A patient always like to hear reassuring words from their Doctor.
A doctor is also happy to see the smile of relief on patient's face.
I reassure my patients a lot.But some times I ask myself
Am I reassuring too much?
The other day in my practise it was a day of reassurance.
First patient was a 29 year old woman,in the last few weeks of Pregnancy.She was diagnosed to have Gestational Diabetes.She is working in one of our Metros and was under the care of a specialised Gestational Diabetic Clinic there. Now she has come home for delivery and wanted me to look after her Diabetes.
She was on Insulin, 3 injections per day and was monitoring her blood sugar every day 2 to 3 times at home with her glucometer. She was given a long list of dos and dont's and a detailed diet chart.She was following everything perfectly.
After reading her reports I looked in her face.She seemed to be distressed. I asked her what was troubling her. She said her blood sugar is fluctuating very much and is afraid her baby will be harmed. She also said instead of gaining, she was loosing little bit of weight and is worried about.
The blood sugars were fluctuating but with in a narrow range and was well acceptable. When ever a small rise in blood sugar happens she is much worried that she reduces food intake. Some of the diet restrictions told to her from her speciality clinic was extreme and had not much scientific basis. Her mother is also confused about what food her daughter should be given. All the home grown wisdom of what to give and what not to give for a pregnant daughter was set aside and they were religiously following the diet chart.
I smiled at her and said " You are worrying too much. Your blood sugars are excellent and I am sure you will have a healthy baby and a normal delivery. Yes, you should regularly check your sugars but eat more liberally. Tell me what you really like to eat and I will tell you what quantity and how often you can eat your favourite dish."
That reassurance visibly made her happy. By next visit she started gaining weight and more importantly was at ease. I hope she will deliver normally a healthy child.
Next patient was a retired Government Clerk. He came to me few weeks ago with features of Cirrhosis Liver,probably due to alcoholism. He was send to a Gastroenterologist for detailed evaluation and was found to have severe Liver disease. He has come back with the reports.
"Is it really bad doctor?"
"Your Liver is affected by your drinking".
"I stopped the day I first came to you. Will the Liver function improve?"
"If you do not drink again you will definitely improve, don't worry", I said looking in to his eyes.
That was really not the truth.The reports showed he have irreversible liver damage and his liver function may deteriorate over several months to years. But his symptoms will temporarily improve with medicines. That's why I could confidently reassure him.
My answer I am sure made him feel better.
Third patient was a 64 year old Rheumatoid Arthritis patient. Her knee joints were so much destroyed that she needs Total knee replacement for both knees. Her family was not very well off . I had discussed it with her son and the family was not very keen to find the money for the surgery.
"Will I be able to walk properly and climb steps doctor?" She usually ask me.
" Let us see. You are showing some improvement.So if you continue the treatment......let us see."
In my mind I was sure she will not be able to walk properly. I had hinted to her once about surgery which she refused immediately citing old age. Also the family may not be able to afford it. So she will most probably go on like that using a walking stick, moving very slowly,swaying her body to either side till her death.
But each time she leaves my room, she is satisfied with my reassurance.
Am I reassuring too much?
Some times I do, hiding the gravity of the illness so that the patient is not too much upset. Some time I reassure prematurely before arriving at the diagnosis to avoid unnecessary mental tension.
Making the patient fully aware of the situation may help in avoiding future surprises.It may also help in compliance with therapy. So should I change my method?
I am confident I did do the correct thing in all three instances.
As the great TB physician Dr Edward Trudeau said
"To cure sometimes, to relieve often, to comfort always,"
should be the motto of each Physician.