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Patients and Their Whims
Jaydeep H Palep*, Sajid Sayyed**, Parag Telang**, Somnath Chattopadhyay***, Sandeep Patil***, Rajeev M Joshi+
 

A study of patients in the doctor’s waiting room can be very interesting. There are patients who spend time looking at every picture and certificate hanging on the wall. This can be quite boring because most doctors have framed certificates and group photograph of their student days hanging on the wall. This could hardly interest any patient! With changing times doctors have gone arty and musical. Some have paintings, piped music and some have even television in their waiting rooms. Patients must find this a welcome passtime. The hyperchondriac will have the heaviest file and list of investigations and will keep boasting to his neighbours about the long list of doctors he has seen. The taciturn patient will study the expressions of patients emerging out of the doctors consulting room making mental notes of whether they had a satisfied look.

Three types of patients who are of particular interest to all of us and deserve a special mention:
1. The magazine thief.
2. The man in a hurry.
3. The bargain master.

Let's take them one by one.

  1. The magazine thief is too well known. No wonder doctors have very old magazines in their waiting rooms. If you happen to have recent numbers of Time, Newsweek, India Today or Film magazine they are sure to get lifted. Some of them will take your permission, some will promise to return (which they won’t) and some will quietly walk away when nobody is looking. There is no way to stop this. Since most magazines are read and re-read one has to take lenient view of it. Collectors items like Time, Life, Annual Issue, National Geographic are best preserved in your own house.
  2. The man in a hurry is very special. He has either flunked his appointment or come very late and has a half dozen excuses to justify it. If you ignore him or ask him to take another appointment, he will keep phoning on his cell phone to your inside number. These men are very successful and not easily put off. They want to intercede themselves between two patients for (by request) two minutes only, but usually sponge on a good chunk of your time. Dogged persistence is the hardest thing to counter and Mr. Hurricane is quite a seasoned player, so the consultant has to humbly accept this man.
  3. The bargain master is familiar to all consultants. He will take full advantage of all facilities, get the blood pressure of his spouse also checked, ask you fifty questions about the investigations and another twenty about the diagnosis and another twenty about diet before he lets you off the hook. But wait a minute he hasn’t finished. He will not hesitate to ask for concession in your charges on grounds of bad times, poor business, aging, large amount of monies spent on his disease etc. The bargain master cannot do this in large five star hospitals, which he probably frequents. If you counter it by saying that you have large over heads and inflation is cutting into your fees he will change his tune and ask for concession on grounds of mercy and charity. Some of them are genuine. Most are not. When you look outside the window you will find him driving a more expensive car than you, which is often chauffeur driven. It is our common experience that a genuinely poor patient will rarely ask for concession. They will only come when they have enough money to pay your fee. It is well known that medical profession is the most exploited profession, and perhaps the only profession that does charitable work. We opted for it. So!!!

STATINS AND THE RISK OF COLORECTAL CANCER

In this case-control study with colorectal cancer and matched controls, statin treatment was associated with a decrease in the risk of colorectal cancer of almost 50 per cent. Although many patients would probably need to be treated to prevent one case, this retrospective study suggests that statin use may lower the risk of colorectal cancer.
BMJ, 2005; 330 : 2184.


USE OF EXHALED NITRIC OXIDE MEASUREMENTS TO GUIDE TREATMENT IN CHRONIC ASTHMA
The proper management of asthma with the use of inhaled corticosteroids requires the adjustment of doses in proportion to the patient’s need for treatment. In this study, the investigators compared groups treated according to two regimens, one based on conventional guidelines for the treatment of asthma and one based on measurements of the fraction of nitric oxide in the exhaled air. In the latter group, equivalent control of asthma was maintained with lower doses of inhaled corticosteroids.
The use of the fraction of nitric oxide in the exhaled air appears to be a valuable approach to the management of asthma.
N Engl J Med, 2005; 352 : 2153.


CALCIUM AND VITAMIN D DON’T SEEM TO PREVENT FRACTURES

Supplementation with calcium and vitamin D doesn’t seem to reduce the risk of fracture in women with one or more risk factors for fracture of the hip. In an open controlled trial, Porthouse and colleagues randomised 3314 women aged 70 and over to a leaflet only or a leaflet accompanied by a daily oral supplementation of 1000 mg of calcium and 800 IU vitamin D. After a median follow-up of 25 months, the two groups did not differ significantly for occurrence of fractures.
BMJ, 2005; 330 : 1003.


MEDITERRANEAN DIET DOES PROLONG LIFE

Adherence to a modified Mediterranean diet, in which unsaturated fats are substituted for monounsaturates, is associated with longer life expectancy among elderly Europeans. Adherence to the diet, which is rich in vegetables, legumes, fruits, cereals, and fish, reduced mortality by 7% (95% CI 1% to 12%). The modification was necessary because non-Mediterranean populations have a minimal intake of olive oil.
BMJ, 2005; 330 : 991.

Ex-hon Paediatric Surgeon, Bai Jerbai Wadia Paediatric Hospital, Parel Mumbai 400 012.