When Dr Rao mentioned my name,amidst ' hot'discussions , I am a bit surprised . Then it occurred to my nindthat iti's just one of those toutine referrals to a skin specialist ,as the theme involves " saving (one's) SKIN " ! I am yet to see , a 'coin with one side ' - "Do you.. ?" . ' A simpleton lady visited once a govt hospital and was mistakenly marked for ENT OPD. The foc, with his head gear light on , straightawy asked her to open her mouth, utter some sounds , as he thrusted differrent mirrors into her mouth , scribbled ' a presription' and said ( impationtly) NEXT !. The bewildered lady , had this surmise to make... "How advanced is the science !" " The doc diagnosed (!) a complint ' down below ' by looking ' up above' !. Sounds as exaggeration ? To me too.... .Yet the feeling is that there is ' lurking truth ' somewhere 'down the story lane.' My driver once told that when he went to take an appointment from an orthopedecian known to him regarding back ache of his wife , he was asked to bring her along with an MRI scan done' ! Worse still is that he complied with when the doc decared ' nothing wrong with her back' and prescribed rest for want ofwhich only she got the ache.! ' Were we not treating ailments ere the CTs and MRIs '@ made in roads into owr daily practice ?' Where did the clinical skills tought so laboriously go ? Honestly how many busy doctors spend time to arrive at atleast DD for an ailment? CTs And MRIs made docs ' lazy' ! I am not talking of the honest participents here- I am talking about those whom every ne of us surely have enough to show an accusing finger at. It must not however be forgotten that ' when u point one finger against somebody, the rest of the fingers are pointing towards u.! Why consumer act has come into force ? Is it not growing awreness of ' consumerism' ? Initially, the docs thought that it is ' others' who indulge in malpractices. Their dreams were belied when despite ' hue and crys' docs were brought uder the act ' ispite of their noble profession ' ! .... But why.. ? " The black sheep" amogest ourselves.! " Don't like it.. ? But 'the proof of pudding is in eating.' There r so many laws around, do they scare us ?. Nay.. ' because we are ' honest citizens ' !. Then why fear this law' if u 'continue to be honest'. I know ur prompt answer- ' The growing litigants and vandalism anong pts.' . " Honesty should be not only there , " but it should appear to be there " !. Do we care to discusfreelyte pros and cons of the suspected diseasewith the pts? Do weconvince ' the absolute necessity ' of a costly investigation and their written consent b 4 the same ? " A convinced and consented pt never complains. ". U may argue that it it is only ' half truth '. There is a remedy still which we don't care to follow ' despite the big talk we make about it. It is good documentation and full justification on paper b 4 any procedure or investigation is done. If u say all does this , ' it is the biggest lie on the earth '. See busy docs papers. They never write full observations made them not to put a probable diagnosis. ' They r conscious of their reputation which prevents them from making any ' commitment to a provisional diagnosis'...or is it because they r not sure of themselves..? Or are they callous not to do what lesser docs do ?. Good documentation, full justification, frank apraisal of the situation to the pts, taking pts into confidence, using our best discretion b 4 rushing to costly and avoidable investigafions, why should we ' cry wolf ' at the consumer law ? Ponder over this and u r sure to come out of the ' phantom fears ' about the consumer law. This is a fact known to all but ' the problem is that we refuse to see the resaon ' out of ' fright and flight reaction ' to an imaginary disaster , ' that could be averted even if it happens at all. " Don't like the post ? No problem... ' It is to my liking. '.
Ethics have been changed now a days due to consumer protection act. As per medical ethics are concerned remotely indicated investigations are not at all justifiable... but society and CPA compells us to fallow the changed ethics.... Very unfortunate!!!!
Violence against doctors and healthcare providers in India has been on the rise in recent years. Doctors, nurses and paramedics are today putting their lives at risk in the course of duty because they are susceptible to verbal and physical assault from patients and their relatives
I agree with dr s shinde Ethics. Standards ..principles all change their values with change of time..the value of 1000 rupees 10-15 yr back is now equivalent to 100 rupees now..previously getting TLC dlc and urine was sufficient.. But now with change of time it has become standard to get tested hep b hep c hiv Even today pt z expectation of standards is diff from rmp.mbbs..pg..dm.doctors So ethics principles change face value with society..time..persons So today ordering elaborate testing is no wrong
For the sake of saving one's own skin one should not forget our medical ethics which we are supposed to uphold.
Dr shinde sir U r 100% right Today's pt deserve no symphthy..u befool them they will praise u......u advise them out of ethics..they will think it ur less hold on subject
I fully agree with Dr S Shinde
If people claim 1 crore compensation howcome a doctor will give. It may be like his lifetime savings. I play safe. For other i dont know
@Dr. Asv Prasad is requested to comment
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PLEASE SOLVE THE CASE case of PCOD and HYPOTHYROIDISM A] A 22 yers female,blood group-B+ve,wt = 45kg K/C/O= PCOD and HYPOTHYROIDISM B] investigation CBC URINE RUITINE BLOOD SUGAR SIRRUM BILIRUBIN HIV 1 AND HIV 2 HEPATITIS B (HBSAG RAPID) VDRL THYROID TEST USG(Ultra sonogrphy) And anomaly scan C] C/C/O : - Pt. having complaints of nousea ,vomiting ,and headache. All day pt. have a throbbing pain in the head,and trembling pain in the hands and the legs. Hands and legs numbness. Vertigo++ , Loss of sleep since 2 months. Swaeting of calf muscle cramp at night. Pain in neck both side up to the shoulder with bachech. Burning in the abdomen. Pt.cross legs during sleep. Loss of appetite, with nousea Pt. having aphoenea[difficulty in breathing ] at night. Since 2 month, Abdominal pain at night continus type CONCOMITANT SYMTOMS Coryza.cold. tonsillitis, E] P/H/O = Typhoid 10 months befofre Rat bite at 7th class. F] F/H/O=- Father – expired Mother – normal She is having 1 brother but he is expired She is having 6 sister. And she last i.e.7 no. G] P/G= Habit- 2cup tea Diet –veg Aversion to milk [due to milk she is having nausea] Curd,soure,sweat,milk taking this she has nausea then abd pain Appetite-low, after eating nausea and vertigo Desire to spicy++ chilly Haed =smeiling of hair+ Frontal headach, pressure in headach, haviness in haedach . EYE=burning in eyes EAR= due wearing a aurnament itching in the auricular lob and infection on that site of ear Nose =coryza ,periodicaly sneezing at morning 2 to 3 times Mouth =normal odour Toungue= flabby centrally yellow ,cracks horizontal, Red moist both side of imprint of teeth Thirt = thirstless Gums =swaeling Taste = bitter test Throat =pain in throat due to tonsillitis, At the time of food bolous swallowing difficulty, and water or drink easily . Pt. having continus sputum present in mouth. And spiting . Chest= difficulty in breathing , and stiching pain in the sternum Stomach= normal Abdomen= soft Bladder= burning micturition , offencive smell . she tells us to go urination again and again.[barbar jaana padta hai] Bowels = normal. FEMALE=Menstrual history 1] at the 10th std she starts menarche 2] duration of cycle 28 days 3] colour of discharge is broun red 4] smell is offencive 5] abdominal pain before ,during ,after, =menstruation. During menses weakness,she cant do any work [kuch bhi karne ko dil nahi karta] Vertigo, irritable. SEXUAL SYMPTOM Painful coition ,during coition buring pain in vagina, During coition abdominal pain,difficulty in breathing Hot flushesh through it ,offencive smell at in vagina,. After this burning in micturition with offencive smell Perspiration = On forehead ,neck,back.with cold sweating, Profuse perspiration. SLEEP= Disturbed sleep Unrefreshing sleep Position back ,better in back Covering + DREAMS= Fright ful ,falling in water and then dancing in water, During sleep jurking and she is weakups, Frightfull about about self death MIND= Edu-bcs 3rd yer Occu-collage and house wife Marital status =married FAMILY Joint family Financial condition –sound About study -10th -65% ,12th -75% Nature –mild ,but desire to be alone Close to mothere++, husband Fear of stage corrage , timid In study studius Occasunaly angry ,irritable Ambition =job setalment Supretion of anger by going to quite place and sitting A/F= Anxiety –health –disease –job THERMALS: summer winter Bathing cold luckwarm Fanning req/fast not req Covering no.req thick(2) Open air desire Required sweter in winterDr. Rajesh Wadode2 Likes21 Answers
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WHAT WOULD YOU SUGGEST FOR THIS CASE? THIS IS THE CONVSERSATION. PLEASE TAKE TIME TO CONCLUDE THE CASE. ANY RUBRIC SELECTION? ANY GROUP SELECTION? ANY KINGDOM SPECIFIC? IMPORTANT POINTS? PATIENT AGE 20/F. DATE 12/11/17 MEDICAL DIAGNOSIS. PYTRIASIS ROSEA TELL ME HOW CAN I HELP YOU? I have these red rashes all over the body. These are very itchy. O/E SKIN The rashes are small oval, itchy and papular all over the body except face. ARE YOU TAKING ANY PRECAUTIONS? Yes, I am not going outside not applying any soap and not wearing any other fabrics except the cotton. OK ANY DIETARY CHANGES??? I am not eating any junk food. OH OK WHAT KIND OF JUNK FOOD DO YOU EAT REGULARLY? Pasta, Pizza and much of chicken dishes. WHAT ELSE? Actually, I eat chicken regularly. SO YOU ARE NON VEG? Yes, but I am not eating these days because of skin issue. DO YOU EAT DAILY NON VEG? Yes, I eat daily egg or chicken. OK, ANY DRINKS? I normally like the red bull and if in hard drinks I like to drink beer but occasionally. YOU DO DRINK BEER HEY! Yes DO YOU LIKE BEER? No no it's not like that's drink it occasionally. HOW MUCH DO YOU DRINK? 1-2 bottles. HOW OFTEN DO YOU DRINK? Like once a month. Now, I am thinking of not to drink beer. OK GOOD. Actually I want to loose weight and want to increase my stamina. TO INCREASE STAMINA? IN WHAT WAYS? SO YOU ARE FEELING WEAK? For gymming. OK HOW MUCH IS YOUR WEIGHT RIGHT NOW? Right now I am 60 KG. HOW ABOUT HEIGHT? 5'3". OK DO YOU DRINK HARD DRINKS TOO LIKE VODKA ETC? ( THIS IS TOLD BY HER MOTHER TO ME THATS WHY I HAVE ASKED) No, very less like way too rare. MEANS YOU DO DRINK VODKA TOO? I had it 3 - 4 months ago. I don't like them actually. DO YOU SMOKE TOO? (AGAIN HER MOTHER GAVE ME THIS INFORMATION THAT SHE SMOKE HUKKA) No I don't smoke ( SHE DENIED) ANY OTHER HEALTH ISSUE? Yes, I get cold very often. OK IN WHICH WEATHER?? Especially in summer. HOW DOES IT AFFECT YOU? I sneeze a lot. OK HOW DOES IT AFFECT YOUR DAILY WORK? Sometime but usually at night nose becomes stuffy and obstructed and I can not breath through nose and I have to breath from mouth. However, the rest of the day is fine I do not have any problem. OK SO YOU DO NOT HAVE ANY PROBLEM IN DAY TIME? No it's just at night time. And it started a month ago. And as the winter starts I am totally fine. WHAT ELSE? Nothing all good. OK TELL ME WHAT KIND OF PERSON YOU ARE? NATURE WISE? I am very kind, Helpful, kind of dominating, and cheerful and wanted to be in group to enjoy more. CAN YOU GIVE ANY SITUATION FOR THE ABOVE SAID WORDS? I HAVE ASKED A LONG QUESTION TAKE YOUR TIME TO ANSWER. Kind:- if some one is sad or in a bad situation I support them. Helpful:- If someone needs my help I barely say no to them. Dominating:- it's like if I want anything to be done according to me so I want it in that way only and I likes to control. Cheerful:- I stay happy most of the time. CAN YOU GIVE AN EXAMPLE WHERE YOU FELT TO CONTROL OVER SITUATION? Like if my family wants to organize something for someone then at that time I felt like to control and sometimes when I go out with my friends and I want to go to the place I suggested then I feel control. HOW WOULD YOU FEEL IF YOUR FRIENDS DO NOT GO TO THE PLACE YOU HAVE SUGGESTED? I feel sad and afterwards I don't think about it. I go with the friends where ever they want to go together. CAN YOU EXPLAIN MORE WHAT DOES THIS CONTROL MEANS? They should do few things according to me. WHEN YOU SUGGESTED ANY PALCE YOU WANT TO GO WITH THEM AND YOUR FRIENDS DID NOT AGREE WITH YOU HOW WOULD YOU FEEL? Sad and ignored (RUBRIC DELUSION?) IS THERE ANY THOUGHTS COMES TO MIND THAT MAKES YOU SAD? Actually what I do for my family and for my friends I do it with my heart. So, if I do not get the chance to express my love, my ideas then I feel sad and ignored. I feel sad inside but will not show on face. WHY YOU WILL NOT SHOW ON FACE SADNESS? It's because I do not want any one to pity on me. WHAT WOULD YOU THINK WHEN A PERSON DO WITH HEART FOR OTHER PERSON AND THEN THAT PERSON WILL NOT ACCEPT THE SUGGESTION THEN HOW THAT PERSON WOULD FEEL? ITS NOT ABOUT YOU ITS SOMEONE ELSE. That person will obviously feel low and ignored. (SAME REPLY IGNORED) HOW DO YOU REACT WHEN YOU ARE SAD AND IGNORED AT HOME? I lay on my bed and I don't interact with my family and just listen to music. WHAT KIND OF MUSIC DO YOU LISTEN AT THAT TIME? Dancing, hip hop, romantic, sad all kind. DO YOU WEEP TOO? No if I weep I weep alone. Because I do not want to show that I'm weeping. WHEN YOU ARE WEEPING AND SOMEBODY COME WHAT WOULD YOU DO? ESPECIALLY WHEN THAT PERSON KNOWS YOU ARE WEEPING? Then my tears comes out more and I think it's human nature. WOULD YOU LIKE TO BE ATTENDED IN THAT SITUATION OR WANT SUPPORT? I would like if someone would give me the privacy. I don't want anyone to ask me questions and just give me the space may be I will discuss it with myself. YOU PERHAPS GET ANGRY IF SOMEONE DISTURB YOU WHILE YOU ARE SAD? Irritated. HOPE I AM NOT IRRITATING YOU? No. You are not irritating. DO YOU HAVE ANY DREAMS AT NIGHT? Yes, before I had dreams but now I am perfectly fine no dreams at all. CAN YOU TELL ANY DREAM WHICH WAS RECURRENT? Once I had a dream and I saw a person but I was not able to see the face of that person a black person totally black. WHAT WAS YOUR FEELING? I woke up WHAT WAS YOUR REACTION? I was kind of scared. SCARED? It felt like someone was following me. DOES ANYBODY FOLLOW YOU IN REAL LIFE? No ARE YOU SURE NO ONE FOLLOW YOU? Yes I am sure no one followed. IS THERE ANY INCIDENT IN YOUR LIFE THAT HAS BIG IMPACT ON YOU? No OK WHAT KIND OF EXERCISES DO YOU LIKE AT GYM? Cardio and all. SO YOU LIKE VERY HARD, FAST EXERCISE OR SOFT, SLOW EXERCISE? I like sort of weight trading plus normal exercises. ARE YOU A COLD PERSON OR HOT PERSON? I feel equal but I would like winters because you have more choices to wear clothes. ANY HEADACHE? When I do not have enough sleep I got headaches. I get bad headache with dizziness. WHERE DO YOU HAVE PAIN IN HEAD? Whole head. WHAT MAKES THE PAIN BETTER? Sleep ANY BOWEL ISSUE? No ANY OTHER COMPLAINTS? Facial hairs. The hairs texture on face are very dark and thick. ANY GYANE PROBLEMS? Lot of pain for the first two days and I can't get up from bed for 2 days. I need-heating bottle to get some relief. THE PERIODS PAIN STAYS DURING PERIODS OR GETS BETTER WHEN PERIODS STARTS. After 2 days it gets better CAN YOU DESCRIBE THE SENSATION DURING PERIODS? Lower abdominal pain with trouble passing stool. I have actually cramps in lower abdomen And do not want to eat anything with mood swings. Sometimes I have loose motions. (DIARRHOEA MENSES DURING) DO YOU LIKE TO KEEP ANY PET? ( I USE TO ASK THIS QUESTION ITS HELPFUL SOMETIMES) Yes, I love dogs and cats . I play a lot with dog. WHICH PET YOU LIKE THE MOST? Dogs THANKS TO ALL OF YOU IN ADVANCE!Dr. Yash Chadha3 Likes14 Answers
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male patient age 36yrs,wt 67kg..tall.. have complaints of right sided abdominal pain. since 5-6 months <while sitting bright red fresh blood in stool since 1 yrs sometimes pain in right chest USG shows rectal polyp. infected polyp on biopsy thirsty , appetite normal, desire sour chilly food stools- constipation..with loose stool with colicky pain before stool perspiration profuse wants fanning n covering both throughout the year HABIT - tobacco anger- express anger do not suppress fear- of the disease he is suffering from..fear of cancer emotional .. cried when consolation was given bp 110/70 headache n vertigo when bending down since 3-4 days may due to excessive stress n low bp USG and histopathology report are attached belowDr. Ashwini Shinde0 Like5 Answers
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9 yr old male child brought by mother with C/o fever since 3 days high grade, intermittent associated with chills ,relived by medication,to resume again, associated with frontal headache C/o abdominal pain since yesterday evening periumbilical region, crampy type,not with food intake ,non radiating, not as so with urination ,relived by medication, Since fever persisted &h/0 pain abdomen H/o decreased urine output ,h/o reduced fluid intake , c/o weakness & decreased appetite since 3 days . Gpe Hr:102 bpm, bp is 98/ 60 mmhg Rr:24 cpm Cft:<2sec Temp:37.8 degree c No pallor Nose:b/l hypertrophy of terminated peasant,throat:mild congestion, dental caries+ Lower limbs thickened oedema peasant P/a -soft ,tenderness peasant over rt epigastric ,preclinical,liver palpable 1.5 cm,liver span 6.5 cm Cns- power 3/4 both upper & lower limbs how to approach to patient basic inv been sentDr. Arshwi A Jasoliya5 Likes17 Answers
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A 45 yr female pt present with c/o uncontrol dm since 1 month rt hypochondriac region back headache gen weakness recently rbs 600mg/dl bp 160/90 mmHg k/C/O type 2 dm since 15 yrs Htn since 7 yrs ckd since 1 yrs diabetic retinopathy since 2 yrs please suggestions best opinion & RxDr. Ruqqaiya Khan4 Likes16 Answers