Thursday, March 6, 2008


My friend Dr.B.S.Prabhakar is a busy practitioner in the inner city area. Like many other GPs who have busy practices he too finds it difficult to make house calls during his clinic hours which often extends to late nights.

When the call came requesting an urgent visit to see an elderly patient it was 7 pm and the clinic was full of patients and there was no way he could get out leaving them waiting as the caller lived 5 kms away and going by the dense traffic it would be two hours before he would return. He however couldn’t refuse the call either as the patient was an old family friend and suffered from diabetes and heart disease. He told the caller who was the eldest son of the patient that he would try and make the call around 10 pm and if the condition of the patient is very serious, he told him to shift he patient to a nearby hospital and let him know.

At 8 pm the call came informing him that the night visit was no longer required as the patient has breathed his last. This occasionally happens to us GPs because despite advise patients refuse to go and seek help elsewhere and sometimes pay a heavy price. Doc Prabhakar was now a very unhappy man with many troubling thoughts in his head. Had he gone leaving his clinic when the call came would the patient be alive, had he failed to assess the seriousness of the call, should he have insisted that they take the patient to the hospital? He was filled with guilt and remorse. These feelings remain for weeks and months and torment us and form an unpleasant part of a GP’s life.

A shaken Prabhakar did not sleep well that night. Early next morning he went to the house of the diseased with the intention of offering his condolences to the bereaved family and to issue a death certificate. Normally the atmosphere in and around the house where a death has occurred is somber and sad. This is often contrived is a different matter. One would see groups of friends and relations of the diseased huddled and engaged in hushed conversation with grave looks on their faces. Amongst most Hindu families there would also be a small earthen pot filled with burning wood emitting smoke, a sure signal to all and sundry that a death has occurred in that home and you are at liberty to take a breather and gawk.

To Doc’s surprise and some consternation, none of these were visible outside the house. For a moment he thought that the body has already been removed and the mourners had left. Then who could have issued the death certificate without which the body cannot be cremated? Would it be that another doctor was called to attend on the diseased and has he issued the certificate? This thought made him feel a bit better. These were his thoughts when he pressed the call bell.

After a while the door opened and the old man who was supposed to be dead was standing in front with a wide grin on his face. Needless to say it was a shock and made my friend take a step back.
After a few seconds when there was no speech from either party, the old man’s son arrived on the scene and narrated the following story.

‘After I made the call to you I went back to see my father. He was restless and breathing very hard and moving his hands as though to tell me something. After few minutes he stopped breathing and his arms and legs became still and he closed his eyes. I thought he has died and I called you to tell you not to come and informed the relatives and friends of his death. Within the next half an hour people began coming and one by one they started pouring spoonfuls of milk in to the mouth as is our custom. This went on for some time when we noticed it [he pointed towards his father] moving the legs and making noises. This made the relatives scatter in a hurry. I too was frightened. A little later my father got up and looked around and asked what all these people were doing? He also said he feels very hungry. We fed him and told him what all had happened. Father has not stopped abusing me since then’ the son looked appropriately contrite.

The old diabetic had missed his lunch and taken very little food in the evening. He had taken his insulin shot later than usual that day and had gone into a coma induced by low blood sugar and the family thought he was dead and the milk that was poured into his mouth had revived him!

The old man lived for another five years and didn’t do any repeat performance and when he did die it was dead certain.


Anonymous said...

From Seetharam.
I have a suggestion to make. If you have five patients in your clinic and you get a call like what Prabhakar recd, attend to all of them quickly but do not charge them. Give them a quick treatment by way of a medicine for pain relief or whatever. Tell them to come the next day explaining the urgency of the situation.I am they will understand and will definitely come the next day. After all you have to earn your livelihood too. By this you will have spent less than ten minutes on the five patients and will still have made the house call.

Anonymous said...

It is easy said than done.Quick dispoasal is impossible.It is not the question of fee. It may mean missing out some serious illness and patients woulD have travelled some distance to see the doctor or would have taken leave from their work and come and they will not take kindly to the doctor disposing them off in a hurry.
Most will gorgive if the doctor were to make an emergency call and leave them waiting but not sending them away!
But most doctors which includes me avoid such calls unless convinced that our going there will help the patient.Such cases are not common but do occur as it was in this case.These days one can determine the seriousness or other wise by phone and when serious it is better to get an ambulance to go rather than waste precious time in reaching the pateints home.
There are other problems
It is not safe to drive in the city especially at night
Crank calls are not uncommon
During the day in the city it will take hours to reach the patient's home.He may be dead waiting for you!
Still, we do make calls but mostly in non clinic hours
The incident nerrated occured more than ten years ago. matters are worse since!

Anonymous said...

I feel ideally they should have taken the patient to nearest hospital,rather than asking their family doctor to drive all the way.Infact sick patients chances of survival is more in the hospital than home despite doctors presence at home as doctor can do really something but not to the extent what is done at home.Just we can not ignore about desposing patients at his clinic infact saving one day to visit doctor these days is quite difficult.