Dr. Kas Nova’s BP Recording

 

A person’s blood pressure can increase temporarily under emotional situations but persistently high or elevated blood pressure (hypertension) is a serious medical problem. Hypertension significantly increases the risk of heart attack, stroke/paralysis, kidney failure,  blindness, and premature death. As a person can be having high blood pressure (BP) without any symptoms, regular blood pressure measurement is the key to detecting and treating this silent killer.

In between two cases in the operation theater (OT) there was a delay and the OT was empty without both the patient and the anesthetists. Dr. Kas Nova (fictional name) decided to make use of this opportunity to get his blood pressure (BP) measured by the automatic anesthesia’s multi-para machine. He asked his resident to switch on the machine and help him in taking his BP recording with the machine.

Being unfamiliar with the machine as it was operated only by the anesthetist, they were fumbling with the switches and settings when one of the anesthetists entered the OT. Noticing them struggling, the helpful lady volunteered to help them.

Standing close to Dr. Kas Nova, in the congested space between him and the anesthesia machine, the lovely anesthetist expertly warped the BP machine around his arm, set the parameters on the machine, and started the process of the BP recording. Within a minute the monitor displayed Dr. Kas Nova’s blood pressure reading on the screen.

It was perfectly normal. In fact, it was towards the lower side for someone of Dr. Kas Nova’s age as the blood pressure tends to increase with increasing age.

The anesthetist went outside the OT to continue her work.

After she had left, Dr. Kas Nova looked at the BP recording on the machine and sighed, ‘I really must be getting old.' The resident standing nearby overheard him and asked with surprise, ‘Why sir, why are you saying such a thing? Your BP reading is perfectly normal!’

‘That is the problem,’ said Dr. Kas Nova, ‘Such a beautiful lady was standing near me and yet my blood pressure did not shoot up.’

Different persons may have different ways of looking at the same thing. What may be a good thing for someone may be perceived as a bad thing by someone else.

— ND

(Based on allegedly true incident.)

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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. 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 NMC and other Board norms. 

Holistic Medicine: A Brief Intro

 One of the first duties of the physician is to educate the masses not to take medicine. — Sir William Osler

Holistic medicine simply means taking a broad view of the patient and disease. Treat the patient as a whole and not as a 'disease case'. In holistic medicine, the aim is the comprehensive care of the patient in all areas, such as physical, mental, emotional, spiritual, social, and economic aspects.

The word is derived from the Greek ‘holos’ which means entire, complete, whole. The word is not related to holy which means sacred or religious. It is not sacred or religious treatment, a common misunderstanding. I have seen an advertisement by a famous epilepsy clinic, which claims to cure epilepsy by 'pavitra' (holy) treatment.

It is not exclusive to any particular system of medicine but how a doctor practices his system. An allopath may practice with a holistic outlook, whereas a ‘vaidya’ (Ayurvedic medicine practitioner) may not.

For example, a person may come suffering from acid peptic ulcer disorder. The conventional practice may involve giving him a drug to inhibit the acid formation or to neutralize it, whether allopathic or of another system, such as Ayurveda. A holistic approach will be when along with drug treatment other factors are also considered and treated such as a change in lifestyle, diet, job, family or job counseling, stress management, etc.

A common confusion is with the term alternative or complementary medicine. These are medicine or therapy systems different from the accepted or conventional system. It may vary from country to country, e.g. Ayurveda is recognized by the government as one of the mainstream treatment systems in India but is classified as an alternative in other countries. Acupuncture is classified as an alternative or complementary therapy in most countries but in China, it is recognized as a mainstream therapy system.

The holistic approach is already enshrined in WHO definition of health given in as far back as 1948:

          "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity".

Therefore ideally we should pay attention to the mental, social and spiritual aspects of illness in addition to just the physical ones.

Although this definition of health by WHO is quite old, why is holistic medicine in so much limelight now? The answer lies in the increasing incidence of lifestyle-associated diseases. In them, even with the best possible medication, there is a ceiling on effect. We need to address the faulty lifestyle for optimum effect. For example, in hypertension or high blood pressure, diet, exercise, mental relaxation, abstaining from tobacco, etc., plays an important role along with medication to get optimum control of the raised blood pressure and prevention of future complications.

There are many problems being faced by doctors in practicing holistic medicine. The most important problem is the lack of time by Indian doctors burdened with caring for such a large population. Another problem is the lack of training. Medical education by and large places most emphasis on the physical aspect of disease and its treatment by drugs or medicines. Some training is imparted in PSM or Community Medicine classes, but there the emphasis is more on maternal-child health and diseases under the national health programs.

The practice of medicine in a Holistic manner should be the goal of all medical practitioners regardless of whether belonging to the allopathic or other medical systems. It does have some concrete benefits for the patient and is not just something exotic or fashionable.

— ND

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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 norms.

The Patna Patient

As an intern, Dr. Dev was posted in the Medicine Department of AIIMS, New Delhi.

For those who are not aware, after passing the final MBBS exam, the students are provisionally treated as a doctor but are required to work under supervision for one year in the hospital in various departments which is known as the internship. After successful completion of the internship, the intern is recognized as a full-fledged doctor and can then practice independently.

Dr. Dev was assigned to see the patients in the Out Patient Department under the supervision of one of the medicine junior residents. Once the junior resident was stuck in some ward work and was late in coming to the OPD. Dr. Dev started seeing the patients on its own to do at least a preliminary survey so that time is saved when the junior resident comes to OPD.

One patient had come from the city Patna from Bihar, a distance of around 1000 kilometer. He had been diagnosed with essential hypertension (high blood pressure) and the Professor of Medicine in Patna had started his treatment. On checking his blood pressure was found to be within normal range, indicating that his treatment was correct.

Dr. Dev inquired that since his blood pressure was well controlled on the treatment started in Patna, why did he come to AIIMS.

The man explained that he had shown to the professor of Medicine in Patna, who had said that he will need to take the medicines for high blood pressure for life. The patient wanted to confirm that if this was true and there was no short-term permanent treatment for his high blood pressure. Those were the days when high blood pressure was uncommon in India and the public was not well aware about it.

When Dr. Dev explained to the patient the chronic nature of the disease and the need for lifelong follow-up, monitoring, and treatment for the high blood pressure the patient got convinced. Since he will require regular check-ups Dr. Dev adviced him to continue the treatment from Patna.

Once the patient had left, Dr. Dev realized the power of an institution over an individual. The patient was not convinced by the professor of medicine as he was from Patna Medical College but got convinced by an intern as he was sitting as a doctor in AIIMS Medicine OPD. This is true in non-medical situations also.

 (Based on a true incident)

— ND
© Author. All rights reserved. 

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

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 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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