TOUCH VS. TECH : FROM A SURGEON’S PERSPECTIVE
Dr. Gangadhar Sahoo
Ex- Dean, IMS & SUM Hospital, Bhubaneswar
Ex- Pro VC S “O”A University, Bhubaneswar
President, ISOPARB
“Technological progress is like an axe in the hands of a pathological criminal.”
-Albert Einstein-
One day five of our friends were enjoying a relaxing time in my office chamber. The Prof Ophthalmology told that LASER has revolutionized the treatment in Ophthalmology. It took just five minutes to treat the posterior cataract of my friend. He is perfect. The Prof Pharmacology friend told how his subject is the most demanding subject because of development of new patient friendly drugs and drug delivery system. Prof Medicine said that in his ward post graduate students are not examining the patients , directly asking for echo, MRI , endoscopy etc. I told my experience when I was taking a clinical class in Obstetric ward. When I asked one of the PG students to present a bed side case she started with Ultrasonography findings. My surgery friend was listening to our discussion while taking sips of tea. At the end when his turn came, smilingly he started telling his experience putting the unfinished cup on the table.
My Surgery friend Prof. Gokulananda Sahoo, retired professor and HOD of High Tech Medical College, Rourkela is now working as a senior consultant in the same city attached to a nursing home owned by our friend Dr. Agrawall who is a medicine specialist. Prof. Sahoo was out of the headquarters for a week to attend a national conference when an elderly male patient was referred from the home town of Dr Agrawall with history of chronic constipation for last six months. He was treated by the local doctor but of no avail. Thinking that it was an age related problem and aggravated by psychological ailments the local doctor referred the patient to consult a surgeon and / or a gastroenterologist. He came to Rourkela and met Dr Agrawall. Since Prof Sahoo was absent, the patient consulted another surgeon who without examining advised for a CT scan of abdomen and pelvis. He did that and came with the report which showed no pathology in the abdomen and pelvis. Then the surgeon asked the patient to get the MRI done. MRI report showed no major pathological lesion except thickening of the right lateral wall of the rectum.
So the surgeon referred the patient to a gastroenterologist. At that time there was only one qualified gastroenterologist in the city of Rourkela and he was working in the Ispat General Hospital. The patient took appointment and met the doctor in his OPD. There was heavy rush in the OPD. It was natural because the doctor was the only person available to cater that specialized service. The patient had to wait for his turn whose OPD serial number was 72 .He got the call at about 4 pm. The doctor saw his reports and posted him for colonoscopy after 2 days. He advised the preparations for colonoscopy to be followed religiously and to come in empty stomach early in the morning. The patient did that. Fortunately his serial number on that day was one. To save time the skilled assistant of the department put the patient on the bed, did all the rituals including antiseptic application, toweling, lubrication of the scope and putting the scope into the anus. By that time the doctor was ready for the procedure.
The endoscopist went up to sigmoid colon and searched all the walls. He did not find any thickening nor any suspicious lesion anywhere in the colon or rectum. He gave the final report that there was no pathological lesion in the lower gastrointestinal tract which can attribute to the symptom of constipation. He handed over the report to the patient telling that there was no disease and he was completely healthy. He should take plenty of water, diet rich in roughage and 30 minutes of walking. If possible he can practice Yoga daily to keep the body and mind free. The poor patient came with the same advices and same load of problems and met the surgeon. The surgeon went through all the reports and advised the patient to visit a psychiatrist. The patient became demoralized and told Dr Agrawall that he would go back home as early as possible. He had come here as a healthy man with a minor symptom of constipation. But now he will go back home with the same persisting symptom added with another new PSYCHIATRIC DISEASE. The more he will stay here in the city the more number of diseases he will carry. Dr Agrawall consoled him that Dr Sahoo will be coming tomorrow. He should wait for one day and get him checked up once by him. He is the most dependable and reliable doctor and never does unethical practice. The patient obliged.
Next day the patient was to meet Dr Sahoo. The night was the most terrible time to pass in his life. No sleep, no dream only masterly inactivity and watchful expectancy. So many questions were coming to his mind. “Will not the doctor put him in the same basket? Will he not give the same diagnosis that I am disease free and a hypochondriac? Will he not send me again to the mental doctor? Let me wait and see. Let me be positive. Things may be different.” Exactly at 9 am Dr.(Prof) Sahoo , the most reliable and ethical doctor entered into his chamber. After performing the rituals of worship and prayer and putting on the hospital uniform pressed the buzzer.
“Call the first patient Mr. Rajaram." Dr. SAHOO to Sadhu, the attendant.
The patient Mr. Rajaram was around 70 years, very much reduced health entered into the chamber. Dr. SAHOO asked Mr. Rajaram to sit down. Before that, Dr. Sahoo had gone through Rajaram's file thoroughly. No where he found that Mr. Rajaram was thoroughly examined. His file was full with investigation reports and advices. No doctor had touched the patient even. During interrogation Dr Sahoo came to know that Mr Rajaram had the symptom of constipation for around six months to one year which was relieved by taking laxatives to start with but later those medicines were not working. At times he was not able to pass the flatus also as a result of which he has intentionally reduced taking solid for last few months.
This aroused suspicion in the mind of Dr. Sahoo. After thorough clinical examination he did a per rectal and proctoscopic examination. To his utter surprise the patient started bleeding. He could detect a large cauliflower like growth just above the anus on the right lateral wall. His suspicion came to be true. Once the diagnosis was revealed Mr Rajaram was stunned because for last six months he might have consulted a dozen of doctors, he might have done almost all possible investigations but no one had detected his disease. There was a doctor in the form of Dr. Sahoo who appeared like a God before him. Not only he didn't brand him as a psychotic but he could detect his disease. He touched the feet of Dr . Sahoo and decided to go to the Tata Memorial Hospital Mumbai for final treatment.
At the end we five senior citizen friends discussed what is the fault of the modern medical practice. We were apprehensive where the health system was moving and where to end in future.
1. The patient doctor relationship is at the nadir. No doctor has the patience to listen to the patient.
2. Nobody is following the basic clinical methods of examination.
3. Over dependency on technology has ruined the sanctity and dignity of medical profession.
4. Unnecessary referral is the norm only to shift the responsibility.
Therefore we teach our students to be patient friendly and have an ethical approach.
*Be patient friendly. Build the confidence in the patient before examining.
* Follow all the methods of clinical examination like interrogation, general examination, palpation, percussion, auscultation and internal examination.
* Make your provisional diagnosis.
* Suggest minimum necessary investigations for confirmation of your diagnosis.
Then either you can treat or refer to a competent specialist. Let not the patient run from pillar to post as a helpless orphan.
Albert Einstein had rightly said,
“I fear the day when technology overlaps with our humanity, the world will only have a generation of idiots.”
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