior ENT surgeon of the city and he had also advised operation for the same.’

‘Now, being a senior ENT surgeon with an advanced setup, Dr. R. S. Sharma’s operation charges are generally 50% more than what most of us generally charge. So, he must have told the patient that the charges for this operation will be Rs. 15,000.’

‘So, when I told the patient the charges for this operation will be Rs. 12,000, he happily agreed as my charges appeared economical as compared to Dr. R. S. Sharma’s charges. The patient was getting a reduction of Rs. 3,000 or 20% in the operation charges as proposed by Dr. R. S. Sharma.’

‘So’, elucidated Dr. Akshay, ‘It pays to know whom the patient consulted before coming to you and what your other colleagues are charging for their services.’

(Based on true incident)
— ND
© Author. All rights reserved. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 


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