Nothing Routine About It

Ok, so I worked tirelessly in my I.Med rotation & it still wasn't enough to finish off all my blood work in time. If I wasn't sending the samples, I was busy procuring bulbs, tubes, bottles & media to send them in! The dreaded "Trolley System" is enough to strike a fear into any intern's heart. For those who don't know, the labs send faceless, nameless & humorless drones with elaborate trolleys neatly marked, into wards at set times during the day to whisk away samples. Time & the trolley men wait for no one! I've had quite a few productive runs tracing the trolley men up and down elevators before they disappeared into their secret passageways.

Image Source

While I couldn't really blame my professors and senior residents for demanding a lot of investigations in I.Med, I can't say the same about surgeons. Ever heard the old adage, "Physicians know everything and do nothing, Surgeons know nothing and do everything"? There're so few things a physician can do, that I think they keep ordering crap for interns to get done because they feel an HRCT for a cold could reveal bronchiectasis! Surgeons on the other hand shouldn't need that many investigations, at least that's what my logic told me. So, last month, either my logic failed or my luck did. The unit where I was posted decided it would be great if they could conjure up not one, but two "All-routine" days every week. These were days of joy, laughter & melancholy where I would have to send each & every damn patient's CBC, renal & liver function tests, FBS & PLBS! Ah, what fun! It didn't matter if the patient was a comatose case of polytrauma, or if he just had an abscess drained. The non-discriminatory intern would swoop to their hematological rescue. 

Over time, I grew quite tired of the entire "All Routine" routine, more so with the explanations I had to give patients. They were obviously not willing to give blood for no good reason so often & half my time went in counselling them. Some I could have a good laugh with, others I had to be a tad serious around. There was this one particular chap, who was quite paranoid. Every time he would come up with a new excuse like giddiness, pain in the arms, feeling just about ok & sometimes he wouldn't even grace me with an excuse. On my last day, all I could muster was, "You know what? This hospital pays me crap. How am I supposed to make money on the side if I don't sell blood?" 

In Sickness & In Health

I am a good doctor. I give my patients enough time to understand their complaints. When I feel my skills fall short, I readily refer them to a specialist. 

I am a good doctor. I give it my all to counsel my patients when they feel the world & their health is against them. I try hard to to get to the root cause of their complaints; even if it means I must dig myself a hole. 

I am a good doctor. I do not ask why they made a particular mistake; nor do I make them feel guilty about their present state. I am not their mother. I merely help & heal, that is what I am here for. 

I am a good doctor. I wake up at odd hours in the night for any complaint, ranging from life-threatening heart attacks to an itching finger. I do not discriminate against complaints.  I am like Sauron from Lord of the Rings, I see everyone & everything.

I am a good doctor. I do not complain about my workload to my patients, they have enough worries as it is. But when I'm in the middle of a 200+ clinic, without much help, at my wit's end with so many patients, and someone comes in to just say they're feeling "healthy & alright" after their meds... I am not a good doctor. I'd like to refer them to Surgery instead

HTMKK

Nobody likes a faker! Not one bit! Not in bed, not at the workplace, unless those two happen to coincide. What's the most irritating part of a faker? That they continue to "act out" even when they've been "found out". They will just refuse to give up; talking about a good-for-nothing idiot persevering (wrong place, wrong time)! But, what angers me most is that I can't label my patients - Fakers. It seems someone came up with a cool term - Malingering. So, I'll have to run with that since using outdated terminology is frowned upon in medical circles. Look at what happened to the Ayurvedic doctor who said he was practicing Voodoo! 

<Image Source>

There're a lot of malingering patients I see regularly, we call them "chronic cases", we know their entire past medical history, family history, bowel time-table & even what they had for dinner last night, simply because we see them "chronically", at times more often than I see my family. Their papers read like the what's what in medical symptoms. Not a single organ system is missed, there're always gonna be multiple complaints & usually they come back within a day, "because the meds don't work".

Modern medicine has thrown in everything to try to describe this "condition". They deem it to be a serious disorder that "handicaps" a large section of the population. I, being the young medical marvel that I am, see it for what it is. I don't go around labeling patients, "Systemic Candidiasis Syndrome", "Fibromyalgia", "Chronic Fatigue Syndrome" or some other Voodoo, sorry, ayurvedic crap like that! Sometimes, a pussy is just a pussy! Surprised?

You can't show up in my clinic every other day with tingling & aches & a general feeling of unwell and have the balls to demand a diagnosis. I've run my tests, I've given you a head-to-toe examination, & yet, you have the nerve to question my medical knowledge? I've filled out your entire case history, written out the prescription for body pain & THEN, you remember you've got chest pain? Guess what? Fakers often tend to forget which symptom is to be given top priority, they're not too bright. They heave when they see me, but when they're with the nurses, their breathing normalizes. They come with a BP of 140/90 & say they have "Chronic Low BP". You know what? I should probably just immortalize my name in medical textbooks by creating criteria for a new condition "Pseudo-hypotensive hypertension syndrome". First 100 doctors to make that diagnosis will get a 1000 referrals & a pen from me!

To all these people who have the tolerance level of a fish outta water, watch the next video & Harden The Fuck Up (courtesy of MDOD): 

I have an old friend, extremely laid back & couldn't care less about any damning news you may have to give him. He came up with HTMKK, short for "Haan, to main kya karu?" for whenever someone shares some shitty info he doesn't give a crap about. For those not fluent in Hindi, its literal translation is, "So, what I am supposed to do"; But, when used correctly, it means, "I don't really give a fuck!"

So, don't be surprised to see FSD, HTFU, & HTMKK on your prescription the next time you see your doc

Quick! To the Laboratory, I've got Magic Hands!!

Me: So, how're you feeling today?
Patient: Doc, I've got this irritating cough & nasty high fever which just refuses to go down.
(I feel the patient's forehead & arm, definitely not running a fever)
Patient: (within a second) Seriously, I think it must've just gone down just now
Me: (mentally slapping forehead)

Eons ago, when I hadn't ruptured my internship's metaphorical hymen, I never really bothered with such patients. There was nothing I could do but take what they said at face value & move on. But, as time wore on, I kept noticing a pattern. I was the only person who kept seeing these patients. And according to ALL of them, "My fever JUST subsided".

This kept me awake at nights, wondering what it was that made my patients seem spontaneously healthy in my presence. I asked myself a lot of questions:

• Is my skin insensitive to high temperatures?
• Am I running a temperature, so I can't figure out if someone else is?
• Is there a Higher power at play?
• Am I exuding some sort of magic pheramone that makes people alright?

The first just wasn't possible, I had myself tested. Ditto for the second one too. I even asked God why he was playing tricks with me; I did not get an answer *cough typical cough*. What does that leave then? Magic Hands? Of course, that must be true! Off to the lab, I dare say... Let's take some biopsies, run a battery of tests, hook me up to monitors all day long, draw some blood, urine, stool, saliva, semen even. Run me dry! Bring me a slew of fever patients, let me cure them all. Perhaps I should start to grow a beard, wear a turban & be named "Fever Baba" instead. No wait... that's too primitive! I'll call myself Dr.Paracetamol™ ! I'll even trademark my name! Doesn't that sound like a plan?

What's the other option? Saying my patients are lying, that they're cases of Fibro or FSD? How dare you?!?

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