The Medical Court Martial and the Punishment
(c) Dr. Rajas Deshpande
“What is the exact diagnosis?” the patient, Mr. Abhishek asked.
In his early thirties and succesful, Abhishek was anxious too. I told him that his looked like a stress headache, migraine was a possibility, the tests I had told him would help us rule out other possibilities. There is no lab test for confirming the diagnosis of migraine.
“What is each one of these medicines for?” Abhishek asked. That the doctor had an experience equalling his total age had nothing to do with his right to ask questions. He was buying the doctor’s services after all! For a moment I wished I was not a doctor, that I could tell people off by snubbing them, that I could rudely decline to reply to questions that were against common sense. But then I reminded myself: that I did not have this liberty. I must face the court martial of a doctor, a chosen punishment, every time I see a patient.
“Sir, you have told me you had a headache. These medicines are for headache” I replied, smiling.
“Is it necessary?”he asked.
“No”. I said., “As a doctor I have only three options: prescribe you medicine which I did, recommend a surgery which is not applicable in your case, or suggesst you a non-medicine path like lifestyle change” I replied. Practice makes one patient too.
“Are these steroids or antibiotics?” his wife asked.
“No” I replied, and thanked God that they believed me here and did not ask for proofs.
“Are these tests necessary?” Abhishek.
I told him the pros and cons of doing the tests, and reassured that it was not an emergency. Even if they did not trust me, I had to do them good. That’s the duty of a doctor.
“What lifestyle changes do you suggest?” he asked.
“Ensure 8 hours of sleep every day, give up cellphone use after evening, reduce screen exposure to less than three hours at a stretch, maximum eight hours. Eat fresh and healthy home cooked food three times, and eliminate fast food. Resolve relationship and work stress issues. Reduce weight by consulting a qualified dietician. Start exercising.” I told him. This simple formula for a healthy life is mostly possible for the poorest of the poor illiterates, but impossible for the educated affluent! What a paradox!
“Impossible, doc! Tell me something practical. My work needs me to use screen and cellphone over 12 hours a day. I mostly work at night, I have to use fast food or tiffins. My wife also works, she has stress of her own, we haven’t had time to even have children yet! There’s no energy left for any exercise when I return” . Abhishek was genuinely frustrated with his schedule without even knowing it.
“Then Sir, please take the medicines as prescribed, and gradually make changes that eliminate stress. Please do these tests especially if you do not have relief in next two-three days” I thought it will be over now.
I was so incorrect!
“Do these medicines have any side effects?” his wife asked.
“Yes, all medicines have side effects, these are the ones with least side effects for your condition” I started getting faster and shorter with my replies now.
“What if he develops any side effects? Can we call you on your personal number?”
How could I tell them that every doctor prescribed over 100 different medicines every day and all of them could have some side effect or other, minor or major, and that if everyone kept calling for each side effect, the doctor won’t be able to practice!
“Usually side effects are not seen with these medicines. If you have any allergic reaction, please stop these and report to the nearest doctor or hospital. I may not be reachable always” I wondered what people did before the cellphone era: how happy the doctors then must have been!
They appeared partially satisfied and left. My court martial in this case was over. “Only twenty more court martials remaining for today!!” I reassured myself.
After about two weeks, I received a call from the casualty. Abhishek was admitted in an unconscious condition. His wife was in a state of shock.
“What happened?” I asked her.
“Doc, sorry, but he did not want to take any medicine with side effects. So we went to someone who gives a herbal medicine without side effects, made at home. We took it for about five days. The headache improved first, then went on worsening. Then Abhishek had a lot of vomiting and did not eat anything for three days. Today he got up and collapsed while taking a bath”.
“Did you ask the person what was the content of his potion?” I asked while examining an unconscious Abhishek.
“No doctor, he says it was his own invention, a secret” she replied.
Abhishek was paralysed on the right side. His MRI showed many blood clots due to dehydration and a small bleeding on the left side of the brain. This is called cerebral venous thrombosis.
Many people who go on prolonged fasting, drink less water, overexert without enough hydration develop clots in the veins of the brain as their blood becomes thick. Some diseases of the blood and some medicines like hormonal preparations, alcohol, contraceptives etc. (even herbal) can exaggerate this tendency. This is a major cause of clotting, bleeding and swelling in the brain, resulting in paralysis or even death. One should never make sudden changes in diet without consulting a qualified expert.
We admitted Abhishek in the ICU. He gradually recovered over few weeks, but his speech remained patially slurred. His company ruthlessly fired him, they did not care how dedicated he was to them. The most fortunate thing was that he retained his intellect, memory and ability to move. The couple has now changed their lifestyle and are far happier although not richer. He is off all medicines now.
Almost every doctor bears the punishment for the few who overprescribe and overinvestigate: a trustless court martial, bitterness and allegations by not only educated but even totally uneducated patients. A doctor must be compassionate and kind, but the limits to how many unnecessary questions he should patiently reply to remains a dilemma.
This daily court martial of doctors must end. The doctor’s consultation time and peace of mind is as much important for the next patient as for himself. Newer generation doctors should also be taught to politely deal with such situations.
A polite reminder to ask only relevant questions, to book another appointment for more time is justified in such cases. The society should understand and accept that a qualified doctor has repeatedly proven his merit, acumen, ability and correctness before being allowed to practice.
Unlike the many we vote for.
(c) Dr. Rajas Deshpande
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