© Dr. Rajas Deshpande
An old man of 82 was admitted in London ON once with stroke during his “regular” morning lovemaking with his contemporary wife. An accurate history and onset time is necessary so we can use a clot buster injection within 4 hours of onset. He qualified and eventually recovered too.
I was amazed at the calm, expressionless responses but courteous attitude with which everyone in the staff treated him there, the couple was never embarrassed by any of the staff or doctors. Upon discharge, the patient asked Dr. H, an authority in the world of stroke, with a cute wink if he could continue his “Morning routine”.
A smiling and about twenty years younger Dr. H replied he could, so long as he took the prescribed medicines, and joked with a return wink that he (Dr. H) envied the patient, making the patient smile!
A twenty two year old unmarried female student came for suspected Multiple Sclerosis once. “I smoke grass (marijuana) for recreation, doc. I also take oral contraceptives often. Does this affect my illness?”. Both her parents sat there without any change of expression, and did not interfere at all with any part of the consult. I couldn’t help remembering the contrast panic and beating up by parents in some of my Indian college mates I knew, whose only fault was stealing a cigarette from their Father’s pack! Also the whole-family-humiliation-screw meeting in which the traditional family-nerds irritatingly shine!
In India, people seldom relate correct history for the shame attached to it. I have witnessed some very embarrassing moments, when doctors (especially junior) openly, loudly ask sexual / urinary history or addiction details to the awkward patient, while their colleagues exchange blushed, meaningful and pregnant glances. This is an obvious turn-off, and whether it is sex, sphincters, alcohol or smoking, no patient likes “Open Questioning” about this without adequate privacy. Then too, people talk only if respectful dignity is offered by the doctor. One must ensure such privacy, but never miss to address this issue out of shame or embarrassment. A history of STD or HIV risk must be asked where important, with relevant but properly formed questions, without a condescending tone. Many doctors half the age of patients actually humiliate the patient in a hope to make him / her quit alcohol / tobacco / smoking. Such patients are irreversibly hurt by open humiliation, and this should best be left to professional / experienced counselors.
This is also why many patients (especially the older, less educated, depressed) who have had heart attacks, spinal cord problems, accidents, strokes etc. hesitate to ask a “Loud Doctor in Hurry” about physical relations and addictions. Some refrain from normal life out of unnecessary fear, which may contribute to their depression. If the patient feels embarrassed or awkward, it is the doctor’s job to reassure and address these issues. A pre-discharge counselling meeting is essential. Fortunately the younger and educated generations even in India are now quite open and frankly ask their doubts without feeling “unnecessarily” guilty.
Actually, every patient, rich or poor, deserves privacy for any health discussion. It is a sick scene to see patients in a queue in most govt. / municipal hospitals having to openly answer such questions in absence of proper space. Overworked and authorityless doctors are helpless here.
My internship days.
A civil surgeon (administrative post) took what we call “Babaji Rounds”: smiling, hand-waving rounds just to ‘show’ the patients that “I am the boss”, talking sweet to every patient and firing everyone among staff. Administrative rounds like these are medically useless, but some depressed patients feel good, and some good administrators correct the service deficiencies.
One thin built religious leader was admitted with acute shutdown/ failure of kidneys. No urine output. Blood pressure very high, we struggled to control it. When the CS came to his bed, the worried wife asked: “Sir, what should I give him to eat?
The CS beamed a big angelic laugh, patted on the back of patient and said aloud “Anything he wants.. icecream, fruit juices, milkshakes..”.
“Samosa?” asked the lady..
“Yes sure”, said the CS and told the patient: “Eat more if you want to get better soon”.
The patient touched his feet and said “You are like God Doctorsaab, my illness is half better just by seeing you”.
That diet would have killed that patient, had not our fuming medicine professor (after a caste based solid expletive for the CS) asked me to rush back and stop the excited wife from feeding all that to the patient!
The CS didn’t even know the condition, diagnosis, or other details. He never wrote anything on paper (Capital or Small in verbal instructions??), but could have severely damaged patient’s health, just by his careless advice under pretension of knowing what he didn’t.
Many unqualified people / quacks/ and some qualified doctors too advise via verbal instructions trivially. Patients blindly follow these instructions. Right from “Shudh Desi Ghee (Clarified Butter)” to herbals!
This is equally or far more dangerous than bad handwriting of a good doctor.
Advice about food, exercise, sex, work, posture, sleep, physiotherapy and lifestyle are all parts of the consult, equally important as the medicines. A good doctor’s routine will include this advice for every patient. Patients should also consult a specialist for their illness at least once in the initial stage, so he / she can plan out long term holistic plan and the regular general / family practitioner can follow it up.
Some patients take advantage and ask the same things repeatedly. In a busy clinic, a personalised printed advice can be given. In a crowded OPD, as in charity and govt. hospitals, a “general instructions for a disease” booklet will go a long way, or special group counselling can be advised.
Things are changing. Many newer generation doctors are making good friends with patients especially from their own age groups. Fortunately, even the youngest doctors still do not use colloquial phrases like “Aish Karo” (Enjoy to the hilt), otherwise some perfectionist patients may really follow it to the core!
Because “Chalte- Chalte” / hurried advice, however trivial, may prove dangerous.
© Dr. Rajas Deshpande