There are two conditions in private practice,
when figures are to be presented to patients to impress upon
them the importance of spending money on investigations as well
as management of the case (even if this includes a biopsy or
an interventional/surgical procedure).
DVT (Deep Vein Thrombosis) is an extremely common condition
in private practice. Not only the public, but even the family
physicians are afraid of pulmonary embolism as a complication.
So much so, that many a times, their talk ends up with the patient
going for a second consultation and changing the doctor.
Therefore, the figures of 20% and 50%,
mentioned below are worth remembering. The family physician
can speak confidently to inform, either:
- Intelligent patients, or
- Patients, who cannot afford to spend more on their illness,
or
- Patients, who are affording but are avoiding expenditure,
thinking that it can only help the prognosis, and not the
diagnosis.
DVT is extremely common in small calf veins and can be easily
missed on doppler sonography. Most of these patients do not
develop serious or fatal complications. The reason is that in
only 20% of the cases, the thrombosis will
extend to the ileo-femoral segment of the vein. Once it extends
there, 50% of such patients will start throwing
emboli in the lungs. Half of these emboli, which are not clinically
significant, might be even silent. It is only among the other
half, when the emboli thrown are clinically significant and
diagnosable, that the fatalities are common.
The second condition - PMR (Polymyalgia Rheumatica), though
uncommon, is a serious illness. Although patients of PMR recover
in less than a week, after administration of 10-20 mg of prednisolone
per day, the family physicians should remember that 20%
of these patients can develop temporal arteritis.
Patients who develop temporal arteritis have 50%
chances of developing sudden, permanent blindness, which is
vascular in aetiology. Not only that, apart from blindness,
they may also develop any other neurological complications of
the brain due to vascular blockage. The only way to prevent
patients from developing these complications is to start them
on a dose of prednisolone, which should be 1 mg/kg body weight.
The physician should fully anticipate grave side effects, because
normally these are elderly patients. |
