Sunday 12 April 2020

The Chronic Ulcer Lesson



Dr. Dev (Fictional Name) was sitting in the surgery OPD when a patient entered the room followed by 9-10 persons. Even before he came near him, Dr. Dev noticed that he was having a small ulcer, around ½ inch in size, just below the elbow crease, covered with dirty slough material. 

When the patient sat on the patient’s chair, Dr. Dev took the old OPD slips from his hand and inspected them. Dr. Dev, who used to speedily cram heavy medical textbooks on the night just before the college exam, quickly noted from the patient’s old record, that as he had suspected, the patient was having the wound for around 15 days, which occurred when he received an intravenous injection at the common site near the elbow crease, which unfortunately spread outside the vein and caused the ulcer. Also, he was diabetic and the last recorded sugar in his slips was also high. 

Making a diagnosis of delayed healing of the ulcer due to uncontrolled diabetes and movement of the ulcer site as it was near the elbow joint, Dr. Dev asked the junior resident sitting with him to take the patient to minor operation theatre and under local anesthesia remove the necrotic slough from the ulcer, do a good dressing, write antibiotics and pain-killers and refer him to the physician for the change of drugs to control of his diabetes. He directed the patient to go with the junior resident for further treatment. The entire sequence occurred in just 1-2 minutes.

On hearing the patient turned livid and angrily shouted at Dr. Dev, ‘You doctors don’t want to work at all. You are advising me treatment without seeing me properly and just shunting me away!’

Dr. Dev tried to placate the patient, saying, ‘I have gone through your records and read the full history and treatment given previously which was correct. Your wound is not healing because of high blood sugar, which the physician will treat, and the movements of your elbow joint, which you will have to restrict. The minor surgery I advised is very well done routinely by my resident. There is no question of negligence on my part.’

Dr. Dev's words fell on deaf ears. The patient continued his harangue, with the persons accompanying the patient joining in by making aggressive gestures and sounds of resentment.

To defuse the situation, Dr. Dev got up, put on pair of sterile gloves, slowly palpated the patient’s ulcer and the surrounding areas and moved his forearm in different directions, all the time, with a look of intense concentration on his face. 

Dr. Dev did not want to do this palpation in the first place as it was painful to the patient and its finding was not going to make any difference to the treatment. 

Once he felt that the patient looks satisfied, he stopped the examination and removing the gloves he wrote the treatment of the patient by his own hand in his OPD slip. This was the same treatment that he had asked his resident to write and then requested the patient to please go to the minor OT with the resident.

It is logical that the time you devote to a patient or a problem should be in proportion to its seriousness. But in actual life, you have to devote time in proportion to the size of the ego of your patient/client/customer. If you appear to be devoting less time than their ego demands then you may face resentment and retaliation, for being ‘superficial’ or ‘not serious enough’.

It is not enough to just provide the treatment or solution to most people. Most people want their doctor or service provider to listen to them, empathize with their hardship, devote time to them and provide the treatment or solution only after due deliberation. 

If you skip any of these either due to lack of time, work overload or the minor nature of problem according to you, then your patient or client is not going to be satisfied, even with correct treatment or solution.

Remember, you may see someone’s problem as minor, but to most persons, their own problem appears to them as the biggest problem on earth.

It may not be true in other professions, but when a crowd accompanies a patient to the hospital than the patient and the crowd either think that the patient is a VIP or that he is suffering from a very serious life-threatening disease. So be ready to respond accordingly to avoid any unpleasantness.

(Based on an allegedly true incident)

— ND
© Author. All rights reserved. 

Please share this post on WhatsApp, Facebook, Twitter, Pinterest, etc.

If viewing from Mobile, switch to Webpage view to see a list of popular posts and index of topics of previous posts.

Please give your valuable feedback via the comments below. Please note that comments will appear later only after moderation. Please Log in with Google Id before writing comments.

You can receive a notification on latest post by subscribing via clicking on the bottom of the page on the Subscribe to: Posts (Atom)
DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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. 
DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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 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 norms. 

Saturday 11 April 2020

The Complete Knee Checkup



One doctor who was posted in the Community Health Centre (CHC) Ballabhgarh which was affiliated to the AIIMS, New Delhi, recounted his experience there. 

An aged woman came to the OPD with the complaint of pain in her right knee. The doctor examined the patient and made a diagnosis of age-related osteoarthritis and prescribed some medicines for her.

The patient looked at the doctor with dissatisfaction and implored him to check her knee properly before writing the medicines. The doctor replied, ‘I have properly checked your knee and then only wrote the medicines.’

The unconvinced woman countered, ‘But you have not used this to check my knee!’ pointing at the stethoscope (steth) hanging around the doctor’s neck. 

As most of you know, the stethoscope is used by doctors to listen to your breath and heart sounds. As most of the patients used to come to the OPD with chest complaints, cough and cold and fever, examining the chest with a stethoscope was done in almost all patients.

When the doctor had logically not applied the stethoscope to her knee, the patient felt the doctor was not examining her properly as compared to the other patients causing her distress.  

Bending to her request, the doctor applied the stethoscope to her knee, acted as if his listening carefully to sounds made by her knee, and then said, ‘I have now done the full examination, but there is no need to change the medicines already written. Take them and come next week for follow up.’

A now satisfied patient happily left with medicines.

When the doctor did not use the stethoscope to examine her, the woman felt that the doctor is not taking due diligence (proper care) in treating her leading to her dissatisfaction.

It is not enough to be conscientious in while taking care of your patients/customers / clients but you should also appear to be doing so to their satisfaction, even if you may have to indulge in showmanship at times.

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

Please share this post on WhatsApp, Facebook, Twitter, Pinterest, etc.

If viewing from Mobile, switch to Webpage view to see a list of popular posts and index of topics of previous posts.

Please give your valuable feedback via the comments below. Please note that comments will appear later only after moderation. Please Log in with Google Id before writing comments.
You can receive a notification on latest post by subscribing via clicking on the bottom of the page on the Subscribe to: Posts (Atom)

DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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. 
DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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 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 norms.