Monday, April 25, 2011

There's more?!?

The intern in me is almost two months old right now. I’ve seen what seems like a buzzillion patients & it’s taken all that I thought I'd learnt from my practical exams pretty well into a shallow grave. Let me elaborate…
The first rule in a clinical exam is ‘Be thorough… or the examiner will be thorough with you!’. We got about 45 minutes with each patient& we spent every agonizing second asking, “What else?” This generally meant that our histories were long and arduous & there was always something jotted down on our sheets using which you can present the case differently to the examiner. That doesn’t mean we twisted the facts, just that we were thinking creatively.

Anyways, so I’m 2 months old now & one of the first things I’ve learnt not to ask is: “What else?” This statement is usually followed by an endless rant of nonspecific complaints that makes me wish I was studying abroad, because then I could add some anti-psychotics, anti-anxiety meds in their prescriptions & they’d take them without batting an eyelid! I’m not saying that there isn’t anything wrong with the patients, but some act like little sissy babies at times. “Doctor, I’ve had throat pain since last night”, “Sir, I have fever since this morning”; sounds familiar?

A large number are chronic malingering (Yes, I spelled that right, google it!) cases & yes, they need some psychiatric help. But, given that Indians regard most psychiatrists as “पागलों का डॉक्टर”, I’d doubt they’d follow through even if I could find them some help! Over the course of the past few weeks, I’ve realized some are even hoarding up medicines, selling unopened bottles out in the wild. Patients ‘classically’ come with ‘classical’ complaints & if they don’t see a pill they recognize, they brew up a storm!

The system is flawed because quite a few cases that legitimately require extra help are surrounded by a superfluous cloud of “symptoms”. One may argue that I’m being impolite or callous & am miserly with my skills. But, I have the perfect example to illustrate just how many patients don’t require much help:
Last week, I was handling a Gynac OPD with a dental intern. The front desk didn't what "Gynac" meant turned my cabin into a general female OPD. We started receiving a steady flow of patients with similar musculoskeletal complaints. Was around 4pm when the dental intern asked why my prescriptions were becoming so predictable. I just smiled as I was just about to start writing the prescription of a new patient complaining of abdominal discomfort. I’d already finished with all my relevant history when the following conversation took place.

Me: So, any other complaints that you may have?
Patient: No, none at all
Me: You’re 45 years old, no joint pains?
Patient: Yes, now that you mentioned it, I have knee pain
Me: Do you get an electric current like pain in your thigh or buttocks?
Patient: Yes, how’d you know?
Me: Any problem in moving your shoulder?
Patient: Yes, it hurts when I move it. Can you please give me something for that too?
Me (to dental intern): Can you please jot down the same prescription as my last one? I need to take a break.

Dramatic exit

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