Agnipath

Monday, 7 August 2017

The MUGA Scan appointment

A patient with an interesting surgical disease was admitted to a Surgery Unit III in AIIMS, New Delhi. On checkup for fitness for anesthesia, he was found to be suffering from heart disease. The cardiologist (heart doctor) reviewed the patient and advised MUGA scan to further evaluate the patient’s risk for surgery.

In MUGA scan a small amount of radioactive material is injected in the patient’s vein. Using a special device (camera) the amount of radioactivity coming from the pooled blood in the patient’s heart is recorded. This gives an estimate of the blood pumping power of the heart.

The trouble with MUGA scan was that due to the over-burdened cardiology department of AIIMS, New Delhi, there was minimum waiting period of 10 to 15 days before this MUGA scan can be done.

The Surgery Department of AIIMS, New Delhi, was also over-burdened and it was not possible to keep the patient admitted in the ward for 10 to 15 days while waiting for the MUGA scan. The patient was from a distant place and it would have cost the patient a good amount of time and money for him to go back to his home and come back to AIIMS for the MUGA scan.

The head of unit, Prof. Tarun Kumar Chaturji (fictional name) also did not want to send the patient home, as it was a surgically challenging case. There was the possibility that the patient may not come back to AIIMS, or may get re-admitted in a different unit.

The senior resident of the unit asked to Dr. Dev (fictional name) solve this problem. Dr. Dev studied the problem and came up with a plan of action.

Professor (Dr.) Umesh Kaul (fictional name) was the acting HOD of the Department of Cardiology in AIIMS, New Delhi, at that time. Dr. Kaul was learned person, master of his field, with a busy schedule. Even high ranking officials and politicians had to take appointment to meet.

When Dr. Dev reached the Cardiology centre of AIIMS, New Delhi, instead of going to the MUGA scan lab, he made his way directly to Professor Kaul’s Office. Without stopping to talk and take permission from his receptionist, just barged straight in his office.

Dr. Kaul, who was having some meeting in his office looked at Dr. Dev with amazement and anger at his rude interruption. Perhaps, the adage ‘Fools rush in where angels fear to tread’ (walk) must have crossed his mind.

Before he can be unceremoniously thrown out of Prof. Kaul’s office, Dr. Dev blurted, “Sir, I am a junior resident from surgery unit III and we have a patient who requires a MUGA scan on priority.”

Dr. Kaul looked at Dr. Dev with exasperation and barked at him, “Why have you come to disturb me for this?” “Go and talk to the reception at the MUGA lab.”

Bowing obsequiously, Dr. Dev replied, “I am extremely sorry to disturb you. I will go the MUGA lab as instructed by you” and hurried out of Dr. Kaul’s office, breaking out in smile as soon as he was out of the office.

When Dr. Dev reached the MUGA Scan lab, instead of going to the clerk giving appointment for the scan, he sauntered to the Lab in-charge and said, “I am coming from Dr. Kaul’s office. He has told me to get the MUGA scan done of this patient on priority.”

The in-charge was surprised that Dr. Kaul himself was instructing about some patient’s MUGA Scan.

He queried Dr. Dev, “Professor Kaul himself?”

“Yes”, replied Dr. Dev truthfully, “Professor Kaul personally instructed me to get the MUGA scan done.”

Still amazed the Lab in-charge asked, “Is the patient some relative of Dr. Kaul?”

Leaning toward the Lab in-charge, Dr. Dev lowered his voice as if he was afraid someone will over hear him and whispered conspiratorially, “I am also not sure, but I think he may be either some distant relative or close family friend.”

The in-charge looked at Dr. Dev helplessly, “It is already past noon and we have many patients waiting for the MUGA scan today. Will it be alright if we do the scan on this patient as first case coming morning?” he pleaded.

“Okay” answered Dr. Dev, “It had been better if the scan would have been today, but we will adjust even if done tomorrow.”

The MUGA scan was indeed done the next day; patient operated on soon after and went home hale and hearty.

(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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Thursday, 3 August 2017

Shift to OT Stat

Please Note: This article is intended only for medicos, especially hospital owners, trauma surgeons, general surgeons and orthopedicians. Non-medicos please skip this post.

In seriously injured patients or whom the relatives consider serious, some surgeons have found taking the patient directly to Operation Theater (OT) after investigations that can only be done outside OT, such as x-rays, ultra-sound, has multiple advantages.

In OT full resuscitation equipment and drugs is at hand. Patient’s wounds, etc, can be stitched or explored better with proper instruments and illumination. Patient’s attendant are also satisfied that the doctors are taking prompt care, by taking to OT, even if inside the OT, the patient is just being examined, given first aid, parts being prepared (shaved), etc. They are also impressed by the long time taken for ‘operation’.

Most importantly, the treating doctors and staff are not bothered by the crowds of attendants surrounding the patient, questioning their every move, and repeated questioning by every new attendant arriving at the hospital. Being sterile closed area, the relatives are kept outside.

Any request to talk with the treating doctor can be politely turned down by the reception staff, by informing them, as the doctor is busy in operation, he cannot talk now, even if he is sitting and sipping coffee inside, while waiting for the anesthetist to arrive.

Addendum: This may not work with some of the hadoti’s netas (politicians). E.g. one MLA walked into the Major Emergency OT of Government Hospital with his followers wearing shoes, etc, to know the status of and direct the doctors to give proper care to one patient being operated for injuries suffered in road accident, who belonged from his legislative constituency.

Tuesday, 1 August 2017

The Timing – Part 3

Dr. Geetika Agrawal (fictional name) was famous pediatrician of the city. Although, her consultations timings were from 9.00 a.m. to 1.00 p.m., she preferred to see patients from 11.00 a.m. to 1.00 p.m. She was also socially conscious and wanted to extend some help to the economically disadvantaged patients coming to here.

With an aim to fulfill two goals with one move, she put notice in her clinic announcing 50 % reduction, i.e. only half the normal consultation charges, to patients coming for consultation between 11.00 a.m. to 1.00 p.m.

This had a desired effect and the maximum number of patients started coming at 11.00 a.m.to 1.00 p.m. Also, if a patient request a reduction in consultation charges, she could rightly say, that you pay the normal charges now but next time come between 11.00 a.m. to 1.00 p.m. and pay only half the consultation charges.

So, if you want the patients to come preferably at some particular time giving them some financial incentive like reduction in charges can work wonders. The hospitality industry (hotels & restaurants, etc.) are using this concept for ages with special discounts, happy hours, etc. in off-season or during lunch or early evening hours.