Friday, March 23, 2012


    This is one of the stories that I am sure can happen to every doctor. We doctors like to do the 'practice ' of the medicine  , by 'the book ' .  Now a days we are told to do things based on the evidence. i.e. evidence based medicine as it is called. But if we follow the 'book ' every time , we don't need doctors , we could do it with the  use of the computer, which is fed the information about the patient, and it will decide the further testing. Then we will be doing all the tests for 55 years old or  90 years, based on 'complaints' or the 'findings ' on the examination or on early testing. ( Abnormal chest x-ray in 90 years old patient with dementia , may not be worked up , even if there is high chance of cancer, but with computer based medicine , which may not take in to account the age and the mental ability we will be doing all the tests, which will not 'help ' anybody. The story that  I am about to tell is one that will explain this thinking.
    37 years old patient was referred to a gastroenterologist. He had some diarrhea and had sigmoidoscopy, looking inside rectum and lower part of the colon . He was found to have a polyp . So he was referred to gastroenterologist. When the gastroenterologist asked him about the polyp , he was quite mad . "You guys are concerned, about fxxxxx polyp, and no one is doing anything about the fever that I am having for last 2 months . " He was having fever and had diarrhea and had lost 30 lbs of the weight . On further questing it was realised that he was homosexual . So the possibility of HIV was high and other possibilities like 'lymphoma ' was also considered. He was admitted to the hospital . Upon the work up the diagnosis of HIV and also of Hodgkin's lymphoma was confirmed . The Hodgkin would need treatment with chemo therapy, which would suppress immunity, which was all ready suppress by HIV. Also with the chemotherapy one could become 'impotent' .  Due to such risk we usually tell patient about the risks , and advice them about precautions . In this case it was very different. He was HIV positive and was homosexual. So when I saw a note written by the oncologist which stated that " the patient was informed about the risks and was told to preserve sperms in case he wants to . " I was surprised.  If one takes in to account the special situation in this case , this was nothing more than writing from the 'book ' The special circumstances were not taken in to account. THIS IS WHAT I CALL GOING BY THE BOOK.!!!  

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