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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