I have seen few deaths from a close quarters in the family and few more in form of patients in the hospitals and I feel, my best efforts couldn't increase a day in their lives.
I have enough encounters with stage four and terminally ill patients in my earlier duty in cancer hospital. Even with a slim chance of survival, we give them a thread of hope, the thread which is breakable and perishable. We all know very well. In these group of patients, still we do cyto- reductive surgery and chemotherapy and radiotherapy.
We hardly explain the pros and cons of such doubtful therapies to our patients. Twice I have seen an oncologist advising chemotherapy to dying patients, so eager that ready to do anytime. Fortunately neither survived next day morning.
Take examples of some silly viral infections, we enthusiastically treat with aantibiotics, knowing that it is a placebo with side effects. Start from headache, toothache, sinusitis, throat pain, expectoration, chest pain, abdominal colic, leg cramps and tell me , how often there is need of genuine pain killers!
I recently scanned nearly one thousand 3D sonography for foetal malformations, with an abysmal rate of detected anomaly of less than 3 percent, with a condition to rescan at a later date! If you simply calculate Rs. 3000 per such sonography, a possible but not positive result cost Rs. Ten lakhs only, a staggering amount in a developing nation!
And there is no master to comment on the said defect and chest- beater to advise a termination! Same story goes on the x-ray, ct scan, mri, pet scan and plethora of blood tests.
And now come your job of prescribing medicines. In front of you, you have a patient clinically examined, partially investigated and improperly treated earlier and you are clueless and for a second, differ writing even a single drug, but then the realities of practice force you write a wrong prescription, you never wanted!
How to write a right prescription and satisfy self. :
1. Have confidence in the self. Take enough time to examine, if necessary investigate .
2. Talk to a colleague and share and discuss the case.
3. Call a patient at a later date, with some excuse, time buying to study and refer a case.
4. Eventhough the symptoms alleviation is primary job, consider searching for root cause.
5. You are a limited edition and the case does not fit into the sphere of your knowledge and honestly needs another opinion. Please refer.
6. Try simplest of medicines. Your approach should be honest and generous and your medicine safe and cost- effective. You may have temptations of short term silly ideas, control them!
7. Don't prescribe a single medicine, if your conscious says so. Please explain the patient, why are you not writing?
8. The right prescription should fetch you a trust , a good- will , and soul- satisfying life experience without ever bothering about competition and lack of money! No day you will sleep hungery and worried.
9.let us all remember our existence to our patients and so our survival. Writing a wrong prescription is creation of mistrust and goodwill deficit.
10. Here is a golden chance to write , if at all , a simple, cost effective, minimum, with least side effect, time- tested medicine.
Your prescription is a God sent letter in response to a prayer of a sufferer. Pen is in your hand , be careful.
Dr Ajay Shah
Date - 20 May 2018