Thursday, December 4, 2008

Non medical reason for referring a patient-Part 2

You may recall my post few days ago on the above subject. Let me continue the story.
The patient a woman of 42 years was brought to my hospital next day morning. My physical examination and the blood results revealed that she is having Dengue fever with a decrease in Platelets, the cell that helps in clot formation when the blood vessel is injured. Apart from vomiting and mild fever she was doing well.
I reminded the relatives about what I told them the day before. I said to them that Dengue fever can be life threatening.
'Next few days are critical. Even if you take her elsewhere the management will be the same. Now you decide.If you like to stay I will try my best to make the patient all right'.
The decision was quick.'We have faith in you doctor'.
I was happy to see their faith in me.It is my experience that if you explain everything about the Patient's condition in simple terms looking in the eye the faith of the patient and the relatives increases.
With in 2 days of supportive therapy her Platelet count improved and she became asymptomatic. I discharged her from the hospital on the fourth day.The family was very happy and thankful.I saved them a lot of money and hardships.
Many patients are referred to a higher centre with out sufficient reasons.Nowadays doctors try to play it safe.
I took a calculated risk here.I admitted a patient to my small hospital with a probable life threatening illness who was referred to a big City Hospital by another Physician.The risk paid off and here we had a happy ending. That may not be the result in all cases.


Seema said...

You are so correct, it is a common mindset for people that treatment in bigger hospitals are better than smaller ones anytime. That gives rise to the mental satisfaction of having done enough and "Accepting it as fate". On the other hand some doctors probably don't want to even try taking up responsibility.

Hope your young AIDS patient is doing good.

Seema said...

A correction to make: I wrote AIDS she is HIV+ right?

atticusfinch said...

True. The patient has as much faith in his dr. as he exudes.If the pros and cons are explained honestly, it can save more lives by preventing shifting of serious patients to higher centres. Sometimes the exertion of shifting may be enough to kill the patient.At the same time, with so many attacks on medicos, the decision whether to shift or not should be taken wisely.As you mentioned it may not be the patient's condition alone which is the deciding factor...

Charakan said...

Thank you for the comments.Good communication makes a lot of difference.It produces confidence in the doctor.Then the doctor may be able to take up more responsibility.

Seema, will post soon about that young 'positive' girl. Yes you can call her an AIDS patient as she is not just HIV positive but suffer from many AIDS defining illnesses.