Article by Prof. MS Krishnamurthy. MD (Ayu)., Ph.D.
The blogs, magazines, news papers, radio, TV channels etc give enough knowledge regarding the health and diseased conditions now a days.
As a result, when the educated people come for consultation many a time instead of telling the general complaints and its sequence of manifestation directly the diagnosis is presented before the physicians.
Also, few of the patients directly approach the diagnostic centers and go for general bio-chemical investigations and the impressions given by the laboratories are the true diagnosis of these smart people.
Few of the available web sites give the diagnosis and special software to conclude some the probable diagnosis and as a result these ‘pre-determined medical patients’ confuse the doctors to jump into the conclusions of biased impressions. In majority of such incidences the patients’ words make the physicians to come to particular diagnosis.
Or else it will bring bias in the diagnosis. Secondly, the patients may deny the diagnosis of the physicians as the impressions or probable given by the laboratories are the highest valid report to few of these ‘sharp, smart and intelligent patients’.
What not to do with physicians during your first consultation?
Do not ask about the possibility of cure or percentage of relief.(listen if the doctor voluntarily tells something)
Do not blame or criticize the doctor or hospital to whom you visited/consulted last time.
Do not debate any matter told/explained by the physician.
Never ask about the success rate of treatment of such illness or disorders in general or in particular from his hand.
Never over react and exaggerate your complaint; also never boost about your bravery, ability, capability, influence etc
Do not give any vague answer or do not try to hide any of your illness factors.
Never tell the diagnosis or impressions of the lab reports by mouth (instead, give the reports to his hand for his reference; because many a time doctor may have to struggle hard to takeout the wrong notions you have already developed about that6 illness/condition/that particular case in his busy schedule)
If you are not a health expert do not use technical or scientific words what you have came to know from media or from other individuals (like malignancy in case of ‘bigger growth,’ acid peptic disorders’ in case of ‘chest burn or blotting or gaseous distention of abdomen’ etc )
Never ask for change of company (products/medicines), unnecessary health suppliments/tonics, change in form of medicines(unless with particular intentions to specific form of medicines),change in potency of the drugs etc
Never hide any other disease/health complaint you are suffering and the medicines followed with respect to that.
Never quote the relationship of great people/politicians/stars/actors etc if it is not at all concerned.
Unnecessarily do not bring the relation of the doctor’s relatives/friends/colleagues/classmates etc
Never ask for concession or partial payment options etc in case of fees or hospital charges etc if you are not liable or immensely helpless.
What exactly you should do with physicians in your first consultation?
Narrate all your complaints (by your own and not with others’ help) one after the other with its sequence (exact manifestation time) if possible
Explain the kind of pain, sorrow, difficulties etc in detail in your most convenient language and make it sure that your doctor is following the same.
Narrate your personal habits, mental makeup, social behavior etc (especially in chronic illness)
Never forget to tell about your food habit/capacity (including liking and disliking, loss of appetite, more hunger etc), sleep pattern, bowel habit, frequency of urine and regarding any of personal bad habits.
Mention any other kind of disease you are suffering and the medication you are following at present (in case if you are approaching a doctor of super specialty).
Explain in detail about your family relation, social behaviors, professional problems etc in case if you are suffering from any of the psychological or psychosomatic disorders.
Answer in precise about your area of residence, free time engagement, interest and concerns with the physician or his team (junior doctors in hospital setup)
Any of the matter if you are feeling shy to narrate or embarrassed ask your fellow person to disclose it in his absence.
Give in detail information about past ill-health conditions, periodic onset etc
Never forget to tell about the allergic reactions manifested earlier to any particular food or medicines.
Unless it is not an accidental or serious condition, you can write down all your complaints and can present before the doctor (if you are forgetting often)
Submit humble thanks before you leave the consultation chamber.
What are all the points to be memorized in your second and succeeding visits of consultation?
Tell about the improvement/benefit/relief first in percentage wise with respect to various signs and symptoms and later narrate any feature which is aggravated or hampered after the medication.
Mention about the impact of medication over routines like appetite/thirst, bowel habit, urine output, sleep etc
If any of the complaint if you have forgot in first visit try to include.
Do not exaggerate the benefits or negative effect of the medication/therapies.
Do not ask for repeated investigations and unnecessary super-specialty references.
Do not bring through any other patient/relative for their health complaint during your consultation unless you have taken the separate appointment for the same.
What are the common mistakes patients do in second and successive visits?
They forget to bring the earlier medicinal prescriptions and Laboratory reports. Making a personal health file is the best solution for this (in the file all reports are to be placed as per the succeeding dates)
The patients or patient’s parties do not respond in pin point manner to the questions asked by the physician or hospital staff. In follow up visits the physician cannot spend much time (like in first visit) on each case and hence the patients are required to answer to the specific questions. In few of the cases some superseding questions may be asked by the physician and all such intervals should be responded appropriately. Even with the doctors who are friendly and joyal do not tell the detail stories as it hurts the hospital staff as well as the patients who are waiting for consultation(especially who took appointment for first consultation and to those who are in critical illness conditions).
Do not exaggerate your benefits or negative results. It may provoke the doctor to change the medicine or line of treatment or to go for higher investigations. In few of the cases physician may treat you people as irritants or disobey patients and may politely (even harshly also) shift to elsewhere so as to remain safe.
People often ask for multiple investigations to know the progress, with the doctors. This may unknowingly pull towards major pit of expense. As your doctor is a best judge he gives every freedom to determine himself.
Never leave the hospital without the consent of the doctor or without paying the fee/hospital charges. Because once rejected/avoided doctor may be required to you or your beloved once to treat and you may have to meet him for one or other cause. So maintain good relation always.
In case of referred cases people often forget the initial doctor. Try to meet those referred doctors after once recovery/progress of the illness and this will increase the rapport between you and doctor.
Consulting doctor early
Do Patients Consult The Doctor During Early Stages Of Their Disease?
By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Earlier the patient consults the doctor, better are the chances of recovery. Ayurveda explains that the diseases occur due to Dosha imbalance. Vata, Pitta and Kapha undergo imbalance in a gradual manner. The process of their aggravation is explained in six stages.
Read – Shat Kriya Kala – ‘Stage-Wise Disease Management’
The stages of disease are –
- Sanchaya – stage of accumulation of doshas in their respective seats
- Prakopa – stage of aggravation of doshas in their respective seats
- Prasara – stage of overflow of doshas from their respective seats
- Sthanasamshraya – stage of amalgamation of vitiated doshas with weak and susceptible diseases, lodgment of doshas in the tissues
- Vyakta – stage of disease formation with its clear cut signs and symptoms
- Bheda – stage of complications
By implementing proper interventions to the disease in the earlier stages, the subsequent stages of the diseases can be prevented.
Read – Main Cause For Diseases As Per Ayurveda
Do the patients approach the physicians for medical care in the early stages of their disease?
In the initial two stages, due to wrong diet and habits, the doshas increase in their own places and then get aggravated.
The symptoms produced in these stages are feeble and often not recognized by the patient. When treatment is not given, then Doshas further aggravate and spread allover the body.
This is called as stage of prasara. Consequentially if this is not controlled, the doshas contaminate the tissues. The disease process begins here and shows the early symptoms of the disease i.e. purvarupas of a disease. These are the first clues for an impending disease.
If the pathogenesis is not curbed here with suitable interventions, the disease may worsen and reach stage of manifestation. Here the amalgamation of dosha and tissue will complete. The disease is formed along with its signs and symptoms.
When the treatment is neglected even after the disease gets manifested, the stage of complications is formed. The disease becomes difficult to cure and some diseases are incurable in this stage.
Read – Samprapti Meaning, Definition, Types, Examples
Why people don’t go to the doctor in the initial stages of disease?
In the first three stages since only the doshas are disturbed, we can consider the –
- Feeble nature of the disease or feeble onset of the disease process – in people with strong physical and mental strength and immunity, these disturbances might go unnoticed. These people may also ignore these conditions considering that they are temporary disturbances if symptoms occur. In these people there is a good chance of auto-pacification of doshas. These people will never come to the physician.
- The disease process in spite of being feeble might look like a big picture in those who have less strength and immunity – these people rush to the doctor or manage themselves with self medications. They may come to the doctor if the doshic symptoms are constant and intolerable or on insistence from the family and friends. There is a big chance that even these people don’t feel taking a doctor’s opinion. They may wait until things go worse and out of control.
- The disease process in spite of being big might look like a small picture in those who have more strength and immunity. These people too will never go to the doctor.
Anyway when the disease is in the earlier stages of manifestation, the disease process and the symptoms are not formed completely. The disease is in a budding stage and is immature. People may not appreciate these subtle variations in the body and mind. Therefore they will not go to a physician.
Read – Importance Of Diet (Pathya) For Specific Diseases
From the physicians perspective –
Even if the patients come to the physician in early stage of the disease, most physicians may not diagnose the conditions properly. The symptoms are too feeble to understand or they are masked.
Some doctors who have very good clinical experience may see this as dosha aggravation and treat the condition with dosha specific remedies.
Some doctors may be misled or carried over and diagnose these conditions as a disease which is in stage 4 or 5. They treat the same with disease specific medication. The history of the patient wherein feeble doshas are presented as big disease by a timid patient having less mental endurance is often misleading. Or the diagnosis from doctor’s perspective itself might be wrong. This may be due to lack of experience, exposure or due to hurry of prescribing in busy schedules
Example – in the second stage i.e. stage of aggravation of vata, pain in visceral organs and the abnormal movements of vata in the belly are the main symptoms. This condition can be diagnosed and treated on the lines of vata prakopa by an intelligent physician. On the other hand, an unskillful physician may treat it diagnosing it as shula i.e. colic or gulma i.e. abdominal tumors.
Read – Symptoms Of Vata Dosha Increase And Imbalance – Vata Vruddhi Lakshana
Similarly a patient of less strength and immunity may explain simple long standing or acute abdominal cramps as severe pain in the abdomen. Investigations and thorough examination might help in proper diagnosis. If the physician is misled, and treats it as colic, he will naturally give strong medications. These medicines are again not tolerated by the patient because they are disease specific remedies and the patient has feeble dosha disturbance.
Similarly a strong and immune person may present his colic or abdominal tumor as a mild discomfort in the abdomen. This too is misguiding. The physician might give medicines of lesser strength. This will enable the disease process to progress. This happens with mis-diagnosis or ignorance of the actual dimension of the problem.
Similarly yellow discoloration, a sign of pitta accumulation might be seen and diagnosed as an early manifestation of kamala i.e. jaundice.
Read – Kamala Roga Chikitsa: Liver Disorder Causes, Symptoms, Treatment
These are only examples on the basis of which we need to understand the other forms of presentations.
In any case either the patient is put into trouble or the physician may go under the scanner if the diagnosis is not made properly.
Small grade symptoms
It is important to see the doctor in presence of small grade symptoms for longer time –
Whether it is the first three stages or last three stages of the kriya kala, proper and timely diagnosis of the condition is the key. It is equally important that the patient takes a doctor’s opinion immaterial of the dimension of the problem. This is important especially in long term presence of the symptoms. But there is a big hesitancy on the part of the patients to go to the doctor, even in this era wherein the medical system has advanced to great heights. This hesitancy allows the progression of diseases and will contribute to the incurability, death and bad prognosis of diseases. The integrated approach of all the four limbs is very much necessary to abort a disease process or to effectively treat it.
The last three stages of kriyakala are self expressive modes of any disease; they are themselves the diagnostic tools. But a patient who goes to a physician even when there are light disturbances in the body is wise. Similarly a physician who diagnoses subtle pathological changes in the body, in the earliest stages and aborts the disease process is a wise physician.
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