Thank You Doctor!

bigstock-young-child-holding-thank-you-37152475The signboard which clearly stated that it was the office of ‘Dr. Nausheen Khan’ glistened after the compounder wiped it with a damped cloth. The nailed signboard was the only thing that made that ugly wooden door worth looking at. It was the 1st of July, 2016 and the cuckoo clock was readying itself to make that annoying noise that it always made when the time was 9.00 am.

The waiting area had already accommodated 3 patients and a kid who was busy saving Mario’s princess on his Gameboy. ‘Umair’ the sticker which was on the back of his Gameboy read. The wait of the patients didn’t last long and at 5 past 9, Dr. Khan entered her cabin. After a minute or two, the compounder came out of the cabin and told the woman who was combing the kid’s hair that she could go in and see the doctor.

The woman, who must be in her early 30’s told her son, Umair, that she’ll be back in 10 minutes and to not go anywhere. He nodded, without even paying heed to what had been said to him. 8 minutes passed since his mom went inside the cabin but Umair was still not able to clear the stage on which he had spent the past 30 minutes. He got irritated and reached for his bag which sat upright on the seat beside him. He threw the Gameboy inside his bag carelessly and started searching his bag for something.

He seemed to struggle with whatever he was trying to find and finally stopped when something purple in color fell from his bag. He kept his bag on the empty seat beside him and got up to pick up the thing wrapped in purple paper. Just as he bent to pick it up, something else caught his eye. Only a few steps away from him was lying a piece of paper which seemed more like a pamphlet. It had footprints over it, raising questions about its importance.

He picked up the purple thing and then directed his countable steps towards that paper which had been abandoned by someone. He picked it up and shrugged off the footprint from it. ‘Happy Doctor’s Day’ he mumbled to himself while carefully examining the sheet of paper. It had that day’s date and ‘Have you thanked your doctor today?’ printed on it. He heard the cabin door open and turned around to see his mother coming out.

‘You still haven’t eaten the chocolate? If you didn’t want to eat it then why did you create such a ruckus at the general store that time?’ She said in a condescending tone. She grabbed his hand and started walking towards the exit. Umair, with an innocent smile on his face, freed his hands and jogged towards Dr. Khan’s cabin.

Before his mom could utter a word to stop him he had already opened the door of the cabin and was greeted by an expected question from the doctor. ‘What happened son?’ She asked. With the innocent smile still intact on his face, he moved towards her and gave her the chocolate wrapped in the purple cover.

She took the chocolate with a surprised look and let her mouth speak her mind. ‘What is this for?’ She asked in a happy tone. ‘I just wanted to thank you for keeping my mom healthy’ and after a pause ‘Happy Doctor’s Day’ he gratefully said. Dr. Khan was awestricken and wasn’t able to find words for a reply.

She wiped a tear which purposely kissed her cheek, revealing the impact that gesture had on her. All she managed to say was ‘Thank you’ in very soft tone. Umair gave her a smile which revealed all of his 25 teeth and merrily walked back to his mom. Her mom, patted her son as he came and said ‘Come, let’s buy you another chocolate.’

They left the clinic and so did the footprint on the paper. Both left a lesson behind.

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5 Ways To Step Up Your Patient Interaction

Communication between a patient and a doctor is a key factor in determining the course, duration and outcome of a medical treatment. When a patient approaches a doctor for help, it immediately places the physician in a position of power. Patients are supposed to open up with their most intimate details and shed their inhibitions for the physical examination. While this position of power and complete surrender of patient helps a lot of times in diagnosing the diseases and comprehensive examination, it also leaves the patient feeling exposed with a developed mistrust for the doctor.

When the doctor patient interaction is only one sided with the patient asking the questions and the doctor answering them, it leads to miscommunications and substandard treatment with unwanted outcomes.

Take for example MDR TB. On talking to doctors in government hospitals it was found out that due to insufficient time patients were not counselled properly. This led to an increase in defaulters who wouldn’t complete their course of medication. This has ultimately led to an epidemic of sorts of MDR TB.

So how can we improve patient interaction? Read through to find out.

  1. Listening rather than asking:
    A patient comes with a lot of apprehensions and more often than not they have a lot to tell the doctor about their problems. This leads to doctor dismissing a lot of these as unnecessary talks. A streamlined approach towards a problem is undoubtedly required but a patient is not a problem to be solved. Listen to them instead of cutting them off mid way.
  2. Addressing patient query rather than dismissing them off as trivial:
    Patients come to you for help and have a lot of doubts. Let them ask their questions and be content. Disregarding their questions would make them feel inferior and you might shut them up from asking any more questions in the future.
  3. Giving ample time:
    Give time to the patient you are examining. Yes there is rush and you are busy, but the patients are exposing their vulnerabilities to you. Let them feel wanted and not just another problem on your conveyor of patients.
  4. Dress to impress not intimidate:
    Dress according to the patient population you are catering to. If working in a modest neighbourhood, dressing up demurely would help to build confidence. Also it’s time to ask ourselves if the white coat is enhancing doctor patient interaction or intimidating it.
  5. Use simplified language:
    Chuck the jargon of medical science in front of patient. Don’t use scientific terms, patients are more comfortable with laymen language. They have a red patch not erythema, swelling and not oedema. The big words make the patients feel like they are on their deathbed. Please don’t tell a patient he has pharyngitis, just say it’s common cold. And of course don’t forget the Smile Language!

This article is written by Dr Prerna Motwani. You can read more such articles here.

Patient & Provider Delays in the Management of Breast Cancer in India

A study, which I conducted during my undergraduate years titled “Patient and provider delays in breast cancer patients attending a tertiary care centre: a prospective study” was published in the Journal of Royal Society of Medicine. This study was conducted in a government hospital at New Delhi, where majority of the patients were from the rural background. Patient delays are a well known fact and more so in breast cancer due to the apprehension shared by many Indian ladies regarding the examination of their breasts. It was not surprising to see that there was an average delay of around 70-75 days was observed in these patients, after the onset of symptoms till the time of the first consultation.

Adding to these patient delays,  63% of these patients first contact after the onset of the symptoms was with an unregistered medical practitioner (quack), which led to further delay in the diagnosis of breast cancer. Another shocking fact was that an average of three consultations were required before the diagnosis of breast cancer was made.

These points clearly highlight why the incidence of locally advanced breast cancer in India is so high!! This along with the aggressive biology of our tumors (high incidence of triple negative tumors), spells doom for most of the patients.

What are the steps which can be taken to avoid these delays in diagnosis?

  1. Spreading awareness about breast cancer: With communicable diseases gradually being controlled in our country, cancer is the next big epidemic which India is going to face. Proper steps need to be taken now to ensure India is ready to face this next big challenge. Awareness about Breast cancer should be increased among Indian women and I feel that Obstetricians and Pediatricians have a huge role to play in this. They should educate ladies regarding breast cancer during their pregnancy and follow-up visits.
  2. Improving the literacy level: In our study, we observed that literate patients were more likely to consult a qualified doctor and the time lag between the onset of symptoms and the first consultation was less in them as compared to illiterate ladies.
  3. Educating Primary Care Doctors: Although patient delays were largely responsible for the late presentation but there were instances, where breast cancer were not detected by primary care doctors. Special sessions should be conducted for these doctors to make them more aware about the signs and symptoms of various cancers.
  4. Hunting down quacks: Quacks lead to unnecessary delays not only in the management of Breast cancer but also other illnesses and our government should take appropriate measures to end this menace.

I know it is easier said than done but with these measures we can certainly cut down the delays in the management of Breast Cancer in India.

No delay

 

Goldilocks Mastectomy – Will it have a fairy tale ending?

Goldilocks mastectomy is a relatively new procedure developed by Dr. Grace Ma and Dr. Heather Richardson. This is a single stage procedure, which gives women facing mastectomy an option that takes the best features of having and not having reconstruction and combining them into a single procedure. This procedure has been a recent topic of debate at many scientific gatherings.

The first question which pops to the mind is that why was this surgery named as Goldilocks mastectomy? The following is the reply given by the surgeons who developed this surgery:

“Most of us are familiar with the story of the young girl faced with uncertainty in the woods and with a big, bad wolf nearby. She had many choices to make, and each time she face a choice, she evaluated the pros and cons; risks and benefits of each one.  Most involved extremes -too hot or too cold; too hard or too soft. But there was a third choice that had attributes of both and fell somewhere in the middle. This was considered “just right”.

We chose this name because this technique embodies the simplicity of not having reconstruction and only having a single surgery with as little as possible discomfort and down time. Yet it preserves as much of the patient as possible and avoids an amputated appearance.

For those who still aren’t quite as large as they would like to be and choose to wear a prosthesis, wearing a bra is much more comfortable and the cleavage much more natural appearing.  Redundant tissue under the arm is avoided and the final result very soft and supple.

When discussing the different choices and options pre-operatively, it is easy to remember what a “Goldilocks” is and how it differs from mastectomy with and without formal reconstruction.”

Not all patients are eligible for Goldilocks mastectomy. It is mainly suitable for patients with large breasts, who have enough tissue left behind after mastectomy, which can be used to reconstruct the breast. It is NOT suitable for patients with small breasts!!

The following are the advantages of this procedure, as highlighted by the surgeons on the website (www.goldilocksmastectomy.com)

  • Can be performed on one or both breasts
  • Can be performed for prophylaxis or treatment of disease
  • No additional surgeries are required
  • No implants or artificial devices are used
  • Decreased pain and shorter recovery time when compared to formal breast reconstruction
  • Surgical removal of breast gland under the skin means:
    • No screening mammograms required
    • Most patients do not require radiation (dependent on the stage of disease)
  • Excellent option for patients who don’t want reconstruction or are otherwise poor surgical candidates for formal reconstruction
  • Patients with extremely large breasts or sagging breasts have the best outcome from this procedure

In this procedure, all the breast tissue is removed and the remaining redundant skin and tissue is mobilized and used to reconstruct the breast, which is usually much smaller than the original size and also in some cases deformed.

As it is a relatively new procedure, long term data is yet to reveal the efficacy and safety of this procedure compared to the conventional mastectomy. Another point which I could gather after reviewing the limited data available on this surgery is that cosmetic results are far INFERIOR than a regular reconstruction (whether implant based or autologous). Another reason for its limited use is that it can only be used in patients with LARGE breasts and a point which has not been highlighted by the authors is the gross disparity in size of the two breasts after the surgery (which is a source of worry to the patient).

It is still early days for this procedure and only time will tell whether it will have a fairy tale ending or not!!

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Chemo curls – Some like them, some don’t

Curls

 

Hair loss is a common side effect of most of the chemotherapeutic drugs used in the management of Breast Cancer and this period is quite traumatic for patients. It takes them some time to adjust to their new appearance, but their problem does not stop there.

After chemotherapy, majority of the breast cancer survivors start curly hair and no one exactly knows the reason behind this. This trend is universal and not restricted only to India. There is a lot of information about this on the net but no one exactly knows the scientific explanation behind this phenomenon. After reading a lot of survivor stories, I could infer that the texture of the hair after chemo is certainly different from a patient’s original hair and although some patients experience slight improvement in the quality and texture of their hair over time, for majority, this problem is life long.

For some patients, hair growth after chemo is a morale booster and they welcome this hair growth, without being concerned about the texture and the quality of hair. But for some patients, managing these curls can be quite a problem. It takes them a long time to get used to their new appearance and new hairstyle.

The following websites provide more information about chemo curls and how to manage them

http://www.naturallycurly.com/curlreading/living/curls-after-chemo-hair-loss

http://www.naturallycurly.com/curlreading/living/chemo-curls-a-survivors-tale

http://www.nbcnews.com/health/chemo-curls-another-kink-cancer-recovery-1C9386921

Our Pink Crusader

Chemo curls

New meaning of ‘Trust’

Skydiving in UK

Skydiving in UK

Like most of us during childhood, I also wanted to fly and as I grew old I thought that Sky diving is the closest I am going to come to flying. During my visit to UK for my MRCS convocation ceremony, I decided to pursue my dream and booked a jump at Hinton Airfield (close to London).

The whole skydiving experience was amazing but it taught me a very important lesson about TRUST, which I felt was applicable during cancer treatment as well. Although comparing skydiving to cancer treatment would be like comparing apples to oranges but I would try to draw some comparisons to make my point.

Jumping from an airplane at 14,000 ft strapped to an instructor whom I had met for the first time that morning was a terrifying proposition but to fulfil my dream and I  had to trust him. I was completely dependent on him to make it a ‘once in a life time experience’ and MORE IMPORTANTLY get me to the ground ALIVE. Similarly, a patient diagnosed with cancer approaches an unknown doctor (unless the patient comes from a family of doctors) to help them battle the disease and help them live. Trust in both cases is of paramount importance. In my personal experience, I have seen patients who have trusted the team of doctors doing well and suffering from less anxiety and side effects as compared to patients who shop for doctors and delay their treatment because of that.