Thursday, March 03, 2011

Tough patients and straight A's.....

Doctors get trained in many specialities. Even super-specialities.

But I sometimes wonder if they have any special courses on "Geriatric Communications" for doctors.

And so what do you say of a sprightly active grandpa in his late 70's who suddenly found he couldn't sit or stand, urged his equally geriatric wife to massage all kinds of medicinal oils and mixtures on his back after having her crush some leaves by hand on a stone (no blenders and mixers allowed) ?........ And when this had no effect and he was convinced with great difficulty to see the orthopaedic doctor in the neighborhood, he rubbished all suggestions of an MRI/X-ray etc, and as a special favour agreed to show some year old X-rays to the doc ? And would you believe , the doctor, patiently explained about vertebrae, and some pain relieving medications, , as grandpa shook his head with a skeptical look , till the very perceptive doctor, brought the subject around to Yoga asasnas , which Grandpa was an expert at , and loved to talk about ? He convinced grandpa to take some pain relievers which would get back his movement in the house, and save grandma from doing all the various leaf grindings and stuff .

And what do you say about a grandpa, who although scheduled for a surgery, listened to some wrong advice from someone trying to push their own protocols, told off his original doctors at a leading hospital , in a ringing voice on the phone, cancelled his surgery, and then suffered through a plethora of infections, complicating his case, and reducing his family to helpless tears ? And when he finally, unabashed, agreed to go back and get everything done by experts at the earlier advised place, his wife profusely apologized on his behalf, to the hospital chief, a well known and highly regarded doctor. And when she wondered if they would still conduct the surgery( she would understand if they refused), the doctor said , " Why do you worry so much ma'am ? We deal with geriatric patients all the time, we know such behavioral issues. Our own parents sometimes tell us off :-) when we advise some new fangled stuff.....Please to come by and get organized for the surgery.."

And what do you say of someone in his middle eighties , getting sudden intense abdominal pain, and rushing with his daughter to the hospital, where they advise an ultrasound, after a quick physical exam. There is the usual water drinking protocol so the bladder remains full, to allow clearer ultrasound reflections; and in the middle of the whole thing , when the sonographer has found something worrying, grandpa announces he needs to go to the loo, right now, this instant , else , and tries to get up ! The sonographer has probably dealt with this before, he calms grandpa, ( all the while doing some clicking stuff on the screen ) to record the various views and details, and someone rushes with a urine pot, to the intense relief of a worried daughter..

Back at the hospital, the duty physician gets the ultrasound report, which shows an aortic aneurysm beyond the danger mark, and advises grandpa to get admitted for a complete physical to be completed in 24 hours. Grandpa rises to his 6 feet height, looks angrily at his daughter who appears to agree with the doctor, and says, " Admit her if you want, I am going home " .

His daughter meets the senior doctor the next day with the ultrasound report, and explains the attitude of her father, and profusely apologizes in advance. Her father has adamantly refused to come, rubbishing the whole ultrasound science. The doctor patiently explains the affliction , risks, dangers, and the care to be taken, and then writes a message for his geriatric patient in big letters (for cataract eyes), admiring his dedication to yoga, indicating which exercise were contraindicated and which would help, why he needed to take some medicines, so he could maintain his activity level, which was by itself amazing. The daughter is to show it to her father on her return and grandpa can call the doctor directly if he has questions. The daughter, totally overcome with his thoughtfulness, apologizes again for her father's words earlier. And the doctor says, "Please don't . This is how old folks are. My parents are the same age. They educated me , allowed me to become doctor, helped me start this hospital. But when I recommend that they undergo some pathological tests, for some old problem, my father tells me off (in my own hospital ), and rubbishes everything saying these are just new ways of making people spend unnecessary money. !....."

But then what would say about a grandpa, of 86, who slipped on the stairs , fell, with a bad injury and bleeding on the forehead; lost blood but still yelled at everyone who said he needed stitches and some antibiotics, and threw the antibiotic ointment across the room, shocking the attending doctor, a young chap, new to such things; his daughter came over from another city, and after some usual wordy duels, simply took him back with her to her house. Took him to visit her family doctor, at the local hospital, to ensure things were healing, and to ask about what things to be careful with. The daughter had briefed her family doctor on the great opposition to antibiotics. The doctor checked things out, asked how it happened, nodded , and he smiled and nodded back at her. She mentioned the antibiotics, recommended some blood tests related to anaemia/sugar etc and asked him to not go out too much in the dusty environs for some time (though walking on the terrace was OK, provided someone was with him). And before he could say anything, she said if he didn't take the medicines, she would have to admit him as an inpatient and give the meds intravenously through a drip.......

It worked like magic. Grandpa liked the doctor, didn't want to antagonize her, nodded, and returned home with his daughter, quietly at peace with the antibiotics for the next 5 days. He did the blood tests with a smile, which became wider on seeing the results. The wound healed well, and he came to see the doctor again before he insisted on returning to his own house. Much thanking and smiling.

I don't know whether any of these doctors took geriatric communication classes in medical college. If they did, they probably got straight A's, thanks to their own family experiences.....

Grandpa returned to his own house, well healed and yet a bit weak.

Turns out that Grandma, used to know her daughter's family doctor.

Grandma was now no more , but she would have smiled and highly approved this doctor's way of dealing with this geriatric patient....

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  1. Very thoughtful of those doctors....and you've written it all so well....God bless those doctors who understand their patients so well.

  2. I understand you being a doctor see the brighter side of all this. I for one to say the least have never been fond of those who proclaim to be the know it alls with god complexes. Particularly in India because of all the hapless people around. Maybe I am senile too. I would definitely have my doubts because that is what most doctors are out to do make a quick buck on your account. And I completely understand what my Tata would have felt. :) thanks for the topic though. Remembered my Tata.

  3. Uma Thank you !

    Sushma Welcome to the blog, and thank you for inadvertantly granting me a medical degree. No, I am not a doctor. At all. Just someone who had the good fortune to meet some wonderful and wise doctors in the last 60 years.....and yes, I have seen the types you mention too. .......

  4. Awww! what a wonderful post...guess such doctors are why medicine is still respected and loved...though there are some contrasting versions to this :)

  5. Good to know that there are such sensitive doctors around .. hopefully we should learn lessons for our old age!

  6. Are we in India?! These doctors are also our own people, but so sensible and caring...

    I need a doctor like one of these to treat my husband after another 10 years...he is 65 and refuses to have even a health check up. Even for sugar tests, long arguments take place in our house.

    Every incident you have explained is so real! I felt as if I am watching the behaviour of my family members, Ugich Konithari and thank you for introducing good people/doctors here, which is very rare.

  7. Ah ! Age. parents. Illness. Tantrums. Well, life comes cull circle with age !

    Sometimes we see. Most times, we live in the perpetual belief that the present will continue endlessly !

    As usual, thought provoking !

  8. Lovely post..I love reading your blogs.. just started lurking around..:)

  9. R's Mom Thank you.

    aativas Thank you

    Sandhya I've kind of been lucky in meeting the most wonderful doctors.

    Kavi All these thngs teach us what to look forward to, in our old age !

    suburbanmumma Please keep lurking, and appearing !