Dr Zeba Hisam (MBBS FCPS)
I am always amazed at people who do not have a family physician from whom they can seek medical advice, when they are ill No matter what is the nature of their health problem, there is no family physician to decide if there is any need for a referral to a specialist. Even patients who are educated and are from the privileged class declare proudly that they do not need a doctor as they have not suffered from any disease. In this scenario, if any emergency arises, they panic and seek an immediate appointment from the most renowned and famous specialist they can think of.
My observation is that the more affluent and educated a person is, the more awkward he feels in seeking medical advice. He decides himself which specialist he should consult. His choice sometimes proves to be wrong.
I remember when I was a little girl, my father had a family physician to whom all my siblings (small and big!) were taken whenever we felt sick. I still remember that old graceful, white bearded doctor, who was always reading from a huge open book of medicine on his table whenever I entered his room with my parents. (My father belonged to Kanpur, India, and migrated in 1948).
My father told me that our family physician, Dr. Abdul Samad, also migrated from Kanpur and he graduated from the first batch of King Edward Medical College. During that time, the standard of education was so high that despite having no post graduate degree his MBBS degree had given him enough expertise in clinical skills to make correct diagnosis of heart murmurs and any neurological disorder.
When I grew up, my father told me that a child in my cousin’s family had breathlessness. When Doctor Sahib examined him he asked us to take him to the cardiologist. When the cardiologist examined that child, he could not find anything abnormal so he sent that patient back to Dr Abdul Samad. The old physician called up the cardiologist and gave his findings of the child’s clinical examination and diagnosis of a heart murmur, which was later confirmed by the cardiologist who sent the patient for valvular heart surgery. That was the level of the clinical examination skill by an MBBS doctor in the 1970s.
Dr Abdul Samad inspired me deeply. it was my wish as also of my grandmother’s that I should become a doctor. But I know where the inspiration came from.
Because of him my parents got the right referrals. My father was guided to the cardiologist but when my mother developed severe shoulder and arm pain, he referred her to a neurologist. My parents returned to him to brief him about their consultations. So he was well aware of his regular patients’ histories.
Today the doctor’s fees also repel patients and the avoid a consultation. This is strange when one sees how much they spend on clothes and eating out but shirk a visit to the doctor. Many even believe that doctors have no empathy for the patients. This may be true of some doctors but not all.
So one should search for a doctor that one can trust and then that doctor can be one’s family physician who is available in an emergency.
I categorize patients into two. First are those who have a positive attitude towards health and disease. They take good care of themselves and get to their doctor at the right time and undergo investigations he advises. If lab reports are normal, they feel satisfied and happy. If they are sick, they recover easily without many complications.
But there are others who are pessimistic, delay their visit to the doctor and suffer more. If the doctor advises investigations and they turn out to be normal, they think the doctor had wasted their money. We doctors have no magic stick to make anyone healthy by listening to the complaints only. We have to first clinically examine the patients for any clues to a specific diagnosis and then exclude the diseases with appropriate tests.
I should also mention people who acquire a doctor’s consultation on phone if they get to know the doctor’s number. They seek immediate advice about the name of a drug, which will solve their problem without realizing the need of a physical examination by the doctor!
Here people first try self-medications including self prescribed antibiotics. This is the reason for the emergence of very resistant bacteria of even easily treatable infections.
People have no awareness of taking care of themselves if they are declared hypertensive, diabetic, or have high cholesterol. They are told about the complications but they do not understand that these diseases are interlinked and can lead to heart disease, heart attack or stroke if not properly controlled. Even educated patients think that blood pressure medications are taken on a “when needed” basis. If they feel some symptom or check their blood pressure and find it to be high they take their medication otherwise not. They take expensive medicines but do not understand that diet and exercise are as important and also come free! Quitting medications for blood pressure, diabetes and high cholesterol is a norm for many patients!
It must be remembered that for a correct diagnosis to be made, the patient’s history is more important than anything else. Next comes his/her physical examination by the doctor, followed by laboratory tests as advised. So relatives and friends seeking a consultation on the phone should attend a clinic for a check up.
The writer is consultant physician,
Zubaida Medical Center
Head of Department Physiology
Fatima Jinnah Dental College