A Doctor’s View on Doctor – Patient Relationship

A Doctor’s View on Doctor – Patient Relationship

MBBS (Bachelor of medicine and bachelor of surgery ) the most inspiring and attractive word for me throughout my whole childhood. But it becomes toughest on 5th June 2015 when the first time I was successfully failed to get an eligible rank in my West Bengal joint entrance examination for medical. Though the word inspiring was existing in my life for MBBS. I desperately accumulate all my courage and restart my preparation to crack the same examination for the next year.  And that time I successfully able to get the entry in my childhood wish. I was started my journey as an MBBS student at the BURDWAN MEDICAL COLLEGE, WEST BENGAL and from the beginning of that, I was an active part of the world medical association.

‘Doctor Babu ‘when I heard the word indicating to me for the first time it was such a pleasure to feel that astounding feeling. In the first year one day I went to visit the hospital for the first time with my white apron. Then a short height, an unhygienic man came towards me and ask for ECG room. But at that time I was not able to help that man because I also didn’t know this. As a doctor, my duty was to help that man.

A healthy doctor patients relationship is the most important part of treatment. Healthy means professional. Some foremost characters should have to be developed to become a successful doctor. At first, a doctor must have to be helpful towards his patients but obvious within his professional limit. Secondly, justice with patients, equality among patients, and equal division of limited resources only and only based on priority need and next one is fidelity means the ability to truths about our each and every action because mistakes are forgiven but lies are strongly punishable. We must have to be understood that patients are not help-seeking rather we are the help provider.

Doctor patients relationships are of different types. One may be doctor-centric in which doctors are superior and patient must have to follow doctors advice and another one is patients centric in this doctors are flexible in their point of views and they give opportunities to his patients to choose their options.

A doctor can play different roles in appearance to influence his patients. We must have to be flexible in our behavior and it will be the strongest ladder to achieve effective care. The term ‘placebo’ is a substantial term conjoin with the medical profession. Sometimes we have to use strongly directive approach to make better treatment. Some pessimistic patients are not aware of their health so they ignore the treatment process. It is our duty to strongly put our advice and make the better health of the patient. But as besides this, it is also important to remember that the right to refuse is the personal choice of the patient. We can’t pressurize them in any aspect rather we can motivate them. As a good doctor, we have to use tremendous politeness and respect during the treatment of geriatric patients and it is an appropriate doctor-patient relationship.  Another one is protectively paternalistic approach and this is maximally used in pediatric treatment. A doctor can advise his patients by gathering kindness, protection, strength, and patience. Because pain is the fearest foe of a child and as a doctor, our responsibility is not to destroy the fear but to achieve the power to fight against it so that he can tolerate it in his upcoming life. Some other aspect is the supportively directive approach. In this type, doctors believe in patient’s choice along with providing reassurance and guidance. Another example of the perfect doctor-patient relationship is the relationship between doctor and female patients. Most of the female patients always choose female gynecologists for their treatment but as a male doctor also our duty is to provide equal safety and security to them so they can trust us . A doctor can play an active role in the treatment of terminally ill patients. As a doctor, our responsibility not only in cure purpose but also provide the hand in care. In the case of terminally ill patients, we can’t stop our treatment by accepting upcoming death but it is our duty to provide a peaceful death to our patients.

Relationship means the mutual connection between two peoples. So both sides effort is necessary to make a relationship healthy. Patients also have to believe in the doctor to make the relationship more trustworthy. Some people told that feel your patients as your family members but I think rather it is important to feel our family members as our patients when they suffer from disease because a professional relationship can handle effective treatment rather than a coherent relationship. As besides the importance of establishing relationships, it is also important to perfectly terminate our relationship with our patients because we can’t expose us as available and as sympathetic so that we become emotional during termination.

As a future doctor, I will definitely maintain these in my working phase and I wish my other co-workers who are reading this may also influence through my words.

 

 

Five Years of My MBBS Life

Five Years of My MBBS Life

I had joined the medical college with all the excitement that is humanly possible. Getting merit-based scholarship and not having to pay a single penny as a donation to college, I had made my parents proud. Not that I had always wanted to be a doctor. Being a doctor is the epitome of success academically in our society. The toppers of the country would choose to be a doctor. More than me, my parents were happy that I was studying Medicine. What more could I do than to make my parents proud. Not that I was forced to study medicine. Personally, I was indifferent. I wanted to go through the tough road that elites chose. Deep down inside, I still wanted to explore passion in life. But I was far too lucky (and thinking now maybe unlucky) that I got my name in the successful candidate name list in the MBBS entrance examination.

First year: Crushed euphoria

I was so happy to sign in the admission forms and submit all my certificates. More than that I was happy to see my dad’s smile while I was signing. Getting my hostel room key and filling a small sheet of paper for college identity card filled me with utmost pride.

As classes started, the happiness curve went down. All my expectation of med school became upside down with the reality. As happy I was to get the key to my hostel room, I was more disappointed to open the room of the hostel that was located 3 kilometers away from the hospital right next to the public bus park. Unlike the photos are shown on the website of the college, the hostel was a temporary rented hotel, with zero facilities. The hostel corridor had a leaking terrace and in the monsoon flooded our room if we opened our door for long. The soaked carpet smell mixed with our own sweat smell during the power cuts was in the air. Love definitely wasn’t in the air.

Second year: Exams

Literally, the second year was nothing but the exams. We had monthly big exams, and countless small posting examination. The syllabus was vast and time very limited. On top of that, we would hear about the terror of HODs of departments during practical Viva examinations. Our only aim was to pass every internal examination so that we would not be barred from giving board examination.

Third year: Honeymoon year

We were posted in the hospital. We had our first share of exposure to the patients. Only two subjects whose exam would be there. Taking history and learning physical examination. It was far different kind of learning compared to learning from the cadavers of first-year anatomy class. For the least, all we had to do was to maintain our attendance to 80 percent.

Fourth Year: Minors

We had already spent a year in the hospital wards and OPDs. The place felt familiar and we had been quite familiar with the history taking and physical examination. Watching POP casts and slabs in the Orthopedics OPD was exciting. Learning to use an Otoscope and be able to visualize the perforated eardrum gave all of us some happiness of sorts.

Final Year: The real exams

We were the same as the third year and our posting was the same. But the way our teachers treated was entirely different and that increased the fear. They would constantly remind of us being the ‘exam giving batch’ and that we had to cover each and every topic. Everyone was seriously studying except for the legends who still got time to flaunt the new bike they had bought.

Time passed in a blink of an eye. There was so much to study and so less of time. Nothing except the syllabus mattered. The frequency of mom and dad calling to ask about my whereabouts decreased. Going out for parties were almost nil. Birthday parties got postponed.

Internship: Three Ds

Dressing. Discharge. Daru (alcohol). The dressing of wounds and especially of the burn patients was really difficult and time-consuming. Making discharge sheets of patients who were admitted for delivery of babies was hectic as hell as the number many a time crossed half-century. And a chilled beer once in a while was the answer for releasing the frustration of doing ‘clerk-type’ work every day.

Right now, I am almost halfway through my internship. The days are so varied. Some days, we get all the time in the world to talk about all the things that are shitty in this country. Other days, we are so tired we fall asleep right as we close our eyes. The way we are treated also varies greatly. Some patients treat as if we are magicians wearing white gloves applying elixirs in their wounds and heal them. Other patients treat as if we don’t even exist there.

Final Note:

With all the free ‘no-need-to-read-compulsorily’ time that I have got in the internship, I get plenty of time to introspect. I think about the situation in the country. I talk with the residents and learn about the things I could do during my internship days to make the future a little bit easier when I would be working in a hospital far from cities. And some nights when I am alone in my room and it is raining outside, I wonder with one question on my mind:

Would I be a good doctor?

YOUR HEART KNOWS THINGS THAT YOUR MIND CAN’T EXPLAIN

YOUR HEART KNOWS THINGS THAT YOUR MIND CAN’T EXPLAIN

 

 

     Days passed by hearing the sudden death news of Celebrities like Michael Jackson, Sri Devi, Sema Lagoo, Om Puri due to Heart Disease. Heart disease can occur in 2 ways:  One by birth, family history, diabetes mellitus type 1. Second by cholesterol, lack of exercise, overweight, smoking, diabetes mellitus type 2.  Nowadays a heart attack by diabetes mellitus is getting worse. If we think twice or thrice, the common effect for this disease can be the mistakes and discipline of our daily life activities.

Recently, ‘diabetic heart disease’ is the highly ranked disease crawling among the adults with an age of 45 to 55. Sadly, this evil that will be been weaving around us at the youthful age. As laziness and unhealthy diet take a major place in your life, the art of heart disease gives birth in your body.

Every profession got its own way of stress, tension, sleepless tasks in simpler word ‘difficulties’ as an employee pressurized by the boss, as a boss stressed in maintaining company statistics, as a student tensed about career and future, a doctor diagnosing patients’ diseases we cannot blame anyone for this. But by these effects of stress, tensions, staying in a stationary position for extended periods of time, our body will be prone to chronic disease like diabetes. Diabetes mellitus type 2 is the most entertained disease in our body. How about the stress of the work which damages your nervous system, increases your blood pressure, constricts your blood vessels? Have you ever thought that not only the junk in your body but even the stress, fear, tension taken up during the work affects your body in a soothing way?

How Diabetes Mellitus type 2 starts?

You get to work and end up the day with an entire body filled with tiredness. All this time the brain helped in thinking, calculating, decision making; digestive system extracted some enzymes from food which helps the other organs to work in a proper way and energy distributed all over so that you may not faint in the middle of your work, but stress disturbed them. As tension and stress make your heart beats fast soon blood pumps fast and your blood vessels constrict by pressure, as the blood moves fast in your body the organs of your body attempts to work fast. This means the body is working more than needed. Eventually, the pituitary gland (master gland of the body) secretes hormones in large amount which means hyperfunction takes places in the organ. As concerned to the pancreas, sometimes it cannot be capable of secreting insulin and the glucose cannot be converted into glycogen that brings changes to the blood sugar level. By this, you will be affected by diabetes mellitus type 2.

Symptoms of Diabetes Mellitus type 2:

If you have diabetes mellitus type 2 you will have an Increased thirst and frequent urination (Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues), Increased hunger, Weight loss (Calories are lost as excess glucose is released into the urine), Fatigue, blurred vision (If blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus), Slow-healing sores or frequent infections, Areas of darkened skin (patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance). These symptoms of diabetes mellitus type 2 can affect your heart.

 

How Diabetes Mellitus type 2 affects your Heart?

By regular fast pumping of the heart, it can become weak and irregularity of heartbeat takes place, which may lead to arrhythmia (irregularity of heartbeat) or dilated cardiomyopathy (heart chambers become dilated because of heart muscle weakness and cannot pump blood properly) sometimes heart failure(insufficient supply of oxygen).

As a foodie, a chicken burger with extra cheese in right hand and a cola in the left hand or trying out new fast food seems to be a magic ‘mantra’ for after work stress-relief. You may enjoy that plate of delicious food and get back to sleep. What about the fat summed up in your body?  There is no way for the calories to burn up!

First, calories pile up and there will be no scope to run out of the body. These tiny calories turn and convert into a thick creamy unwanted layer of fat in the body. The unwanted fat slowly turns into cholesterol and lead to obesity. Some of the diluted fats go around the body and stays at a place like heart, bundles up into cholesterol, mostly in a coronary artery, one of the main arteries of the heart. This leads to improper pumping of the blood leading to coronary heart disease. Sometimes, myocardial infarction (heart attack) caused by a blood clot that develops in one of the coronary arteries and can also occur if an artery suddenly narrows or spasms occur.

 

Symptoms of Heart Disease:

You should be aware of what is happening in your body.

When you feel an unbearable pain that travels through the body (for example from the chest to the arms, neck, back, abdomen, or jaw) light-headedness and dizzy sensationsprofuse sweating nausea, and vomiting clearly shows that your heart is in trouble. It is not getting enough oxygen to pump up the blood. Immediately run to the hospital.

 

Medications for Heart Disease:

The main medications in use are statins (for lowering cholesterol), aspirin, clopidogrel, and warfarin, (for preventing blood clots), beta-blockers (for treating heart attack, heart failure, and high blood pressure), angiotensin-converting enzyme (ACE) inhibitors (for heart failure and high blood pressure). The doctor will work to find a medication that is safe and effective. They will also use medications to treat underlying conditions that can affect the heart, such as diabetes before they become problematic.

 

‘Prevention is better than cure’

The only way to get rid of the disease is proper diet and regular exercise. When you wake up a 5-minute meditation or yoga will give fresh start and calmness to your mind which controls your anxiety, stress, tension for the entire day, regular breakfast, minimum 30-minutes exercise per day, power naps, healthy diet, avoid smoking, avoiding or reducing junk food and soda will be helpful to get a good health. By this, you will be healthy and have a great immunity in your body.

Clinical case of Dermatology

Clinical case of Dermatology

A 63-year-old woman presents to the dermatology clinic with an enlarging scar-like area behind her ear. The area has grown progressively over 2 years and has become increasingly tight, uncomfortable and pruritic. The area is hard, raised and erythematous with central scarring and atrophy. Her medical history is significant only for hypertension and osteoarthritis.

  1. What is the most likely diagnosis?
  2. What are the potential complications of this disease?
  3. What are the treatment options?

Answer:

i. Based on this patient’s clinical presentation, the most likely diagnosis is morphea, an inflammatory disease in the dermis and subcutaneous structures. The main variants include plaque-type, linear and generalized morphea.

The most common variant is plaque-type morphea, which is characterized by the development of erythematous to violaceous plaques that expand radially over several years with central sclerosis. The lesions are usually asymptomatic, but more advanced lesions can cause discomfort and skin tightness owing to the progressive scarring and induration of the skin. Although these lesions usually resolve spontaneously over a course of years, they can lead to permanent atrophy and changes in pigmentation. Relapsing disease is uncommon in plaque type morphea.

Linear morphea is a clinical variant that often presents as a linear, inflammatory streak or an initial plaque-type lesion that extends longitudinally to form a scar band. One specific type of linear morphea is known as morphea en coup de sabre, which refers to linear morphea of the forehead and scalp. Generalized morphea is a rare clinical variant that occurs when multiple plaque-type lesions arise at once and become confluent to involve almost all of the total body skin surface area.

ii. Morphea is a disease process that is localized to the skin and does not involve internal organs. However, in the linear morphea variant, the underlying fascia, muscle and bone can be involved, leading to impairment of mobility. High-risk areas are those overlying the joints, which can lead to joint immobility. Morphea en coup de sabre can also involve underlying muscles and osseous structures and rarely progress to involve the eye, meninges, or brain. In the generalized form, the diffuse sclerosis can lead to vasoconstriction leading to symptoms such as difficulty breathing as a result of impaired thorax mobility and inflammation ofthe intercostal muscles.

iii. Although typical plaque-type morphea regresses spontaneously over several years, there are several treatment options available to expedite resolution. Phototherapy with UVA1 or bath PUVA therapy is efficacious in providing faster clinical improvement and longer periods of remission. For systemic treatments, immunosuppression with oral corticosteroids or methotrexate can be helpful during the acute inflammatory stages. There is some evidence supporting the efficacy of oral vitamin A derivatives such as etretinate or acitretin. Topical therapy plays a smaller role in the treatment of morphea. High-potency topical steroids, calcineurin inhibitors and vitamin D derivatives may help reduce local inflammation in acute lesions, but overall are ineffective by themselves in resolving the lesions.

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