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

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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’s norms. 

The Fracture Reduction

Forget the ancient period when the knowledge was shared only among a few select persons, often in a secretive society or cult; even just a few years ago, there were many who were secretive about their knowledge or techniques. 

Dr. Ashok Tiwari, senior professor of orthopaedics, in Kota Medical College, recalled the scenario just a few years ago giving the example of treatment of fracture. 

After fracture of the bone of the limbs, depending on the bones involved and exact place they are broken the distal or lower part of the limb may become deformed. In health, there is a complex system of muscle surrounding the bones, fulfilling their function and balancing the action of each other. With fracture, this coordinated action of the muscle becomes unbalanced, causing the distal/lower part of the arm or leg to take a deformed position. Just putting a simple plaster cast or splinting the fractured limb may result in the bones joining in a deformed position, causing cosmetic and functional problem to the patient. 

The distal / lower part of the limb has to be manipulated in a precise sequential manner, depending on the site and type of fracture to bring the limb in normal position, known technically as 'reduction of facture' before applying a plaster cast. Some orthopedicians used to practice great secrecy about their technique to bring the fractured limb in proper position. They did not want other to learn their methods so that they can have a monopoly. 

Some orthopedicians used to ask other doctors and staff members to leave the room when they would do this manipulation to bring the fracture in the proper place. One orthopedician used to throw a heavy cloth or blanket over the fractures arm or leg then manipulate it blindly covered with the blanket so that others including the nursing staff assisting him do not learn how to bring the fractured part in proper position.

In contrast, now when Dr. A. K. Tiwari goes to medical conferences, he notices that the best orthopedicians from India and abroad, freely talk about their methods and techniques to various orthopedic problems, and demonstrate them by an on-screen presentation.

As Dr. Tiwari had so aptly said, ‘In old times surgery used to done behind the screen. Now it is done on the screen!’ or ‘पहले सर्जरी परदे के पीछे करते थे अब सर्जरी परदे के ऊपर करते है!’

This is true in almost all fields now. There are many workshops, courses, classes, seminars, etc. available nowadays in almost all subjects. With the advent of internet, YouTube, bloggers, Wikipedia like sites, there has been a tremendous change in the knowledge and information available to any person with desire to learn something new. There are lots of educational resources available on internet such as video lectures and online courses both in orthopaedics and diverse subjects from medical and engineering science, arts, craft, technical and vocational subjects and what not.

The present students should be thankful that they live in such an open society. Please use wisely the available resources to increase your knowledge and expertise to enrich your life and better serve humanity.

(Based on allegedly true incidents)

— 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 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. 

The Chest Injury Visit

Dr. Dev (Fictional Name) was on way to his son’s school to pick him up after the school when he received a phone call from a private orthopedics hospital where he used to go on call consultations. The hospital’s receptionist informed him that a patient of a road traffic accident with chest injury has been admitted and they want his consultation.

Worried at the patient’s status, as chest injury can be very serious and need prompt treatment, Dr. Dev phoned one of his colleague whose son also used to study in the same school as his son. Dr. Dev asked his colleague to find his son at the school and drop him at his house as he had to go on an urgent call. Dr. Dev turned his car towards the orthopedics hospital and drove quickly to reach the hospital as soon as possible.

When he reached the hospital and reached the patient’s bedside, he received a shock to see an apparently normal appearing patient sitting comfortably in the bed. You can imagine Dr. Dev’s exasperation when on inquiry he learned that the patient had the accident two days ago, and was only having mild pain in the chest at present. The orthopedician had ordered the surgical consultation as a routine.

Whether calling a doctor for consultation or your plumber for a leaking tap, mention the time frame in which you want him to visit, eg. immediate, urgent, priority, routine, etc. depending on the severity of the problem and the trouble it is causing. These will show your consideration and appreciation of the visiting person’s time and he is more likely to cooperate if you really want him to rush in future.

(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. 

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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The Useless Doctor

100^th Post

To write what is worth publishing, to find honest people to publish it, and get sensible people to read it, are the three great difficulties in being an author. — Charles Caleb Colton

One patient came to the surgical outdoor and said he was suffering from fever. The surgeon sitting there requested him to consult the physicians in Room No. 104.

Sometimes later he came back saying that his wife is suffering from backache and so write some medicines for her. The surgeon sitting there asked him to consult the orthopedicians in Room No. 120.

Again after some time, the same patient came with his young son saying that he is suffering from a sore throat and nasal discharge. The surgeon sitting there asked him to consult the ENT specialist in Room No. 124.

At this, the patient looked suspiciously at the surgeons sitting in the Surgical OPD room and angrily demanded, “Do you treat anything here or just send patients to other room?”

No matter what your qualification or skill is unless you can satisfy the need of the patient or client standing in front of you he will consider you useless and behave accordingly.

(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. 

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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The Hostel Examinee

It is exam season for Post-graduates (PG) in Medical Colleges across the country. The PG student whose practical exams have not yet conducted are waiting nervously for the day of the exam. Those whose exams had been completed are waiting anxiously for the final result. Let me share with you the story of one unique PG student.

Dr. John (Fictional Name), an orthopedics junior resident had failed in the previous final MS (Orthopedics) exam in a Government Medical College in Rajasthan. Since the exam result to large extent was dependent on the Head of Department (HOD) of Orthopedics and the other internal examiner, Dr. John was angry at them. 

In the next examination held six months later, Dr. John was the only candidate in the orthopedics department as he was the only PG resident who had failed in the exam. On the day of the practical exam, while other PG residents were busy doing last minute revision, Dr. John was busy getting the corridor in front of his hostel room cleaned to a sparkle. Then he proceeded to arrange the flower pots in a row leading from the hostel’s main gate to his room. The other residents watched in amazement. 

Finally, someone asked him what is the meaning of this strange behavior? Dr. John replied, “I am doing this as the examiners will come to my room to take the exam!” The residents were amazed at his statement and looked at him with disbelief.

The time for the practical exam to start was at 9.00 am in the orthopedics ward. The HOD and the other internal examiner reached the ward at 9.00 am and were furious that Dr. John had not yet come to the ward. The external examiners reached the ward at 9.30 am and yet Dr. John has not appeared for the exam. 

The HOD Orthopedics anger slowly started to turn to worry. By 10.00 am when Dr. John has yet not come for the exam, the external examiners asked the HOD to produce the candidate or declare the exam annulled. Now a highly worried HOD sent one of the junior residents to go to Dr. John’s hostel room and bring him to the exam. 

The resident came back after some time alone. Hesitantly he informed the HOD that Dr. John has refused to come to the ward to give exam and had said the examiners are welcome to come and take his exam in his hostel room if they promise to pass him.

The HOD grudgingly agreed to Dr. John’s demands and he convinced the other examiners also. The problem was that Dr. John was the lone candidate appearing for the exam. 

If Dr. John did not appear for the exam and sign in the attendance sheet, the exam will be deemed canceled. If the exam was declared canceled, then all the examiners will not receive the examiner's fees for checking the theory paper and the thesis and for the practical exam. The traveling and other expenses of the external examiners will not be reimbursed. The external examiners coming from out of the city will have traveled in vain. The HOD orthopedics will have to foot the bill for all arrangements made for the exam from his personal funds. 

Face with such monetary disincentives, the examiners went to Dr. John’s hostel room, took his exam there, wrote qualified on his result sheet, after which Dr. John signed the official attendance sheet.

It is not always the examiners who have the upper hand in an exam. With knowledge of the rules and regulations and certain chutzpah sometimes the examinee can gain the upper hand.

 (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. 

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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Physician for Surgical Patients

Please Note: This article is intended only for Doctors and medical undergraduate and post-graduate students. Non-Medicos please do not read this article.

The profile of surgical patients is changing. More and more surgical patients are having co-existing medical problems such as diabetes, hypertension, COAD, and so on. In addition, more and more, new drugs are being introduced in the market with multiple effects, side effects, and interactions. This has made the care of surgical patients a challenging task.

One of Dr. Dev’s friend (Fictional Name), a leading orthopedician of the city, moving with the changing times has made the physician the essential part of his team. The physician attached to his orthopedic hospital routinely sees all patients admitted to the hospital, whether they have any apparent medical problems or not. This leads to the comprehensive care of the patients and avoids any oversight due to the concentration of the primary consultant's attention on the orthopedic problems.

 (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. 

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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The Delayed Operation

Please Note: This article is intended only for Doctors and medical undergraduate and post-graduate students. Non-Medicos please do not read this article.

Please Note: Although not essential, it may be better if you read the earlier post, ‘The Late Appointment’ at https://agnipathdoctors.blogspot.com/2018/05/the-late-appointment.html before reading this post.

Frequently in private hospital setup, a similar problem is faced for patients scheduled for surgery.

On the mention of operation, a large crowd of relatives and well-wisher gather in the hospital premises. If there is a delay from the scheduled time, the problem is worse, due to a large number of attendant present in the hospital.

Each of these attendants considers its duty to personally go and ask the staff, the reason for the delay in operation. The staff may get irritated by the repeated questioning by patient’s attendants.

As the delay increases, their level of agitation increases, with rising of temper and sometimes an exchange of harsh words between the attendants and hospital staff.

One of Dr. Dev’s friends, a senior orthopedician, having his own small hospital, gives the expected time of surgery around one hour later than actually planned with the anesthetist and OT staff.

 In this way, even if there is a delay of one hour, the patient and relatives do not get agitated.

If the surgery starts at the actual scheduled time, before the time conveyed to the patient, the patients are usually happy as the patient is usually not taking even water while waiting for surgery. Frequently the patient is inside the operation theatre before a large crowd of his well-wisher gathers.

(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. 

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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