Monday, February 22, 2010


B.P are his initials. His expanded name is Badri Prasad. I called him BP as visits to me caused some anxiety and raised my blood pressure! He did not mind me calling him BP and the name stuck. It must have been twenty odd years since BP became my patient. During these long years BP must have seen me some five hundred times. Every practice has a percentage of patients who have no real disease [or we have not found any] but have plenty of symptoms.

Twenty years back, when he came for the first time it was for radiating chest pain. The history was so typical that I thought he must be having a heart attack and told him to get admitted under the care of a cardiologist. BP was unmoved; he slowly took out a folder and placed it in front of me. In side I found reports of every available test for heart disease available in the city at that point of time. All tests were normal but BP continued to have pain. I then said it could be something wrong with his neck which could be causing the pain. He took out another folder and gave it to me. It had all the reports pertaining to his neck. There was another folder which had investigations pertaining to his liver, stomach and gall bladder. All were normal. I asked him what medications he was taking. He showed me a list of seven medications and none really required. I told him so and asked him to stop all of them and see what happens.

He came a week later and said he felt much better and wanted to get his BP checked. After getting his BP checked he would not leave. He requested me to feel his abdomen as he was feeling queasy. That done he most reluctantly took my leave with the parting threat that if things are not alright he would soon be back.

Things can never be alright all the time. Many minor ailments we are privy to, are self limiting and we don’t go to the doctor. BP did. In the course of time it became a habit and after due examination I would say,’ you are OK’ and he would go till next time which was not far away. My worry was in the midst of this normal would I be missing something serious? [Every physician’s nightmare]. Another problem was his habit of consulting all kinds of doctors and then reporting back to me to find out if he can follow the advice given. More often than not I said in the negative and he would ask why. This entailed often laborious [to me] explanation. He would go but would leave behind a lurking doubt in my mind what if the opinion given by another doctor was right!
Now you begin to understand why I would become anxious with his visits. You are justified in wondering why I put up with him and not refuse to see him. Times without number I must have told him, ’BP, you are wasting your money and time, I cannot help you, please stop coming to see me’ His reply was ‘it is my time and my money, why are you bothered’! This unhappy state of affairs continued till fate intervened to solve the problem once and for all.

BP died some time ago due to septicemia [virulent infection] unrelated to his myriad complaints. He was 75. What were my feelings on hearing of his death? Mixed. Relief that I do not have to suffer him and that a troubled life ended and some sorrow that I would not see this familiar figure with his huge bundle of medical records. I confess relief more than sorrow.


Anonymous said...

Good stuff.
Dr.B C Rao,could you please give some insight into rheumatic fever. I hear you have treated couple of patients successfully.

Anonymous said...

Surely, there must be some kind of psychiatric treatment for hypochondriacs-and save trouble for doctors ?

My thoughts said...

Difficult to answer in the short space available but I will try.
Rheumatic fever is caused by an allergen released by the germ called streptococcus hemolyticus. This allergen [antigen] shares some antigenic similarity to the tissues present in the heart muscle and joints.So the antibodies that the body produces in an attempt to counter this antigen, go and attack and this attack takes place in the heart and joints of our body.
So rh fever produces symptoms realting to heart and joints.
Years ago General Practioner names Ducket Jones laid some basic rules for diagnosis of Rheumatic fever which go by his name and followed even to this day. Early diagnosis and treatment with penicillin prevents damge to the heart and joints.Long term penicillin therapy still remains the mainstay of treatmnet.Damaged heart valves may need repair/ teplacemet, many years later.
Streptococcus is a friend of the poor who live in crouded communities, especially childern.Thus you find this illenss rampant in developing countries with poverty and overcrowding and lack basic public health.It has almost disappeared from developed countries!

Anonymous said...

Thanks Dr. Rao for your inputs on rheumatic fever.What are the symptoms? A son(12yrs) of my friend seems to have some pains in joints and finds it difficult to close his fingers into a fist and feels very irritated at times..! Hes been made to undergo various tests and looks like the diagnosis hasn't come to any conclusion. Can you, if you don't mind suggest a good GP to visit in Indiranagar area?
Would appreciate a feedback please.

My thoughts said...

Pain in finger joints is not due to rheumatic fever.One should look for other illnesses.
The only GP i can think of in Indiranagar area is yours truely.
Being an old hog who has lived in this area for over thirty years it should not be difficult to trace me!