© Dr. Rajas Deshpande
“Doc I have severe headache since last three days, with nausea, vomiting, and giddiness”. Young girl of 24. Recent break-up from first love, changed job. Completely normal physical examination. Accompanied with a caring new boyfriend. Both work in same software company. Simple, common problem. A few years ago, just a painkiller and symptomatic treatment for nausea / vomiting, reassuring the patient and sending home, advising rest would be sufficient. May be a mild antidepressant. Even today it is, in most cases.
Or is it?
“Take these medicines for a week, and show me again then. Take rest. Eat fresh, warm food. Avoid cold and sour”. A good doctor is half your grandma!
“But doctor, what is the exact cause?” Caring new boyfriend asked.
The game of shadows starts now. Honest answers wreak havoc.
“This primarily looks like stress related headache. There are over 150 types of headache, with still more precipitating agents. Like lack of sleep, dust, sinusitis, screen exposure, oral contraceptives etc. Sometimes there is no identifiable cause, there may be a combination of reasons”.
She asked her boyfriend to wait out, then asked “Doc I had taken birth control pills till three months ago. Is this related?”
“In some cases it may cause clotting in the brain, but you have no signs at present”.
“My father will call you today to ask about my headache from xxx city. Please don’t tell him about the contraceptive pills. Also, please don’t mention it to my friend who’s with me today.” She requested. I nodded in affirmation.
Her colleague joined us again, once I wrote her a prescription.
“But is it a brain tumor? Is it something dangerous like bleeding?” he asked.
“Very unlikely, given her normal examination.” Although I said this, a doctor is never 100% sure, having seen many cases where even mild headache turned out to be something dangerous or critical. Mostly there are examination findings, but not always.
“An MRI and few blood tests can answer that question in most cases, but we can wait for a few days in her case” I said.
“Can’t you say for sure without an MRI?” CNB.
“Only the external examination does not always tell everything. Most probably there’s nothing dangerous. You can start treatment, and if you have no relief, you can plan an MRI”. I sense an awkward restlessness.
“But till then nothing will go wrong na? Guaranteed?” patient.
“Most likely not, but I cannot guarantee. You can get admitted if you are worried. Headache may fluctuate, you may need extra doses of the painkiller” I state the facts.
Law has royally screwed the normal language of all doctors across the world!
“Ok we will wait. If she has any problem, I will call you”. CNB.
“Sorry, I may not be able to take calls always.” I hate my own rudeness, but my sleep hates me more.
“But what if the headache worsens?” Patient.
“Bring her to the casualty. Here’s the number”.
….© Dr. Rajas Deshpande
When simple reassurances like “You are ok, go home and take rest” are still legally liable, the options for the doctor to reassure a patient have become fewer. Now, even for a little suspicion and especially if the patient is “legally aggressive”, the doctor starts prescribing tests and medicines to protect himself / herself legally. Because law has renamed patient as a “customer”, every doctor must now treat them so.
Fever? Check for the dangerous causes. Head injury or headache? Get a scan. Chest pain? Get an angiogram.
One “father of sarcasm” patient once told me after a successful, life-saving angioplasty done by one Dr. KR, a heart specialist: “Dr. KR sees the patient only in cath lab, and I heard he scares everyone in doing a stenting / plasty”.
“If you knew it, why did you go to him?” I asked, “You should have gone to someone who treats without any tests, does not stent, and guarantees what you want” .
“Because Dr. KR is very good at his job, and I wanted the best for myself” said the FoS.
So you want the good doctor, best service and a guarantee at minimum price. You know that a doctor may want to investigate after physical check up. If not having faith, why go to a doctor? If having faith, why suspect? And if one wants to do away entirely with faith, and proceed only as per protocols, PLEASE say so, because in that case, you will accept either more tests or more risks. Just write it down, that you refuse all tests. It is often the doctors who actually advise LESS than prescribed tests as per scientific protocols to save patient’s money, please check medical sites about your condition.
Please don’t label the doctor bad because tests, procedures or surgery were required and you didn’t have money reserved for health. One always has a choice to NOT go to the doctor, to not do the tests, to not take medicines or do the surgery.
The “emotional-legal” exploitation of doctors where “faith, trust, humanity, ‘You are God’ etc.” words/phrases are used freely for convenience, and then legal guns are simultaneously wielded at any mistakes, should stop.
A good doctor never treats a patient as a ‘customer’ (Beg your forgiveness, Mylord!). A good patient should also never question the integrity of a doctor treating him / her.
Be either a truly ‘faithful patient’ of a good doctor, or a ‘customer’ of a so-called bad doctor. Be as moral, ethical, scientific, honest, kind-hearted, soft-spoken, and non-corrupt as you want your doctor to be.
© Dr. Rajas Deshpande
There is law above all, if the doctor makes a mistake, let the law take its course. When some patient threatens at the very beginning and the whole process of any interaction with the doctor has a legal attitude, there is no option for the doctor but to turn on his/ her guards. Loosetalk and judging will never achieve anything. Bad doctors are as common as bad people in our society, only lesser by ratio.