Tag Archives: Headache

“Is The Diagnosis Wrong, Doctor?”

“Is The Diagnosis Wrong, Doctor?”
© Dr. Rajas Deshpande

“Doctor, there is no improvement at all” said the angry husband, throwing the case-file upon my table.

Well this is not an extraordinary sentence for any doctor, one must be prepared to openly deal with this. I had been quite polite and well mannered with them, there was no reason he had to cross that line. I could understand though. When they pay my fees, they expect some result or satisfaction.

While teaching my students, I have always insisted that if the patient / relative says that there is no improvement or change with the prescribed medicine, one must first consider the possibility of a wrong diagnosis, a missed condition or a misinterpreted finding. Doctors are humans, and do commit mistakes, or misinterpret findings. This is normal, and happens with every doctor. Medicine is far more complicated than most people think they know. A good doctor knows this and learns, while all the time keeping patients safe, but a doctor with ego kills his own practice, and may cause harm to the patient.

I asked them to sit down and reassessed the case in detail. A 28 years old female. Headache, giddiness, imbalance, palpitations, breathlessness. Lack of sleep and bouts of crying. Past and family medical history not contributory. Physical examination completely normal. MRI of brain normal, Vitamin B12 and D levels low. I had started vitamin supplements, anti-anxiety medicines and an SOS for headache.

She told me all her earlier complaints had improved, but now she had a severe backache. I told the patient that I was trying my best to understand her condition, and to resolve her problem, but her findings and complaints didn’t match. She looked at her husband, and asked him “May I speak frankly to the doctor?”.

Openly agitated, the husband sarcastically offered to wait outside if she needed privacy. However he stood glued to the chair as if he knew her answer. © Dr. Rajas Deshpande

The patient thought for a moment, told him it’s ok he can wait inside, then started to talk. She revealed that she was the only child of her affluent parents, had passed engineering, but now had to quit job and stay at home to raise children. They lived in an extended family, with grand in-laws, in laws and an elder brother, his wife and two children. This patient was the ‘last in the line’ to take orders, all others being senior to her. Her husband and in-laws were perfectionists, and she was tired of their continuous expectations. She had dreamed of making a career too, wanted some free time outside home for herself, but year after year, she didn’t get even a minute for herself. She was tired of it all and there seemed no respite. © Dr. Rajas Deshpande

“I am not averse to hard work, but the continuously condescending and fault-finding attitude makes me feel that I am useless”, she said, and added cautiously: “We were in the same institute and my ranks were always better than him. Look at where I am now” she started crying.

I offered them water and coffee, and waited for her to settle down. The husband became restless and defensive, but his tone was far lower. “I understand her problem, doctor, but what can I do? I cannot leave my family. My work pressures are quite high too, the IT industry is going through a bad phase”.

“I can assure you that she has no neurological problem now’ I replied, “she should improve with lifestyle changes, counseling for the family, and adequate free time for herself. I will refer you to a good counselor” I told them.

The husband laughed. “I can understand, but my parents will not. We will see what best we can do for her”. A bitter tone in his voice didn’t escape me.

‘Sir, she told us what bothered her, and must not be held guilty for trying to speak her mind. It will only help identify and treat the problem better. Please see a counselor together and avoid discussing this at home right now” I requested the husband. © Dr. Rajas Deshpande

There are many reasons why a patient does not improve. Untreatable medical conditions, depression, seeing the wrong specialist are the most common reasons, but there also are patients who want medical leave,those who want to avoid work, who want attention, so will keep on complaining of false symptoms. They do not improve with drug treatment.
On the other hand there are many who keep on taking the wrong medicines for years, those who self-medicate, do atrocious / injudicious dieting and exercises, yoga that doesn’t suit them, and do not follow the doctor’s instructions about abstinence, who keep on indulging salt, sweet, oil, alcohol, tobacco and other drugs freely available in India. © Dr. Rajas Deshpande

A doctor remains a lifelong medical student. A doctor who thinks he / she is always correct is most dangerous. It is not uncommon to meet doctors who are angry / upset with the patient / colleagues when their diagnosis, treatment is questioned. The first thought of a doctor when the patient does not respond positively should be to consider a misdiagnosis, reevaluate the case in more detail, reassure the patient, and obtain a second opinion if necessary. All this done, one must look into other possibilities, with an approach to resolve the issue rather than trying to shove down the patient’s throat their own faults.
We all go through bad patches in life, doctors and patients. If the child is wrong, the parents correct them still with love. A doctor’s attitude should be similar, with due care to also protect themselves. If not the doctor, who will understand the patient whose family refuses to understand them? In so many ways, especially in the Indian society, the doctor must don the role of an elder brother/ sister. Although patronising is legally discouraged in medical practice, and should be refrained from in cases where trust is questionable, one can make exceptions for some cases that need reassurance where the family fails to do so.

The nobility of our profession also lies in reassuring the patients that they are well cared for by their doctor, through the thick and thin of their life.
© Dr. Rajas Deshpande

Please Share Unedited.

Cure This Headache

Cure This Headache
© Dr. Rajas Deshpande
This young woman in early thirties complained of severe headaches. She was accompanied by a caring but frustrated husband, and two sweet kids. One withdrawn and cranky while the other one was hyperactive.
“These headaches started only after shifting to this city 5 years ago” she said. They were from a state far away.
“I am usually fine on holidays, but on almost all other days I wake up feeling sick, without energy, and even a small factor like bright light, loud noise or reading brings on the headache. It then becomes so severe that I have to sleep or take pain killers. I can’t sleep every day, so I take this painkiller daily. Even small stress at work makes me very irritable, and when I return home I have no energy left to do anything. We have started fighting a lot” she said looking at her husband with wet eyes. “I know he is tired of my headaches, but what can I do? We have seen so many doctors in so many places”.
“She used to be very happy when we married, doc” said the husband, “I feel this is a totally different girl now. I do everything I can to help her, but I have work pressure too”.
Nuclear family. Both working 6/7 days. Both on highly responsible posts. Long hours. Changing shifts too.  Kids attended by maids when not in a day care. Their parents on both sides far away.  They have had two kids with a very short interval between them, so their “growing up” is almost together.
“Is it possible that one of you change the job?” I ask this very cautiously, almost knowing the answer.
“No, Doc, our current jobs have excellent prospects and incomes too” said the husband.
“Can you change the timings, so you get an hour ‘s rest without having to attend any tasks?”
“I can’t change the timing. I don’t think I am stressed.  My husband helps me a lot by cooking and looking after the kids. It’s a daily affair now. If these headaches are gone, I will be all right”.
The caring husband who was until now attending both the kids, especially the hyperactive one, said “I have suggested her that she can take a break, but she wants to continue as she thinks she will get bored at home”. He threatened the hyperactive one, now climbing upon my table, with his hand.
I explain that the habit of taking painkillers may itself be worsening the headaches, in addition to the “dual” stress at work and home. All said and done, a woman usually attends two jobs when she works. I also enquired if they can have their parents stay with them alternately, so things will be better arranged at home.
“They don’t get along well with us, doc. My parents irk him and I don’t get along well with his parents too. We have had a love marriage”.
“Sometimes I feel like ending my life” she started crying.
Her examination was completely normal.
As I wrote the notes, I wondered how many of these things were correctable. Nobody wants “Gyaan /Philosophy” or counselling. No amount of medicines were going to take away the basic problem: lifestyle without rest or peace, and no time for love. What happens to a relationship where there is no more “Gelling”of the husband and wife, of parents and kids because they don’t get time to be together?
One of my Yoga teachers, Mr. Mohandas (at the Kaivalyadham Center on Marine Drive Mumbai) always told me: When you mix the “sample curd” and milk, it will not all become curd immediately. It has to stand for some time before the mixture forms new curd. Any relationship that has to mature into something meaningful will require quality time spent together, both with and without the kids. This time has to be separate from merely eating or sleeping together, or travelling for work.
Fast friends who fall in love and marry end up in tangled fights after becoming too busy, sucked up in the work and family routine so much that they become strangers again. Everything for a good life is at their footstep, but life itself has taken a vacation for lack of time. Bodies change, and so do minds. Too much company becomes an irritating nag. Need for personal space is disputed if at all recognised. Meditation is not truly possible when chores keep knocking your door.
As I advised her some medicines and Yoga, I could not help but suggest her that they both need to rearrange priorities in life.
It is not my place and these are not the times that one can “politically correctly” suggest the right options: but kids growing up neglected because both parents are either working or tired when at home is certainly not a healthy option. Lifestyle choices should not take childhoods for granted.
In Canada, they have a law: that one must have one separate bedroom for each kid above three years.
In India, we desperately need this: that at least one parent / grandparent must spend few dedicated hours with kids every day, quality time without being exhausted or irritable.
I wished the mother well via my prescription, but my heart was with those two kids.
For what those two kids were unknowingly suffering is beyond our society’s conscience to deal with, and maturity to logically talk about.
© Dr. Rajas Deshpande