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
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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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