The Consultation Room

Prof. Dr. CMK. Reddy

General & Vascular Surgeon, Halsted Surgical Clinic, Chennai, Tamilnadu, India

Chapter 51: Doctor as patient

‘Doctors make worst patients’, but may not apply to all. Medical etiquette dictates that an early appointment be given to a Doctor or at a time convenient to him, if possible. As a matter of courtesy to a fellow practitioner, he may be called in as early as possible, keeping the waiting time to minimum. Similar privilege may be extended to a Doctor, if he is accompanying a patient, who may or may not be related to him.

If a Doctor (or any VIP) brings a patient to you for consultation, it’d be nice to pass a remark to the patient, ‘Dr/Mr._______ is such a busy person, how did you manage to bring him along with you?’. This will be appreciated by the Doctor as a compliment, about his involvement with his patients. It’s quite in order that we don’t accept consultation fees from a Doctor or his dependents. All possible concession may be arranged for him in carrying out investigations or surgery, if required, especially for professional services.

One Doctor remarked in a lighter vain, when his colleague offered to pay him the consultation fees for seeing his wife, “dog eats all kinds of flesh, but not dog’s flesh”. Being a medical person, counseling a Doctor is easy and technical pros and cons of various options in the treatment may be frankly discussed.

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Chapter 52: VIP as patient

VIPs demand early appointment and ‘zero’ waiting in reception hall, when they want to see a senior consultant. It’s sensible to respect their ego and cooperate as much as we can, because of two reasons.

Firstly, when a VIP visits as a patient, the value of the Doctor goes up in public eyes. This is true also with other legendaries in film field, sports etc.

Secondly, no one can predict, when he suddenly becomes a very influential person in politics or government and may be useful to you at some point of time.

It’s also wise business that we don’t expect consultation fees from this group. Certain amount of maturity and balance of mind is needed to treat a VIP, like any other patient and not to be tempted to create a ‘VIP syndrome’.

The-Consultation-Room-2“Good News. Your cholesterol has stayed the same, but the research findings have changed.”

Chapter 53: Your relative as patient

You may know him well, may be studied together or might have helped you in some way, during your early days. They may rightfully expect and deserve some special attention and concessions in various services such as labs, scans or for surgery, if they’re required.

Your helpful nature, beyond the call of duty, will definitely be appreciated and publicized at appropriate gatherings, indirectly boosting your image among your close relatives and friends. The similar courtesies, may be more, have to be extended if your teacher (in school or college) or his dependents, come to you for medical help, not forgetting the ‘ladder’ on which we climbed and reached the present position.

More than honoring them, it reflects on our culture to acknowledge their services and to utilize the opportunity to invoke their blessings, by touching their feet.

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A senior doctor asks a young lady to go into the exam cubicle. When she hesitates and requests if her husband could come with her, he remarked, ‘Don’t you trust me? You know me for so long’.

She says, ‘No, no, I have full faith in you, but I don’t trust my husband alone outside, with the good-looking Receptionist’

Chapter 54: Documentation

Maintaining patients’ records is very important and has several advantages. Firstly, very often patients don’t bring their old records, when they come for review. Having their records with us is a big help to proceed further.

Secondly, patients develop emotional attachment with you, since they feel that you have all their records.

Thirdly, when any of your patients calls you or writes to you for some clarification, we can give them ‘intelligent’ reply, if we can peruse their records.

Fourth point is for legal or insurance purposes. You may get a letter from a lawyer or an insurance company asking for some details of the diagnosis/treatment given to a patient, whom you treated some time (or even years) ago.

You can give an authentic reply with all the dates and what was his condition when seen last, only if you have the old records of the patient for reference. Later on you may be even summoned by the Court to give expert evidence, to help disposing the case.

As long as they are readily retrievable, you may choose any form of records that is suitable to your set up, it may be as Cardex system, in the form of a file or computerization. The former two requires manual retrieval, may be time consuming and occasionally unsuccessful, because of the large number of patients with similar name.

Though it’s the best, computerization has some problems; cost of installation & maintenance, skilled manpower requirement and possibility of data corruption or ‘virus’ infection. Other problem with the computers is unless you key the exact spelling, it will not oblige you. For example, name Satagopan may also be spelled as sadagopan, sadakopan, satakopan, sadhagopan, shatagopan, satagoban, sadagoban and so on, posing problem to retrieval.

This may not be cost effective for smaller establishments. When we use retrieval by manual mode, those staff can by utilized for many other purposes, during other times. Taking photographs (of course with the permission of the patient, especially if the face is shown) and preserving them in the patients records, may be useful in areas like cosmetic or reconstructive surgery, hair transplantation, limb gangrene (before amputation) or orthopedic correction of deformities, for future comparison.

A simple card we deviced and found very useful, explaining the various check lists and codes, is shown below. If the patient has undergone surgery, salient details are entered in the card by the Doctor himself, obviating the need to peruse the discharge summary at every visit. (Size of the Card is 135mm x 115mm).

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Chapter 55: Prescription by phone

It’s also advisable not to prescribe medicines on phone, more so, if the Doctor had not seen the patient recently. In an urgent situation or for a patient, who was recently seen by you, prescription by SMS, WhatsApp or E-mail may be safer and foolproof, till the patient is able to see a Doctor.

Unfortunately, during the pandemic situation, since we are unable to see many patients directly, we are forced to send telephonic prescriptions to them, even for ‘routine’ ailments. Of course, the patient should be advised to see you or some other Doctor, if the he had not improved with the treatment suggested by you within a specified time, for further evaluation.

Patient may also call you for some clarification in the prescription or a particular drug prescribed, not available or for some drug ‘reaction’. If a drug is not available, it’s best to ask the patient to call you from the pharmacy, so that you could talk to the pharmacist directly and suggest a suitable available substitute.

If a postop patient calls you for a stitch abscess or wound infection, you may ask him send a picture, so that proper advice can be given.

If the combination drug you prescribed, is not available, you may ask the pharmacist to give both the ingredients separately and advise the patient accordingly. The subject of drug reaction is discussed elsewhere.

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Patient: Dr What happens after we die?

Doctor: hmm we clean the bed and admit a new patient.

Note: Don’t ask your doctor philosophical questions

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