A patient walks into the consultation suit in an upscale cliniq of a south Indian Metro.
Good evening doctor !
Welcome . . . what brings you here ?
Doc , I have a vague chest and back pain since two days . It had been a strenuous week . . . I had to travel a lot ,
I am worried it could be a heart attack
Let me examine you ,
(After the examination )
Will you please lie down for an ECG ( Records it in a minute , Glances it )
Every thing looks fine , i believe you are under some stress and I am sure it is a pain from your muskulo – skeletal system
You should be alright by few days . I will prescribe some pain killers .
It is not uncommon to find a patient wear a doctor’s mask
Doctor , why don’t you prescribe a 10 second 64 slice heart scan*, I just saw an ad in yesterday’s “Times of India”
I want to confirm every thing is fine with my heart doc , I believe there is a special World heart day offer too !
You will not need a scan for that ! I can confidentially rule out a heart problem right now , and you can schedule a exercise stress test later.
You may sure doctor , but I am not !
Please , will you advice a scan for my satisfaction ?
It is not correct for patients to demand investigation . . . thinks for a moment . . .umhh .. yeh . . .ok . . . any way I will do just that . . . after all we are here to satisfy you.
By the way , you take the scan in this a particular centre , (Let me also benefit by your foolishness ! )
Thanks doc , you are really great ! upholding the dignity of the noble profession !
(* A single 64 slice CT scan of heart is equivalent to radiation of 100 chest x rays , which is equal to a life time dose of medical radiation)
Can a patient demand an investigation and a prescription ?
It is an awkward question . Our medical schools do not teach about these issues. If the answer is yes , it would be diagonally opposite against the principles of practice of medicine , It is same as self medication with a non academic ratification by the doctor !
The patient guided medical practice has a niche market by itself . Now patients tend to ch0ose not only hospitals and doctors but also they want to decide the investigation and treatment as well , fueled by crazy mass media advertising . It all started with from simple master health check now extended into all common disorders.
And no wonder . . . future looks bright for medical practice .
**Please note : When the treatment is debatable and outcomes are not clear in certain complex diseases , one has to involve the patient and their relatives with an informed consent and allow them to make a learned decisions.This is an acceptable form of patient and family guided disease management.
Dr.S.Venkatesan MD 