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Typical patients, past and present

The evolution of the patient-doctor interaction over these years has been striking

In those days, a medical practitioner examining a patient by feeling the radial artery for the pulse, listening intently to the thoracic acoustics through a stethoscope, and measuring blood pressure with a sphygmomanometer, would invariably wear a deferential expression befitting a physician on the crucial job of auditing God’s creation.

A rare few, subscribing to the dictum, ‘laughter is the best medicine’, would beam at him, relaying a message, “don’t you worry, you will be as right as rain soon,” although most of the sick ones would welcome only an air of seriousness and not bonhomie.

The majority of doctors would not call out the measurements as tailors do to their assistants. Since many patients would not know what the systolic and diastolic readings signified, they would blink like a barn owl, even if they were told. Ignorance was construed as bliss. Perhaps the exception was the body temperature. Even the ignoramus knew the threshold limit was 98.4. Yet, the doctor who took out the thermometer from the patient’s sub-lingual area would not reveal the reading unless pressed. Diabetes mellitus was not widely known as it is now. This metabolic disorder was treated with respect or even awe as it was perceived as a cross to be borne by the wealthy person, who led a sedentary life without even lifting the little finger.

A typical patient invariably wore a woollen muffler, smelling strongly of naphthalene balls. He would release clusters of guttural coughs, the patient’s signature tune the world over. He will be clutching a graduated empty bottle to collect the medicine, called ‘mixture’, the compounder’s cocktail from different jars. Packets of powder, pulverised using a pestle and mortar, may also be given.

If we jump cut to a present-day scene, we will see a middle-aged patient, smartly dressed, ushered into the doctor’s gleaming consulting room by the smart receptionist.

Before the doctor could open his mouth, he will proffer a plastic folder containing his laboratory reports he had collected in advance, checkmating the doctor.

The conversation, rather the monologue, that would ensue will proceed somewhat like this:

“Morning, doctor. You look younger day by day. I am in a hurry. I will have to rush to catch my Delhi flight. The reports are all here. ECG is same as last. The sugar levels are well within the biological range, though fasting sugar could have been a few numbers less. But the clincher, HbA1c is just 6.5, indicating excellent control. The lipid profile is good. Total cholesterol and triglycerides are okay. HDL, the good cholesterol, is not touching 40. No probs. If I resume my brisk morning walks, it will improve. My BP is ok. You know, I check it periodically with a digital instrument and post in an Excel sheet. Your nurse Seema called out 140/90 when she checked five minutes back at her desk. Slightly high, may be due to the White Coat Syndrome.

“I have a black sticker-like mole on my left forearm. I keep a wary eye on it. Google warns if a mole or wart starts growing it could be the early sign of cancer. Thank god. My mole is not growing. But I have some problem in swallowing. Dysphagia? Right? The know-all Google warns it could be due to oesophageal, stomach or throat cancer. But I think it is a false alarm. Maybe due to the sub-standard, taste-free meal my caterer supplies in my wife’s six-month absence.

“My god! Is that the time? I should rush to the airport. Don’t you think I am doing fairly well? See you after three months, doctor. I will pay the consultation fee to your secretary Pamela. Bye, doctor.”

writerjsr@gmail.com

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Printable version | Apr 5, 2020 5:18:56 AM | https://www.thehindu.com/opinion/open-page/Typical-patients-past-and-present/article14019624.ece

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