Hide it from your doctor
‘Don’t hide anything from your doctor or Lawyer.’ Right?
I don’t fully agree and I will tell you why.
After more than 2 decades of medical practice, I believe that there are something that we want our patients to hide from us.
The thick file
The elderly gentleman had come to consult me for the first time.
‘Please take a seat’
‘Doctor, I know you are busy, but I hope you have little time for me. My story starts in 1952 when I was posted in Kolkata. You know those days Kolkata was not so crowded; we used to walk down to the Victoria memorial, the air was so fresh……’
He opens the first page of a thick file, with several page-marks.
I was attentively listening, trying to not to miss the hint of starting of an ailment, but finding none I introduce subtle clues.
‘So tell me, what brings you to me now?’
‘Oh doctor, that is another story. You know Capt. Nair? His son is your daughter’s classmate. It is his recommendation ……’
I quickly glance at my watch and then the display counter, hoping that it would move up magically from 24 to 49. Ten minutes later we had reached 1975; at this rate 2017 was still a distant goal.
It is good to be organized and methodical, it is also important not to miss out vital information that might help the doctor to make a correct diagnosis; but if you are too elaborate, your doctor might get so bored that he may actually miss out on vital clues.
I am a member of few Guideline writing committee in India, and spend hours updating myself, sorting out through the large amount of new data that come out in medical journals. So it is really frustrating when the patient brings out a google printout, carefully unpacking it like a diamond jewelry and place it on the table, expecting a surprise on my face.
‘Doctor, did you know that the tablet you prescribed can produce muscle cramps?’
We had many debates over that 0.01% muscle cramp issue with this drug for hours on and concluded that it was non-significant. I did not want to wipe out his thrill of teaching his doctor something new; his smile confirming his belief on ‘Siri’ and ‘Ok google’ more than the balding hunchback sitting in front of him in white coat.
‘And since when did you have these cramps?’
‘Since college days!!’
I cannot go to a car showroom and announce that a nut here and a bolt there, might improve the car; he would surely consider me to be a nut and promptly bolt me out of the door. Doctors are no different in their thinking, but more than 10 years of training makes sure that we keep mum despite any provocation.
Busy OPD, token 25 at 2 PM, My wife had already called me to ask if I had lunch, and I lied (we are very good at telling lies with a flat face).
I work up the patient referred with a provisional diagnosis of heart disease because of ECG variation, and finally make a diagnosis that it is not a heart problem, just thyroid deficiency. I do a detailed counselling, taking the fear of heart disease out of her mind. By the time I was getting that kick of serotonin of a ‘good diagnosis’, the lady points my attention to her husband and says ‘I know doctor you are busy, but can you just see my husband? He too has some chest pain once in a while and refuses to see a doctor.’
I remembered the teaching at school ‘tell a lie and thou shall punish you’.
There is a huge difference between see and just see. The doctor is not a magician.
Big bottle of foreign vitamin
‘Doctor my son has sent these bottles, they are the latest vitamins from the US, very expensive. But he told us to take it only after consulting you’
She brings out two huge bottles of attractively packed vitamin capsule bottles, each containing 200 capsules. These are useless placebo pills, so safe and ineffective that the stringent US FDA has allowed them to be sold in hundreds over-the-counter in all stores and pharmacy across US without a prescription. NRI children send them home in plenty, partly to please their parents, and partly get relieved of the guilt of not being able to spend time with them. I don’t believe that they do any good, but then how can I tarnish the image of the American frequent flier son?
‘you can take them if you wish’
The patient’s expression clearly shows that she still believes that the local Indian doctor is yet to be updated about the latest vitamins introduced abroad.
The poor doctor next door, incapable of getting a boarding pass to settle abroad, has lots of worry. A lighter file, a stronger confidence, a little respect for his time and an understanding that everything imported is not always good, is likely to help your doctor treat you better.
(Dr. Tiny Nair, MD, DM, FACC, FRCP(E) is Head, Dept. of Cardiology, PRS Hospital, Kerala and he can be reached at firstname.lastname@example.org )
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