This is not about predicting the future. This is a question raised by a hapless doctor (yours truly) grappling with persistent queries by a patient’s attendant. Curious? Please read on!
The patient was referred to me to rule out diabetic retinopathy before he underwent surgery. As the cataract was dense, I advised an ultrasound scan of the eye. I assured him that the eye appeared structurally normal and advised him review after surgery to look for any subtle changes which might have been missed in the scan. This is when the attendant took over. He asked me if diabetic retinopathy was suspected and whether I was qualified enough to diagnose it. I said the only way to know was to reassess the eye after surgery and offered him the benefit of a second opinion. His reply was, “It means you don’t know about retinopathy.” I said that was not the case and again offered him the option of a second opinion.
His next question was on the outcome of LASER and surgery for diabetic retinopathy. My explanation did not satisfy him. He asked me if I knew what LASER and surgery meant. I assured him that I had managed a good number of such cases but in this particular one, I was not even sure if there was any need for any of these procedures.
Not convinced, the attendant again asked me what would be the outcome of surgery. I said that any further opinion could be given only on the basis of the status of retina post-surgery. At this point, he asked, “Doctor what would be the outcome of retina surgery?” Clearly realising that my words had no effect on him, I asked him in desperation: “Sir, I do not have any children, will my son be an IAS officer?”
In another incident, a person working in the IT sector walked into my wife’s clinic. The conversation went like this. “Doctor I am not able to see and my eyes are itching.” Attempting to put him at ease, my wife started talking in the vernacular language at which the patient was mortified. “Only English madam, I work in an MNC.” His history revealed allergy in the eyes. He was advised two medicines, of which one was discontinued after one day as he felt it was useless. His complaint was watering of the eyes while riding his bike. My wife suggested using a helmet with a pro-shield to avoid wind blowing into the eye. He said that wearing a helmet was bad for his hair. He gave her a “mind-your-own-business” look when she talked about the safety of wearing a helmet. And then suddenly from nowhere he took off, “Madam, you know, I have a bike, I also have a car and a 3 BHK flat.” Then he asked her about lens which he “read in Internet” made by Roshanlal company. (Messrs Bausch and Lomb must be having quiet a laugh in their graves!).
He was told that his current state of allergy was not ideal for any contact lens and was asked to come back after a week to look for any improvement with the prescribed medicines. The need for good compliance and follow-up was impressed upon him but, needless to say, he never came back!
I was reminded of an oft-quoted statement by Sir Robert Hutchison during our training:
‘From inability to let well alone
From too much zeal for the new and contempt for what is old
From putting knowledge before wisdom, science before art, and
Cleverness before common sense;
From treating patients as cases;
And from making the cure of the disease more grievous than the
Endurance of the same, Good Lord, deliver us.’
To this we may add, “Good Lord, deliver us from patients who come to test us rather than getting themselves examined!”
(The writer’s email: firstname.lastname@example.org)