Thursday, November 27, 2008

Mistaken Identity

I have always kept records of my patients. The records are with the patients unlike other doctors who keep records with them. I make the patients keep their records for two reasons. One it helps me to conserve space in my little clinic and spares me the bother of searching for the file when the patient visits me. Those of you who have no knowledge of the working conditions here need to be enlightened. Unlike other countries most of us have no receptionist/secretary/recordkeepr/assistant that takes care of these matters. Here, in most solo practices the doctor is all in one. He is the baby sitter, bottle washer and cook cum housekeeper. At best he may have an assistant to help keeping the patients to order in the waiting area and protect the doctor from unforeseen problems. Not unlike a bouncer in a bar [I am exaggerating this a bit]. Records with the patient also helps the other doctors because our patients go shopping form one doctor to the other and the records help the other doctor in not committing the same mistake that I probably did and other details of past illnesses and medications that he has had.

This also has several disadvantages. One major one is that patients need training to bring their records with them each time they come. In a generally indescilplined population such as ours it is tough to get them to do it. In some cases they are just incorrigible and it is impossible to get these to maintain records. But it is to my credit that most of my regulars do maintain records and it is a pleasure for me to see case records dating back to mid seventies! Some do bring their records but not always. There are reasons. Misplacement and no time to search or they would have come from office and have not gone home to get the records are common explanations for not bringing records. But one who did exasperate me by not only in not bringing records but also by the regular irregularity of follow up is Mr. Jayaram.

Jayaram is a chronic asthmatic and those days, asthma was one illness which kept us literally on our toes. The maximum number of house calls and night visits were made to see patients with acute asthma. If I remember right the only inhaled drug available then with some effect was Cromolyn. Inhaled steroids which have virtually eliminated acute asthma in my practice now were yet to make their advent thirty years ago. Mr. Jayaram who is now sixty five is so well controlled that he rarely visits me. Those days he had to see me regularly and I had to meticulously titrate the drugs to keep him free from distress. But regularity was not a word in Jayaram’s dictionary. He chose his day and time which was when his wheeze became worse. When he came with breathing difficulty I used to get wild with him. The reason why I wanted him to come regularly was precisely to avoid this distress. I used to administer injection of adrenaline under the skin ever so slowly and the results would be dramatic. The patient got immediate relief but also would have severe head ache, his heart would race and often he would vomit some times on the nearest person which was I. Though I hated using this drug I used it often enough and my friend Jayaram was one of these recipients. Despite my telling him that he can avoid these if he came in for regular follow ups, he persisted in being errant. Worse, he always had a valid excuse. I held my abuse at bay till the distress was relieved and then would let him have it. Those days I was called with some justification, ‘a good doctor with a short fuse’. With age and experience and mainly due to my forgiving patients, I have now become a doctor with longer fuse but I am aware that the fuse still remains.

Jayaram has other interesting characters. He was always smiling. Even when he came in distress he had that smile. This smile occasionally got on my nerves. When I am discussing some important issue I don’t want my patient to be smiling vacantly at me. He was always well dressed in contrast to my wayward dressing methods. He sported a goatee and a moustache which were confluent and in addition had bushy eye brows. All this combined gave this small time contractor, the looks of a distinguished college professor.

So, when he came again with one of his acute attacks and after the tiresome administration of adrenaline and relieving of his attack I asked him for my file. His face was blank. He said,’ what file? ‘The file with your records which you are supposed to bring with you’ I said. ‘You gave me no file’ he said. This irritated me no end. I wondered whether his asthma attack has made his memory lapse or is he feigning? I, after numerous encounters with him could not put this beyond his capabilities. I insisted he does have the record file and has forgotten to get it with him and is now pulling a fast one on me. He said,’ really doctor, you have not given me any file, last time I came you gave me this paper’. He showed me a note which had a prescription and his name. The way he said this made me take a closer look at him. This was not my old friend and tormentor Jayaram but his look alike! Except for a few additional greys in the goatee everything else was the same, even the voice. I looked at the prescription, the name read Charan Shukla. This north Indian gentleman bore an uncanny resemblance to my errant friend Jayaram and has suffered from the same illness. The reason why he did not have a file is that I had not started one as yet in his case. How is it that I missed the resemblance last time he came over? I apologized and told him of the resemblance and wondered how I could have missed it last time he had come. He said, ‘Doctor I have grown this beard since the time I met with you last!
So a clean shaven Shukla looked different from the bearded Jayaram and with the beard they were virtually same. My apologies were well accepted and a grateful and relieved Shuklaji took my leave.

Few days later Jayaram arrived once again in an acute attack of asthma. Before administering any drug I asked to make sure that he is not Shukla, even in his distress he gave me a worried look and said, ‘ sir don’t you know me? I am your old patient Jayaram and not Shukla; I have come here so often’. Thus confirmed that there is no mistaken identity, I asked him to show me his file [after giving him the dreadful adrenaline]. As usual he had mislaid the file and did not know the dosage details of the medications he was currently on. His bashful grin raised my heckles. I gave it to him and told him to find another doctor and stop bothering me hence forth. He stood there for some time looking at me. For a change his grin had gone. I would not talk. He waited for a while and went out. I thought to myself good riddance, I don’t have to deal with this fellow any more.

I got busy with the waiting patients and an hour or so later, finished the morning surgery.
‘Sir, may I come in’ my friend and tormenter Jayaram was at the entrance. He asked me,’ sir are you still angry?’

Looking at the grinning face, I could not help but laugh. He promised to come on time next time and surely would bring his records without fail.

I don’t have to add that he remained as errant as ever. Now he rarely gets severe attacks and takes the inhalers regularly and at 65 his health is better than when he was 30, thanks to the advent of inhaled corticosteroids.

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