Thanks to a doctor’s strike in response to a very obnoxious law that the State Government is intent on passing, I finally get the oppurtunity to sit down in front of a computer without the chaos that I’m usually immersed in. Kids packed off to school, no patients waiting and my ward rounds done, I sit in my OPD and wonder how to start off. Its been so long off the blogosphere, that just the thought of writing something is giving me the heebi jeebies of a newcomer climbing on to the stage for the first time.
And then, there is a discrete knock on the door. My hired help comes in to enquire about medication for her daughter’s cold. I give her the name of a tablet and look back to my laptop screen. She hovers around and finally asks ” Ondu tonic kodbahuda? (Can I give her a tonic too?”.
And gives me my fodder for today’s blog.
Practising in a smaller city gives me an oppurtunity to deal with a potpourri of patients. Some of them young, google friendly and fit bit savvy and the others who still believe that spending a few lakhs of rupees on a puja is much better than spending a few hundred on a qualified person’s consultation. The rest oscillate between the two.
Every place and its population has its own etiquette and culture which make it unique. Apart from the cultural and religious norms that we follow, there are certain illness behaviours specific to people and their mindsets. Most of these dictims are age old and seem to have no logic attached to it, but are still followed diligently. These are a few things that seem to constitute a set of behaviours that I call “patient culture”.
Sample a few of them:
- Post partum mummifying:
Just as a pregnant woman can be identified by her baby bulge, so can a post partum one (in any part of India), by her near mummified state. This special garb includes a head scarf which conceals cotton stuffed ears, a heavy sweater over a nightie which is covered by an even thicker shawl, socks, (occasionally gloves) and hawai chappals.
Never mind that it may be the middle of summer with average temperatures hovering between 30 to 40 degrees. Just looking at the woman makes me feel like taking the ice bucket challenge (which was an internet sensation) willingly!
On my ward rounds, innumerable number of times, I have admonished the relatives, made sure that the additional layers are removed and switched on the fan- only to find that the moment I leave, they sneakily get back into the same attire, tch tching about my state of ignorance about correct post partum fashion!
The lady in question accepts this with equanimity though she is sweating buckets!
2. The obsession with tonics and tonic injections (mind you, both are different and decided on by the patient, based on severity of his symptoms).
In my part of the world, patients believe that any consultation with a doctor which ends with only a prescription and some well meaning advice is a complete waste of hard earned money. Throw in a colorful looking injection and a bottle of vile smelling B complex syrup, you rise up in their eyes, as a doctor of worth.
So strong is this obsession, that occasionally, when they are strapped for cash to buy medicines, they buy the tonic and give up their antiepileptics!
I recently visited a renowned stroke center in the middle of a village in Uttara Kannada district. The center is famous for an injection which is supposed to cure stroke. Pushing through a patient line of close to 200, we met the administrator to find out what the miracle injection was. Turns out that it is Methylcobalamine (which is vitamin B12). The administrator rues the fact that patients cannot be convinced into taking physiotherapy and medication. The center does not even have a neurologist! A huge board which claims “We do not give injection for stroke” hangs desolately next to the serpentine line, with no takers for its claims!
3. The glucose panacea.
In furtherance to the obsession with injections, is the enormous level of faith that our masses have on “glucose” – which means any IV drip. Feel tired, feel woozy, not feeling like work, heart burn, heavy bleeding during your period, seizures, heart attack…. go to the nearest doctor for a glucose to solve all your problems. If the patient so much as skips one meal, the relative discretely asks me why I have’nt yet thought of the “Glucose”.
4. The concept of cold and hot foods.
Deriving directly from the concept of ayurveda is the concept that certain foods cause “heat” and “cold” in our body. When a patient innocently asks me how to cure his constipation, he gives me no clue that he knows the ins and outs of his body’s reactions to a million items on the food list. Consider this- bananas cause phelgm, milk and ragi cause cold, nothing from the fridge beacuse it causes his throat to itch, ginger and garlic give him piles and mouth ulcers, sesame and papaya are known to his give his wife increased mentrual bleeding, oily food causes cough, sour foods and peanuts give him gastritis, porridge cause flatulence, and so on. I am left grappling with a tiny list of acceptable edibles to prescibe. So much for balanced diet!
Once you accept these stoically without batting and eyelid and nodding understandingly, your are accepted as an experienced doc!
Have you had any experiences to add?