The Consultation Room

Prof. Dr. CMK. Reddy

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

Chapter 76: Pandemic

There is no better example than Covid-19, which devastated the entire world and many healthcare workers (over 500 Doctors and 2,000 nurses) lost their lives in the process of carrying out their noble services to the victims. As much as it’s our ‘god-given’ duty, it’s more important to protect ourselves, by all means possible.

Since the morbidity and mortality of the pandemic is higher in elders and those with co-morbidities, many senior Doctors closed their offices and carry out only ‘on line’ consultations. However, attending to genuine or life threatening emergencies can’t be avoided by a conscientious Doctor.

Precautions such as, taking plenty of rest, doing regular exercises, eating healthy wholesome food, supplementation of micronutrients, wearing a face mask, frequent hand wash and maintaining social distance should not be difficult for any Doctor to practice. Using a face guard or personal protection equipment (PPE), setting up special isolation chamber to the Doctor in the office, while interviewing or examining the patients, offer additional safety.

Patients should be allowed observing full precautions into Doctor’s chamber,i.e., with full mask covering nose and mouth, both hands sanitized and infrared temperature screening of forehead. It’s better not to allow patients suspected (or diagnosed) to have Covid, into the Doctor’s room. Instead, an attendant may go in, to show the records and take instructions for further management of the patient.

Other option for additional safety to senior Doctors, is interviewing through video calls, fortunately such a facility now readily available with most of the patients. Of course, Doctor can’t do physical examination, but can ask his assistant or the referring Doctor, to discuss the findings and request for the relevant investigations, before arriving at the final conclusion and further management.

In any event, as a matter of precaution, senior Doctors and those with co-morbidities (obesity, diabetes, hypertension, ischemic heart disease, COPD, dyslipidemia, thrombophilic state, smoker, alcoholic, those with compromised liver or kidney functions) are advised to restrict the appointments for personal visits to bare minimum, to very essential or life saving situations.

Fortunately most of the viral infections, including Covid, can be prevented by appropriate vaccination. Though the safety of the vaccines available is a cause for concern, it’s advisable that senior doctors to get vaccinated, as we did for hepatitis-B, if they wish to resume active practice.

Our ancient scriptures and the present law of the land affirm, ‘nothing is above self’.

“I didn’t get to see the Doctor. The office closed before I finished filling out the ‘New Patient Forms’.”

Chapter 77: Details of attendant

It’s very useful to note down the name, occupation and contact number of the attendant, who accompanies the patient. During subsequent visits, you can appreciate the glow in their faces, if you address him (attendant) by his name. Not only they’d be impressed about your ‘memory power’, but feel very comfortable with the idea that you are trying to get close to the family.

It also helps you to decide at what ‘wave length’ you can communicate with them. Lastly, if he (attendant) is in some important position in a Govt office or an organization, he may be useful to you in some form or other, at some point of time (of course, if they’re satisfied with the care given to the patient by you).

Keeping in touch with the attendant is also very useful, if a critical development to the patient during treatment or after surgery has to be discussed. He will also give you moral support, if the ultimate outcome of your treatment is unfavorable.

Nurse answers phone, while doctor is examining a pretty girl with stethoscope. She says ‘Sorry, Doctor is busy on the other line’

Chapter 78: Indicate report to be mailed to patient

We have to innovate some procedure by which we don’t forget sending the reports to the patients, as promised. If the report is received next day or a few days after you had seen the patient, normally it would be brought to the notice of the Doctor, report entered in his record, but no one will remember that it had to be mailed to him, often causing embarrassment to the Doctor, when the patient points out during his next visit that he hadn’t received the reports.

It’s very useful to put some code or symbol ( I put ) in the area in the record, where the lab reports are usually entered, to draw their attention, that it had to be sent to the patient (or communicated in some form). Needless to say, the patient would be greatly elited to promptly receive the reports from the Doctor, with appropriate advice and develops full confidence in the foolproof system in your office.

If a reply to the referring Doctor was not given to the patient, when he was leaving the office, this is the best time to enclose that letter also in the same envelop, with instructions to deliver it to his Doctor, at the earliest. The date of mailing the letter should be recorded for two reasons : firstly it’d ensure that your staff did the job and secondly if the patient, during his next visit says he didn’t receive it, you can show him when it was mailed.

Doctor: Your liver is grossly enlarged. You have to quit drinking Alcoholic patient: Glad to know that. Now my liver can accommodate more alcohol’

Chapter 79: Remembering quotation

This is more relevant to patients undergoing surgery. Surgeon’s fees is bound to vary depending on the economic status of the patient and many other factors (such as if the patient is related to a Doctor or some important Govt servant or if the bills are paid by a third party or whether he is having adequate insurance cover etc).

Sometimes patient may report for surgery after a few days or weeks and the Doctor may not remember the earlier quotation given to the patient, leading to unwanted difference of opinion and argument.

Some patients (who may not be very honest) would deliberately make a wrong statement about the earlier quotation, for their advantage. To avoid such confusion, it’s better to indicate the quoted figure in a specified place in the patient’s record (may be coded), so that it can be remembered and resolved easily, in case of a dispute.

This also creates a positive impression in the patient’s mind that the Doctor always ‘sticks to his word’ and is ‘trust worthy’. If they are acting funny, sometimes I mention a higher figure than originally quoted, then they will reconcile to the correct amount.

Patient : ‘I’ve been suffering for several years, seen so many doctors, spent lot of money, but no one could relieve me. Finally I decided to commit suicide, then someone advised me to see you sir’

Chapter 80: Social media

This will help you to keep updated on various issues, during your busy professional preoccupations. It’s also very easy to pass on a message very fast (almost instantaneous) to a very large ‘like minded’ group, including pictures, obituaries, anecdotes, videos, conference notifications etc.

The facility to be able to talk ‘face-to-face’ with friends or relatives, especially with children, if they’re abroad, is a heart-warming feature of the modern video communication systems. Agreeably there are certain drawbacks in the present high-tech era, but if judiciously used, the benefits far outweigh the probable risk of abuse, since the scope of its applications in day to day life, is virtually unlimited and by and large free of cost.

It’s advisable not to post or forward any objectionable or offensive matter related to a public person, to avoid inviting legal proceedings. Also, in view of over crowding messages, we should avoid posting matters which have no news value, such as pictures of deities, flowers, sceneries, ‘good morning’, ‘happy weekend’ etc. otherwise we may miss useful messages, drowned under the plethora of such postings.

“I’m sorry – I’m a left-foot podiatrist”

The Consultation Room