Clinical Skills in diagnosis, Consultation on Phone and taken for granted attitude of the Patients


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Clinical Skills in diagnosis,
Consultation on Phone and taken
for granted attitude of the Patients
By Dr. Munawar Aziz*

During our Medical College days we were taught to take history of the patient very seriously, because sixty percent of the diagnosis was made by taking proper history, twenty percent by the clinical examination of the patient to confirm the “provisional” diagnosis made from history and if still in doubt then to go for certain tests like x-rays, ultrasound, CT scans and laboratory tests etc.” However, now a days, because of easy going attitude and commercialization of the society as a whole, the laboratory and other tests are either done by the patient himself (to save his own time) or doctors go for certain most unwanted tests because of reasons known to everyone.

Still there are majority of clinicians who prefer to take pains to dig out the diagnosis from history of the patient and only order investigations if unavoidable to reach a proper diagnosis.

The British and American systems differ. In British system which is mostly followed in our setup, there is less reliance and dependency on “tests”, whereas in American system almost 100 percent reliance is on “tests”.

In a developing country like ours there should be more stress on history taking and clinical examination of the patient to save unnecessary expenditure. Similarly cost effective drugs should be prescribed after taking proper socioeconomic history, since same salt is sold under different names with huge difference in price.

Being a practicing doctor, in cell phone era, means your contacts take you for granted, that you are available 24/7, day and night, ready to pick up calls or write prescriptions on WhatsApp (free app), not realizing that you are also a human being, you also eat, sleep and have other worldly chores to do. One SMS received at two at night with laboratory report pictures said, “My sister’s tests”, please advise. Another message read, “Your timings in Ramadhan, when replied about morning and evening timings that clinic closes one hour before Iftar, the reply was a master piece....”clinic open in the  evening also or not ?”...!

Here is an interesting questions and replies messaging:

If you write “one tab at night” in reply to an SMS at 12 O Clock at night...
(Q) Milligrams? A)3mg...
(Q) Before meals or after...(A) after.
(Q)Not in the morning?...(A)no...
(Q) Any side effects...khamoshi..
(Q) Jawab naheen dia...(A) koee khas nahee...
(Q) tou agar na loun tou...
(A) Marzi...(reply) ok thanks.

Same patient comes to clinic after one month...(Q) Did you take that tab?...No, my friend said it has side effects. Some time, a battery of test reports and prescriptions of other doctors are sent for your approval at 5 AM.

Another one:

Mairay pappa aap se checkup karwa k gay hain...”koee pareshani wali baat tou nahee...un ka kia masla ha? Test reports kaisi hain?,Ma boht pareshan houn.”(A) pappa se khud pooch lo, doctor aik doosray kee beemari share naheen kartay...(jawab) matlab kuch serious baat ha, aap btana naheen chahtay!...Shab Bakhair.

After the COVID-19 vaccination started:

(Q)”Is it safe, I got vaccinated!”
(A) Yes. It reminded me of a Muslim Pakistani family travelling on a foreign airline, sitting in front of me...after eating all the lamb and chicken served in flight (which I didn’t eat) the man leaned towards me and asked, Sir, was it halal”, I asked him “Did you eat it”? He replied, yes...well it is too late, you should have asked me before eating!

Too disturbed and annoyed one day I replied to a person calling at night, No more clinical advice on WhatsApp”,...reply...”Everything is online these days, therefore I can’t come to clinic that’s why I asked for your advice” without realizing that everything on line is also not free!

I have blocked some contacts, deleted others and do no reply to most.

It is suggested that no medicine should be used without examination by a qualified physician, whatsApp and other SMS facilities should only be used if extremely necessary keeping in consideration the limitations of the doctor as well. Serious patients should be shifted to the nearest medical facility dealing in emergency cases.

*Dr. Munawar Aziz. M.C.P.S.
102/1,Rah e Sakoon,
Habibullah Colony,
Abbottabad. Pakistan.
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