One of my close friends, is suffering from high BP 140/100 
He went to this Sagar Apollo hospital in bangalore, for this reason.
Point 1:
The doctor there suggested some medical tests to find out the cause for this. No the doctor didnt stop there.
Point 2:
She said, if nothing abnormal is found in the medical tests then there could be some problem with the heart, and some cardiology tests needs to be performed. Doctor didnt stop here too.
Point 3:
In case the heart is functioning normally, then there is a chance of kidney failure.
And if nothing was found in Point 1,2 and 3 then he will be termed as a permanent hyper-tension patient and need to spend the life under medication.
I found the doctors attitude strange. She neednt have explained all this right at the beginning? She could have taken it one step at a time. Like she could have recommended for the medical tests, and then based on the findings suggest point 2 if required. Instead what she has done now is create mental uneasiness for my friend and his wife
Isnt it a doctors duty to make the patient comfortable as well? Whats the point scaring him right at the beginning mentioning all permutations and combinations. I fail to understand the strange behaviour of the doctor!
If there are any doctors reading my blog, would request you to share your comments on this topic!
on 13 Dec 2005 at 10:03 am # rsubras
hmm yea i cud understand his problem prabhu…. it wud be so much so that, he wud be happy if something abnormal is found in the 1st test itself so that, it wud mean his heart and kidney are safe……..
but fine nowadays docs are like that…. we all are used to cinema doctors hiding all facts from the patient and wud say everything wud be normal after 1 or 2 days, even if the patient has cancer and going to live only for 1 more month.. but these days even if a guy goes for a very ordinary headache, he wud be explained all the posssibilities of what his 1 hour headache cud turn into
neway hope your friend gets well soon both from depression and problem
on 13 Dec 2005 at 10:05 am # F e r r a r i
rs,
True. One small correction. He is not depressed and wont be
on 13 Dec 2005 at 10:18 am # Insidemamind
Before commenting.. I would like to point out at a teeny weeny mistake made on your part.
It’s supposed to be “Bengaluru” and not Bangalore. Remember? Lol!
This incident has reminded me of a visit I had with my doctor. Even before the test result could come, the doctor made a prediction that I might be having a dreaded syndrome. Although nothing of that sort happened.
Well I think doctors are more “practical” these days. Perhaps they do not want to create an air of suspense for their patients. When a doctor tells the patient what could be the possible outcomes from these tests, the patients are more likely to equip themselves with greater courage and strength for the next visit. Even if the result of the test turns out to be bad, the patient eventually is brave enough to bear it all.
on 13 Dec 2005 at 10:51 am # Prasad
Insidemamind - well i disagree with your comment that they are being practical, i feel its the opposite, this unnecessarily creates panic.. especially for one reading of a high BP.
i’m not a doctor, but the explanation i could think of is, its either because doctors in bigger hospitals believe that patients come to them after consulting other doctors whose treatment did not help, so they give them a detailed explanation of what the possibilities are (this is unlikely as most would ask the patient history)
or its because they see more and more serious cases on day to day basis than your doctor around the street, they start thinking in those terms.
or the hospital policy may encourage such behaviour (i’m not saying any one does it, but some may do this to carry as much tests as possible to extract the most money, its sick but its not just my imagination)
on 13 Dec 2005 at 11:00 am # vee-jay
The doctor could have reacted in two ways
- Prescribe all those tests without explaining any of them
- Do what she actually did
Two things in the first case:
we always abuse doctors to presribe more tests than is actually necessary. An exaggerated example would be the hospital scenario from ‘Ramana’. If she had done that, your friend & his wife would be very worried - cha, indha chinna vishayathukku poi ivvalo tests-a types. That way, I agree with Insidemind - probably she was trying to make your friend more comfortable by explaining why those tests at all.
Second: You cannot do one test at a time, diagnose it negative and then do the next one. It sure costs more stress, time and effort for everybody involved. So, in a way, I think the doctors reaction is justified, not completely though.
The reason why I am against the doctor is because Hypertension is always associated with cardiac problems. So, maybe she could have clubbed steps 1 & 2 together and then waited for the results and then gone ahead with the diagnoses of the kidney etc…
PS: Am not a medico in any way and I may be completely wrong. This is just my opinion from how I view the situation.
My wishes for your friend to get well soon.
on 13 Dec 2005 at 11:07 am # Maverick
Actually, I liked the doc’s openness in this case. When you are going to a doc with any such possibilities, the patient would like to know whats going on with the tests, what are the possibilities and would very much like to be in the loop to know why these tests are being done and whats next rathern than just being asked to do something without knowing what it actually means. When the doc gives him a complete picture whats coming after if he pass the tests, he’d feel more confident about the doc’s ability and atleast have hope that the diagnosis is going in the right direction. I know of another doc near my home (whom I call Vasool Raja) whom I consult when I get afflicted for some common cold and fever. He came to know that I am in IT industry and deduces that working in IT is the root cause for all the problems. High BP aa? Stress in IT industry. Sinus aa? Pollution in Bangalore and sitting in A/C in IT offices. Back pain aa? Sitting for 8 hours in a chair in front of the computer.
I know all of these are true to an extent, but I still feel that he doesnt know his trade well enough to do any proper diagnosis and just use these IT industry excuses. Standard aa oru painkiller injection and tablet koduthu anuppiduvaaru.
Compared to this guy, I’d prefer the doc you mentioned in your post who seems to know what he/she’s doing and lets the patient also know about it.
Another thing about letting the patient know about it…I assume your friend is young and educated enough to know what his problem is and not get panicked unecessarily about it. Maybe, it if was with someone in his/her 50s, the doc could inform the patient’s family rather than telling the patient itself.
on 13 Dec 2005 at 11:31 am # Cacaphonix
my twenty-five paise:
certain people would not like/want to informed about why the doctors’ do those prescribed tests before the actual diagnosis certain people like it exactly opposite way. i could see the reason behind doctor’s approach, it is a kind of process oriented approach that has the safe-guard clause which made the doctor to explain everything. i presume its a poly-clinic and the doctor who was diagonising your friend was an “employee” of that clinic. we cannot blame it completely on the doctor if we don’t like the way the doctor conducted him/herself. why? because, we, the patients are also partially to be blamed, because we too take some decisions and for that we need these information. this is typical US style, may not be completely suitable for indian style. This poly-clinic process oriented approach is a limitation to indian style. If we had continued with our “family doctor” concept that doctor would have known our psyche and would have taken appropriate decision in telling or not telling to us; and that too to the patient or to the relative. So may be it is better to have the “family doctor” concept if we prefer the indian style otherwise we can go to the process-oriented style. Both options are still available in india and it is we, the people, who have to choose between the two.
on 13 Dec 2005 at 11:49 am # Prasad
Maverick, if i’m not mistaken, I think we may be talking two different things here.
One is a doctor explaining why he prescribed the treatment (eg: anti-biotic or painkiller) or why he believes ‘this’ (eg: a stress or flu) was the reason for the problem. (Basically this is explaining the diagnosis after a diagnosis is made)
and the Other is giving a lecture on what all possible causes could there be for this condition (seriouslly do you know there are hundreds of possible reasons for a simple headache? Should we expect a doctor to lecture on all that and scare the hell out of everyone?)
I completely agree an explanation of the diagnosis is very much needed and that also re-inforces our trust in the doctor. I don’t feel the same about the latter.
on 13 Dec 2005 at 12:32 pm # prabukarthik
Assuming the doctor was acting on good intentions…
i guess doctors do take into consideration factors like the age of the patient, whether he is in good health, where he is employed etc. Also it depends from patient to patient.
i dont think she wud’ve prescribed all tests if the patient was say 45,50 yrs of age for such BP range.
she wud’ve probly prescribed Bp tablets and asked the patient to come if BP is still high. i am not sure. its just my guess.
similar thing happened in my case sometime.
i ended up spending 6k in tests for a problem which turned out to be almost nothing.
i dont know whether i shuld be happy that nothing was found out in all the tests or i shud feel enraged that i was ripped off 6k of hard earned money for nothing.
The problem is, i dont blame the doctors. Some patients dont go to the same doctor twice if their problems are not solved They think the doc was not effective after all.
Supposing in this case, the doc just prescribed some tests and some medication, chances are the patient may or may not tkae it seriously. he may not persist with further diagnostic tests if one was negative.
And things will get more critical and sometimes irreversible damage occurs.
So, its better for the doc to explain the common possibilities especially if the patient looks like he can afford the tests or may be his employer will bear under some insurance scheme. so as i said it differs for each patient profile.
on 13 Dec 2005 at 2:16 pm # visithra
U have not met my dr - he can be the wackiest person
i have flu - r u quarelling with the bf?
I have a headache - did u break up with the bf?
Only consolation his medicine works!
N he has a tendency to tell u how severe the case can go as well
on 13 Dec 2005 at 3:33 pm # dr dang
prabu, ipdi naalu test eduthu vutta andha tension-leye patient-ukku heartbeat egirikkum. Appala, athai vechu cardiology test panni innum konjam karakkalam.
Pozhappula manna podadhappa.
on 14 Dec 2005 at 8:00 am # Ram
the physician is paving the way for an ecg, echocardiogram, xrays and a complete ct scan — they would be well taken care of by all these tests — after all tests the physician will clear the patient and suggest some placebos. that is the present day medical profession !!
on 19 Dec 2005 at 6:09 pm # preethi
well i donno whether am late in comenting……. but then tot i could say something…..
we docs usually tell everythin before hand to make sure tht the patient wil be aware of his prob….. and wat would be the worse consequences……
and if the pt gets a positiva answer at point 1….. he would be really happy when he thinks abt the worse things he would have undergone if it was negative
on 02 Jan 2006 at 3:39 am # DR R K Linganathan
Dear Prabhu
In the decade of Internet
Its very difficult to deal with any patient. I am Working in the UK. The old method of letting the patient Know what the doctors want them to know is not only impractical (the patient will bring an internet download of the same condition which will contain even worse things) but also difficult (the changing attitude of Doctors and patient relation ship)
No longer are doctors are looked like gods, but are now looked as mere humanbeings which we rightly are. We are accountable for our action not only in the ublic courts but also in the consumer courts
The third thing is the fact that there are no personal doctors. in olden days u had a family doctor who knows the family and tells them what they need to know. but with the doctor shopping and hopping the doctor may not know the nature of person they are dealing with.
Its a dilema for any doctor about how much to tell them, but there is a definite shift towards telling them all.(them - patient).
I under stand that its difficult for some of the patient, but its their body and they have a right to know why they are undergoing these tests. as preethi said its better to say the worst then say thank god u didnt have any than to have a patient who says that u could have told me earlier. coz it breaks the relatioship if the patient loses the confidence.