The Key to Getting Well 2


Many a time I come across obese patients with varied complaints directly related to their excess weight. Many fat people believe that 'Fat is ‘Fit. This wrong notion is more pertinent to our Indian milieu-a pregnant woman is made to eat for two'—she is fed with delicacies made from pure ghee, dry fruits and other overtly nutritious ingredients, the end result being that a once slim and trim pretty girl is turned into a fat and grotesque woman. Only when the dangers of obesity are highlighted, the patient is motivated to lose weight. In the ultimate analysis, I think, motivation to lose weight is important—not just a strong motivation, but a permanent one. "Longer the waistline, shorter the lifeline" should be impressed on every patient. It is also worthwhile pointing out that while losing weight is difficult enough, maintaining the weight at the lower level is infinitely harder.

I come across many diabetics who have achieved excellent blood sugar control without the use of any anti-diabetic drugs. Just by careful attention given to food habits, regular exercise and avoidance of all excesses, some recently diagnosed diabetics seem to have attained near normal blood sugar levels. However, there are patients who are blissfully under the wrong belief that the diabetic pills will allow them to take liberties with their diet. I have seen many a diabetic taking an extra pill of Diabenese or Daonil for each rosagulla that he delightfully pops into his mouth.

Anxiety is one of the chief reasons why many patients consult their doctor. Fear psychosis— fear of the unknown should not be under-estimated. The number of patients suffering from such a psychosis is to be seen to be believed. Readers will be surprised to know that the day our beloved Prime Minister the late Mr Lal Bahadur Shastri suddenly died of a coro nary (heart attack), I had 4-5 patients all with the same complaint, chest pain. All of them had a non-cardiac chest pain chiefly due to anxiety. A thorough examination, including an electrocardiogram ruled out the possibility of a cardiac pathology and with a fair amount of reassurance and understanding, all of them felt better.

One of the commonest conditions I have come across in practice is depression. Normally, such a condition is tackled by psychiatrists, but since the symptoms of this illness are mainly somatic, we, the general physicians (or the M.Ds)see these patients very frequently. The symptoms could be loss of appetite or even excess of it, insomnia, palpitations, aches and pains etc. It is rather sad but many of my patients are reluctant to go to see a psychiatrist because of the social stigma attached to such a visitwhen, in fact a timely visit when to the friendly ‘shrink' would alleviate many of the symptoms.

Cancer-phobia exists amongst all patients, irrespective of their caste or creed. A lot of coverage in the lay press and the visual media has perhaps led to this. This is not to decry the usefulness of the information in diagnosing early cancer. This phobia is particularly prevalent among the close relatives and friends of patients suffering from the dreaded disease.

When I was asked to write down what I felt when I handled my first case, I was wondering what indeed were my feelings then. Was I nervous? Did I fumble? Did I become a nervous wreck? The truth is that my very first case was a clear-cut and simple one. I distinctly remember the occasion. The patient was a young, unmarried Maharashtrian girl. She showed classical symptoms and signs of a disease which in the early sixties was associated with a lot of unnecessary social stigma: pulmonary tuberculosis. This disease was very easy to diagnose and easier to treat. Needless to say, the patient completed her full course of anti-Koch's treatment, got married and eventually became the mother of a bonny child. I really did not feel any extraordinary emotion when I dealt with my first case independently. In fact I used to see many patients, independently in the various hospitals as a House officer, Registrar, Senior Registrar, but then, of course, I always had the backing and support of senior physicians and hence was ‘protected'. I must have committed mistakes in diagnosis and management, but under the overall supervision of my seniors I learnt not only from my mistakes but also from the mistakes of others.

Because of working in public hospitals like King Edward Memorial(K.E.M) and the Sion Hospital, Bombay, I was confident of managing patients successfully. The message I am trying to convey is that no medical education is complete until a doctor works after graduation, in a Public Hospital for a minimum period of 1-2 years in different capacities.

Accountability to the knowledgeable and experienced seniors is very important in the learning process and with this comes a natural confidence which is pre-requisite for dealing with one's patients independently. There is nothing more tragic than a doctor being perceived by the patient as a bundle of nerves. A physician should be an example not by preaching but by Practising. I think in whatever profession one may choose, one has to be a good human being first. How would I treat a patient? Exactly the same way I would treat my father or mother or a close relative. I think this should be the motto and guiding spirit of a good physician. The attitude of the doctor towards his patient, while being sympathetic and rational, should also be detached. A doctor should refrain from getting into any emotional hassles with his patient.

One often comes across doctors who brag that they have never made any mistakes in diagnosis and management of a disease or that they have had to attend to cases that had been messed up by others. I can only offer my heartfelt sympathy to such doctors. It is my honest belief that if one says that one has not failed in diagnosis and management of patients in the course of one's career, it means two things: (1) the doctor is a liar and (2) he has not seen enough patients. Genuine mistakes in diagnosis and treatment do occur unwittingly and they have occurred in my practice on several occasions. It is well nigh impossible not to have ever made a mistake. As long as there is no negligence involved, one has to learn to accept this as part of one's professional life.

Two points may be made in this connection: one, that there is genuine grief at a mistake committed, two that one would conscientiously see that there is no encore. Then mistakes become part of one's continuing education. I would further advocate a doctor discussing his ‘problem' patients with his colleagues, both senior and junior. Thereby one enables others to learn from one's mistakes, just as one learns from the mistakes committed by others. Frequent group discussions help a great deal in keeping up with recent advances in medical knowledge. As for me, every patient I see teaches me something. My learning will never stop till the day I leave the world.

I can never forget Dr. Ghanti who was a leading family physician at Dadar. He had suffered many illnesses and had undergone many operations that ultimately played havoc with his health. In spite of many odds, he actively practised medicine with a smiling face and a hearty laughter-both of which went a long way in alleviating the distress of many of his patients. Unfortunately, this courageous doctor died of complications of a surgical procedure performed on him but till the last moment he maintained his cheer and wit. I have learnt a lot from the exemplary courage he displayed in the face of death. Not a day goes by without my remembering him fondly.

Whenever a doctor encounters the death of his patient, one thing of prime importance is to handle his relatives sympathetically and to offer genuine words of solace. In fact, if the condition of the patient is such that he is unlikely to survive, it is better to take his close relatives into confidence and explain to them the gravity of the situation. This approach not only mentally prepares them for the eventuality but also softens the blow when death actually occurs. Many a misunderstanding can be avoided by proper and helpful and, more importantly, a timely communication with the patient’s near and dear ones. This does help in making the end a solemn occasion instead of one of melodrama and hysteria.

In the course of my medical career, starting right from my student days, till I became a consultant, there have been several eminent doctors I have looked up to who were my idols worthy of emulation. I would be failing in my duty if I do not name a few of them: in particular Dr. G. M. phadke, Dr. A. V. Baliga and Dr. M. D. Motashaw (my teacher). All of them were giants in their respective fields but what impressed me most was their exemplary character and their human qualities. We still have such people amongst us in our profession but for all that, it is an unfortunate fact that ethical values are rapidly going down in all spheres of human activity - and the medical profession is no exception to this.

There are patients and patients—they make a fascinating mosaic when taken in their totality. I had a patient who was poor and could not have afforded to pay me but whom I had asked to see me for a follow-up. I refused to charge him but he insisted on placing a five-rupee note in my pocket, saying that was for my 'chai-pani' cup of tea or, shall I say, incidental expenses! And then there was another patient who left fifteen paise on my table and coolly made his exit when I rather absent mindedly told him that my consultation fee was fifteen. I suppose I should have added the word 'rupees'! And this was in the sixties!


Compilation of professional reminiscences of specialists - edited by M.V.Kamath and Dr.Rekha Karmarkar