Wishing you a 'No Complain" year ahead !

Its my first blog for the year 2012.I wish all a wonderful year ahead.

My resolution for this year is - Don't Complain.

However being a doctor by profession if I say this -it does not make sense.Patients see me when they have some complains..hence in medical language we write chief complain.

I meant this in a general way of living life.I think the environment also influences our thoughts & behaviour.When I relocated from UK to India,I was very happy.First few years flew...new work place,setting up new practice......& having my daughter.I did not complain much.I thank my family for all the support .

Things are only getting better over the years.Professionally,I have grown.But somewhere I have learnt to complain excessively.I also think people around me complain excessively.

I read spiritual books & also became member of a spritual networking site.I am proud to say that the spiritual site has promoted me from a 'Wandering Soul' to 'Seeker'.I am waiting to become a master.
I am complaining at the same rate though!

Again coming back to profession,I see a lot of patients also complain more now.Some are so stressed they do not stop with their main complain or they say the same complain again & again!(worried or stressed).Their is also a rise in patient complaints nowadays against doctors or professionals.

To understand patients better & become a part of their movement -I became member of participatory medicine.I paid to become a member & then realised I am anyway pracising or doing what patients expect.However I will next year pay for life membership as it is always nice to keep reading views & learn from them.

Where are we going wrong?Why complain has progressed to more of complaint now?
I did some thinking & my own research.

On a personal level of leading my life,I try to follow the mantra below......well most of the times.
If you don't like something,change it.
If you can't change it ,change your attitude.
Don't complain

At professional level,we need to undersand & implement changes in the way we deal with patients.(I do not like to call patients Consumer or Customer...too old to change that view in my head!)

Imagine telling the nurse "please send the next customer in ".......

First lets go through the dictionary meaning of each.
com·plain

   verb (used without object)

1. to express dissatisfaction, pain, uneasiness, censure, resentment, or grief; find fault: 

2. to tell of one's pains, ailments, etc.: to complain of a backache.

3. to make a formal accusation

complaint

In legal terminology, a complaint is a formal legal document that sets out the facts and legal reasons (see: cause of action) that the filing party or parties (the plaintiff[s] beliefs are sufficient to support a claim against the party or parties against whom the claim is brought [the defendant(s) that entitle(s) the plaintiff(s) to a remedy (either money damages or injunctive relief

Why the medicolegal cases in India have risen 25-30% or more in the last decade?Errors are bound to happen in any healthcare organisations which are complicated matrix organisations.

Medical error is the third most frequent cause of  death in Britain after cancer & heart disease.Medical errors have four times more chance of killing someone than being killed in all other types of accidents.

The key to prevent above is to develop & maintain a good patient doctor relationship.

The qualities a doctor needs (this includes busy surgeons also!!!) is communication skills & empathy.

The qualities a patient needs is to give proper information & be precise. Follow up & communicate.Your doctor may be busy in the clinic or not answering phone calls..get in touch with email.

I also wrote a blog on how to prepare for doctor visit.Its not for humour..we need to follow it as the doctor appointments are tight & you may need to be very well prepared.I do not worry if a patient comes with list of questions but do worry if he comes with googled printouts of what he thinks he is suffering from & his own differential diagnosis!!

Some busy doctors may have team members (qualified doctors ofcourse!) to answer patient queries or have their own website for patient education & getting in touch.If you have not reached this blog through my website,please visit www.entbangalore.in.

Lets hope a healthy & no complain year for all ahead.

Doc " I need a scan !"

Its not uncommon nowadays to see a patient & get this request of doing a scan.I am specifically talking here of a new patient who is visiting clinic for the first time.

Coming to a diagnosis is related to doing tests & scans & reports.

Are we treating a person or a patient or the scan ...I wonder.

One of my best teachers taught me "treat the patient..not the scan!"..

There is so much information to gather in history & clinical examination.
When i meet a new patient ,I try to give them time to talk & then start asking leading questions.If i feel the conversation is diversing,i try to bring them back to the purpose of their visit.

Since ENT  is vast speciality -history is very important for further course of action i.e.investigations or treatment.
Just to give an example -my approach to a recurrent sorethroat & swallowing problem will be standard in any patient but if its a tobbacco user -in the first visit -i will do an endoscopy.

I cannot stress upon the importance of followup's.

Rather than getting all tests & scans done in one visit -it's better to follow up & further tests are done accordingly.

Again interpretation of the tests differ.I always insist on looking at the CT/MRI myself than reading the report.
Depending on the presentation of the patient the tests results are acted upon.For eg even a mild hearing loss in a school going child is significant than a similar report in a 60 year old.Again a unilateral or onesided hearing loss though mild in a 40 yr old needs follow up or scan.

What i am trying to say is -approach could differ in each patient though the symptom may sound similar.

The doctor patient relationship is very important.As i have mentioned in my previous blog-prepare yourself for a doctor visit.If you feel as a patient that enough time was not spent & doctor was busy-have another medium of approaching your doctor-may be email-whatever suits your doc!

How to prepare your child & yourself for visit to the doctor?

I have been thinking for a while now how to make  the patient visits more time efficient-especially so for pediatric patients of mine.

I would like parents & child to be prepared -so that we make most of the time spent together in the clinic.As the practice gets busy -either overbooked or dealing with a complex medical issue,I would not like any child /parent to leave the clinic with any questions.Of course I can always be contacted on email or phone later for small queries.

As soon as we talk of parents being prepared many parents think they need to gather information from internet,bookstore or tv.I do not mean this at all!

It is not uncommon for me nowadays to meet a parent or patient who starts with their symptoms ...& somewhere in between ..  "But I do not have this symptom of tonsillitis "..,Basically they compare their symptoms with the diagnosis they think they have & do what I call "Match the Following"-matching their list with the one mentioned on the net.

I have compiled a small list of how to prepare for doctor visit..

• Good communication is a two-way street.It's good to ask questions, but let the doctor know that you want decisions, diagnoses, and prescriptions to be based on the best decision for the health of your child, not what's easier for you or makes you feel better.
• Explain the purpose of the visit to your kid & do not make it look like punishment.
  

  Tell the child the doctor may look in to her /his ear ,throat & nose.May listen to the chest or check the tummy.In younger children-a pretend game at home works!
• Let the child participate in making the list of  symptoms & questions to be asked.
• Be specific-write them down before the visit.Now this is very important for me as a doctor.For eg it will help if you say :my baby had 102° Fahrenheit (39° Celsius) temperature rather than "he is warm"!
• Be informed & focused.Do not distract the doctor by discussing non urgent issues
• Follow up..Follow up ..Follow up -If adviced. Doctor may have noticed some mild issues which they may not discuss [many times it may unnecessarily worry parents] but ask to follow up.Simple issue like ear fluid related hearing loss-follow ups are important as hearing loss can lead to learning delays.
Hope its helpful....
Sheelu
www.entbangalore.in

Role of ENT in pregnant women

 I get an opportunity to see pregnant women regularly in my outpatients.

While dealing with them it is  very important to be well versed with the ear,nose & throat issues in pregnancy & consider safe treatment.Also I do not hesitate to communicate with the referring obstetrician in front of the patient as it reduces a lot of their anxiety.

I would like to discuss some of the common ENT manifestations which happen due to physiological & metabolic changes in pregnancy.
The common presentations are nasal symptoms ,aerodigestive tract symptoms,oral changes,thyroid & ear related -hearing & balance symptoms as well as Bell's Palsy.

The commonest nasal symptom is nasal congestion & nose bleeds.These are treated with local medications & its worth noting that even cetrizine is to be avoided especially in the 1st trimester.
The oral manifestions range from pica to change in taste to mild gum bleed due to gingival hyperplasia.The symptoms of gastroesophageal reflux worsen in the third trimester.The management involves antireflux precautions & small frequent meals.The newer generation antireflux medications again to be avoided in the first trimester.
Though the ear symptoms are not very common they can be debilitating.The common presentation is of ear block due to eustachian tube dysfunction.Some of them may lead to fluid in middle ear.The risk of idiopathic facial palsy[Bells palsy] increases in pregnancy.There can also be dizziness due to iner ear fluid imbalance-Meneire's Disease.
There is a risk of thyroid enlargement during pregnancy.Investigations include ultrasound of thyroid & Fine needle aspiration.If malignancy or compression to airway only then surgery is advised in second trimester.
In conclusion,I would like to say that most of the symptoms during pregnancy are self limiting & need supportive treatment.

Evidence Based Medicine-How a doctor needs to be careful

Sharing this talk which is self explanatory
http://www.ted.com/talks/view/lang///id/1234

I enjoyed every minute of this talk.......its a sad truth.

Need of Medical Practice -involvement of patients

I have always been wondering - is there any platform where patients are patners in healthcare?This should be the gold standard & many talk about it -but there is still a long way to go..
However today I stumbled across this society & instantly became a member.The white paper is worth a read -e-Patients:How they can help us to heal healthcare.
Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.
They is already a movement amongst the select doctors in India who have realised to involve the patients.The paternalistic approach is outdated.Medicine has advanced & it is not possible for our brains to store all information about every disease.
I have been blessed with teachers who warned me early in my training days- " Do not treat the scan -treat the patient".Another warned "Concentrate on the patient -not the disease".They were visionaries .They knew how a young doctor can get carried away.They taught treating the patient not just with brain & body but with heart & soul.
Few months ago ,I have come across blog of Dr Aniruddha Malpani & have learnt alot from him.
I must mention -I still come under the pressure of finishing my appointments on time & wonder whether quantity is going to compromise quality.
I am looking for patients who can form ENT self help groups & can have discussions.There are groups on Head & Neck cancers & Pediatric ENT related groups.It will be nice to know about Indian groups as it will be more real... I feel!
I have a long way to go on this..first thing is to renew my website.
My Email is :drsheelusrinivas@gmail.com

 

How do I decide a disease management?

I am sure patients will be thinking -how does a doctor decide treatment?

Is it a standard protocol for everyone or its doctor's favourite drug .....so on.

Actually things have changed for the past few decades.

When I was training to become a doctor the choice of antibiotics was limited or shall i say the bugs were limited.Now the bacteria are changing ,the lifestyle is changing & the way we treat is changing.

The practice is more evidence based now.For example ,there is a X & Y drug which should be First line prescription for sinusitis.We should keep in mind the duration of taking it & NOT to stop half way-this leads to resistance.
If a particular patient does not respond to this X or Y drug,it is important for the doctor to look into complaince & associated factors -like treating allergies in a case of sinusitis.
If still symptoms persist -instead of blindly changing antibiotic-your doctor may consider a local swab from the nostrils or back of oral cavity[pus from sinus drips in throat].This swab may grow some bug & it will be worthwhile to treat accordingly.Of course if this exercise fails -we go to Second line drugs.

Its a step by step approach.This needs good communication & understanding between patient & doctor.The doctor has to keep him/herself uptodate with latest evidence based medicine.

Experience definitely counts for the rare cases.Most of the routine work requires evidence based approach.