Saturday, February 19, 2011

ideal Vs Real................ ..........!!

It’s not an easy task to be a good doctor, especially when nothing is known about many things, no specific treatments are available for many diseases, and many treatments those are available are not reachable to your setting… no diagnostic tools are available, and when patients have bad habits like addictions and false beliefs… I encountered today a patient with fully developed rheumatoid arthritis… with Z thumb, and bent fingers, and lungs shouting fibrosis and COPD, coughing and moaning with pain and with a packet of beedies peeping out of his pocket… and was asking me about the cause of nodules over the back of his elbows, and was requesting me to give some “high quality” drug that would cure him. He was emaciated… I wanted to refer him to higher center (the heck, to my hospital!) but the MO stopped me. Anyway it was a question what they could do for this patient… (I guess nothing other than prescribing a RA factor test and ESR and CRP- what if they were positive… and high) He was a regular patient over there, and was an alcoholic along with being a smoker. I had to give him some analgesics and after him I faced another patient brought by his wife, who was looking like his daughter… he was with full stretched abdomen with ascites of high grade and pitting edema over his feet… and she said that he had vomiting of blood in the morning. And he had same kind of vomiting few months ago… but no swelling. He was having liver cirrhosis (alcoholic) and he was drunk at that time also. And I found that ascitis tapping is not being done here. I searched for diuretics… alas, they were also not available. I ran to MO to ask for what to do, and he told me to send him back with some Tonic capsules (Tonic!!!??? He was as if closer to last stage… I would definitely have admitted him if I were in my hospital). I told her to take him to the causality (the emergency sector) of my hospital in case if some emergency arises… and then I caught the assistant of the pharmacist giving gamma benzene hexachloride ointment to a patient whom I had prescribed betamethasone ointment for atopic dermatitis.

What is going on here…? When are we going to get up and start practicing logically if not ideally? I see steroid tablets being given abundantly because the stock is in abundance, and the nimesulide… and tramadol injections for people with chronic trivial low back ache. I accept opioid analgesics if given after trauma or for severe pain. It’s not something that should be given to each and every patient complaining of pain. And nimesulide is totally unacceptable. And health advices like how to protect lower spine from injuries, and how to take care of spine, and to do exercise are not being given at all. And even if they’re told to do so, the smokers and alcoholics are not going to seize it.

How to change this? Where to make a start? Am I too small to think of that? I don’t know… maybe I’m… or maybe I’m confused. Is my dream of healthy happy world a daydream of a fool? Maybe it is; I never say that I’m a sane person. And I’m going to keep on trying, let me see what the future is going to show me…

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