The Bone & Joint Clinic

Patient Heal Thyself

The whole purpose of medical science including, the diagnostic & pharmaceutical industry is to effect Healing. Who actually heals the patient? Many Doctors write in their office,-I treat ,He cures. Thereby implying that though, Doctor can,after due examination & lab. Tests, prescribe drugs or do Surgery but it’s the grace of God that cures. So again who heals, the doctor, drugs, surgery or God.?Perhaps all contribute to healing. Including the patient’s family & certainly the patient too. A little understood fact is that patient too plays a big role in his/her healing & that is what I want the patients to understand.. Many would say- every patient wants to be healed. That’s true; but not all patients are willing to put in the effort required to effect healing. To recover from any illness , a lot needs to be done, spending money on treatment is the least part. The doctor, patient &his family have to put in lot of team effort.The team usually being led by the doctor. A common mistake on patient’s part is unwillingness to devote time to the process of recovery.They tend to think, visiting the doctor& taking medicines is enough.Having spent some money,patient begins to feel he is entitled to recovery.Actually the patient has to do a lot more than spend money.Spending money is the least & easiest part. In this fast-paced world lot of lifestyle changes are reqd.. commonly prudence is needed in drinking, smoking, eating& exercising.A man who has spent 40 yrs. drinking, smoking & eating rich food is loathe to change.I commonly tell my patients, I am a doctor not a policeman. I can only advice, not enforce it. If you don’t follow the advice, 10 yrs. from today, you might be sorry. Here I would like to mention a patient, who is around 60, overweight,enjoys his drink & smoking . This gentleman had arthritis of knee along with backpain. Every few months, he would enter my chamber smiling & just say, again- the same thing.As a doctor even if I know the diagnosis,I have to do physical examination of the patient. As I would sit down to write the prescription, he would put on a innocent smile & say”Doctor I can not leave smoking or drinking ,but you have to manage the situation; as I cant walk even 50 yards.O.K., So I write a prescription & also advice physiotherapy.His instant retort,”doctor ,I have no time to come for physiotherapy,can you send some one to my home.Still ok. I sent a Physiotherapist to his home with instructions, to make sure the exercises are done in front of him, as many patients try to escape from this ,by telling the Therapist, you tell me the exercises, I will do them later.When actually , they want to avoid exercises altogether.Later, I asked the therapist- How was it;And the reply invariably would be,Sir, he paid no attention.All the time the Therapist was there he kept discussing business on phone.Thanked & paid the money to Therapist. Two weeks down the line, he is again sitting in chair in front of me & saying brazenly,” Doctor there is no improvement.”for such patients I have practice of painting the picture from the bedside of a terminally ill patient.I request you to read it carefully, because this is the truth. In a major hospital, when a consultant visits a terminally ill patient.You pick up the file.In front of printed word Diagnosis on the file, there is not one word mentioning the illness but 3-4 lines which may go like this-“Diabetes with Hypertension with Cardiomyopathy with endstage Renal failure with severe Osteoarthritis of both knee joints &Lumbar spine”.Family will tell you it is more than two weeks since patient sat & more than two months since he walked last.To the question-has he taken treatment regularly-answer would be, doctor we have visited every major hospital & all the famous doctors of the city, we have spent all the money, we could. On further probing family would confess,He is irregular & moody about treatment. So basically,the patient had lot of diseases which were ignored earlier, when possibly they could have been managed. Every body took it easy when things were manageable &than at the end-moment “Panic button” is pressed.My advice to everybody is; don’t ignore a medical condition no matter, how trivial it seems.There are many diseases hiding behind a disease.If you ignore the first one; the rest would manifest gradually but certainly. It cannot be said with authority; of all players mentioned above whose role is bigger or smaller. We will see each one’s role. Many would vehemently insist- its all done by God. I cannot & will not argue against this. Indians commonly say- even a leaf cannot move without God’s permission. Similarly all other major religions consider God as the Creator, Controller & doer of all things. so, naturally ,by extension, God must be playing some kind of role in recovery of patient. If God is Powerful enough to create & sustain the world, how can his role in healing be denied. No wonder so many people resort to prayers & other religious acts when in grip of a disease. Guru Granth Sahib, the holy book of Sikhs preaches-“ Sab Roga Ka Okhad Naam”.Or Prayer /Meditations the treatment of all diseases. This belief in God varies; among different religions, according to educational status. The severity & chronicity of the disease can also turn a person religious.In certain religions ,people like to make very obvious show of their belief, while some people are strong believers but may not may not make a show of it. while some resort to charity & other religious acts .But certainly most of the believers turn to God(In form of prayers or charity)if they or a family member suffers from a severe or chronic disease. but it must be noted that even the strongest of believers take medical treatment. When I was in Libya I noticed, that most of patients would fast during the month of Ramadhan, In India it is common to see the family members reciting a holy text as you come out of Operation Theatre. Of course there are people who wear a blessed object(charm) also known as Tawiz in Urdu, around there neck or arm. I see many people with Lowbackache, going down a leg tying a thread round one of their toesas some kind of charm. So,who heals. Doctor is the most obvious & agreed source of healing.But is it actually so.Doctor certainly has a role to play, but he is not the sole source of healing. as we will see. The medical profession stands on four pillars. One pillar is doctors, nurses & other medical staff.second pillar is diagnostics. Constituting of companies that manufacture equipment & reagents plus run the labs which carry out various tests.Third pillar is pharmaceutical industry, which manufacture drugs as well as carry out research on them. The fourth pillar is hospital industry who erect & run hospitals. Though I might be considered prejudiced ( being a doctor myself), I think doctors are the most important among all these pillars. All other services, like pharma, diagnostics & hospitals stand on the shoulder of doctors. Paradox is doctor is first in line of fire in case of any mishap.All others can hide behind doctor.As they say buck stops with doctor. Another paradox is doctor is the least paid among all the players (barring nurses & technicians.). In a typical hospital bill, doctor’s charges may be 15% or even less ( to be shared among the 3 or 4 consultants of the unit) while the rest 80% is shared among the other three pillars. Interestingly doctors are least tormented (but their wives & family members are) by their share of money because they derive enormous pleasure from their role in alleviating human suffering. Healing of the patient also heals/sooths the soul of the Doctor. Most of people know about the Karmic theory of Hinduism.I once heard a Hindu holyman (sant) talk about Karma in relation to doctors. He said when god is Kind to some Soul, than in order to cleanse his accumulated bad Karmas, that soul is born as a doctor ; so it can serve the suffering humanity &cleanse its karmic balance. Well there is no way that this theory can be verified or backed up but it does make sense.In recent times, we have seen Mother Teresa serve the terminally ill & achieve the status of Sainthood.I am not trying to promote this theory but just putting forward a point of view & reader can make his own decision. For the whole of this medical structure; doctor is the interface with patient. Patient will tell doctor not only about his disease, but also about any other issue he may have. Like a complaint against the hospital, any drug adverse reaction,any mixup with lab report. And the doctor will than take up the issue with appropriate authority. But some times patient may complaint to doctor even about a uncooperative family member or even traffic jam on way to hospital. Some of these complaints may seem absurd or exaggerated, but they are disturbing the patient & tell the doctor something about patient’s personality. In many of these situations doctor has to comfort the patient like a parent or family elder. A doctor also learns as he grows how to handle these situations.It is not uncommon for patient & some family member( even a spouse ) to have a arguement in doctor’s office. I once had a patient with severe backache who also had diabetes with renal(kidney) failure.his wife visited me after his death & she was very bitter against her dead husband. After her husband’s death she found, he had hidden “barfi”- a rich Indian sweet; at various places in his house. Like pillow cover,side almirah & even behind the flushtank in toilet.There are many instances like this when patient does not observe precautions leading to obvious tragedy. So often doctor has to become a counselor. I have had patients who even complain of things like; last night there was a power cut so I could not sleep.I have learnt to take it lightly with the patiets-Like some times I say, you want me to treat your fracture,remove traffic jams from your route& also restore supply power to your home.Such talk helps by bringing some humour into an otherwise difficult situation. Now I come to my main proposition that , “The patient is his own healer.”. A good patient will follow all the do’s & don’t’s advised by the doctor, while others will come with feeble I had no time, its difficult, I just forgot, etc.After about 35 yrs. of experience,I can say with confidence & authority ,which patient who is going to get better or worsen.A patient who has the motivation to improve will follow Doctor’s instructions 100% or may be even more. Like in Orthopedics & Neurology , besides Cardiology exercise is a very important part of treatment .And we (The Orthopedic Surgeons),very often advise the patient to execise.And we will teach the patient how to do it. Here I would like to share an interesting tidbit with the reader.This story was told to me by a patient who was driver of a richman. Now this rich businessman had diabetes for long time & even his kidneys were damaged. He was on biweekly Dialysis but could not control his weakness for tasty food or alcohol. Being a clever man he found a way to nurture his fondness for food. one day before Dialysis he would take his driver & visit a particular restaurant which cooked fish to his taste.He would have a few drinks & fried fish to his fill & ask driver to go for a long drive. He would return home when driver told him he could no longer smell alcohol in his breath.His logic being today I can eat & drink as I like because tomorrow my blood is going to be cleaned anyway & there would be no adverse effects of his indulgence.It might be convenient logic for this particular patient but certainly wrong. I have seen this tendency among many selfmade rich, who have more money than education; they don’t tend to take doctor’s advice seriously. If they don’t like one particular doctor’s opinion, they will consult more(money being no consideration) but in the end will follow the advice that’s most convenient to them. They treat their doctor with scant respect because, they rationalize as they are more successful, they are more clever.This example demonstrates the role of a patient in management of his own illness. The patient who is going to improve takes doctor’s advice seriously & follows it 100%.Never forgets to take medicine as well observes all the do’s & don’t’s. taking medicines is not as easy as it seems.Many patient’s are old with impaired memory, have lost the spouse and are forced to live alone besides suffer from multiple diseases.Some have to take 20 or more pills every day.In this regard family can be very helpful.Patients living alone or without spouse find this especially tough. Having taken some pill, they may forget whether they have taken any medicine or which one, & hence may endup taking same medicine again. Medical conditions are worsened, as Some people will not take treatment for a disease in early stages, because it is still not so severe & they can get by. More & more ailments keep coming as a person ages. And they actually end up collecting diseases so that in sixties they have 5-6 illnesses & it becomes difficult to treat them anyway. For example I had a patient , who developed knee pain (osteoarthritis)in fifties . but because he could get by he ignored the knee. In sixties he developed a heart condition, for which doctor advised daily walk of 3km.Now because he had an old neglected knee problem he could not walk; & heart condition worsened.If he had taken treatment for knee in time, not only knee joints would have been allright, but heart could also be managed.This is how a patient can collect illnesses.This is akin to packing your body with diseases, like you pack a bag with clothes. I know some will find this statement surprising, but it is true. This very often happens in patient of Hpertension(high blood pressure) & Diabetes. Some of them take negative attitude, that this condition is incurable so whats the point of going to Doctor.Fact of the matter is the Doctor may not be able to cure Hypertension or Diabetes; but he can play a major role in preventing their complications.Some such patient’s don’t go to Doctor because of a defeatist attitude, while some think this is a waste of money.I have seen many patients & so have other doctors; who have seen doctor once & continue to take same medicine for years. This is possible in India because from one prescription patient continues to buy same medicine from pharmacist, as there is no law against it unlike u.s.a.Some of these patients are ignorant while others are plane casual about it & don’t entertain the idea that a disease needs regular monitoring & the dose of medicine is also to be adjusted from time to time. Instead of saving any money, unfortunately such patients endup bedridden with multiple avoidable complications. I will cite another example.Many patients with Gall Bladder stones are advised” cholecystectomy” i.e. surgical removal of gall bladder.This surgery now is very safe & not expansive either.But because the pain is not constant, patients tend to avoid/postpone surgery. Besides in India there is another factor.Some unqualified, self proclaimed doctors,advertise that they can dissolve the stone with herbs. And some people tend to believe them because they offer an easy option besides being cheap or even free.Those patients who postpone Gall Bladder surgery for one reason or other.These patients develop complications later like infection or tumour in Gall Bladder.A problem which could have been easily cured , ends up becoming a serious complication or even death. For some time in West & now in India too; patients will often sue a Doctor for his apparent negligence or dereliction of duty. But what about the patient himself who has been gradually packing his body with diseases,neglecting all medical advice.So many over weight people will neglect (for decades,altogether) their Doctors advise to exercise & adopt a healthy lifestyle.It is not uncommon for such patients with decades of negligence behind them,come to Doctor’s office when their body is packed with diseases & consequent complications. Now they will present a very inncent face,praise the doctor to skies( & in India calling him next to God) & ask for a tablet to cure all their ills.Surprisingly even now they will refuse to undergo any tests, consider surgery or even exercise & persist with their demand for a Goli.(tablet in Hindi)Actually to cure a disease lot of effort is required.Paying doctor’s fee is the easiest part.A patient has to actually fight & struggle to overcome the disease with doctor’s guidance.Orthopedic patients very often ask, how long I have to undergo Physiotherapy.The answer to this is not so many days or weeks, but till you get well.This is a fight which patient cannot afford to giveup.Because at stake is his own life.Having suffered from stroke myself, I know firsthand, how frustrating the fight can be.I have seen patients work hard on their paralysis for 3-4 yrs., improve &than lose the will to fight with his disease.Such patients quickly shift into a back gear; lose all the progress they had made & than adopt defeatist attitude.These patients quickly worsen & die.What to do with such patients. You can not chide & scold them as you may do a naughty child.I once had a female patient turn back & tell me “Doctor you don’t know how to speak to a lady.” So what about medical negligence.? Is it nonexistent.? Certainly not.But what happens generally in a hospital is what can be termed as culpable negligence, not wilful negligence. Few examples are-hospital may not properly maintain equipment or keep underqualified staff.A doctor may not keep himself updated with the latest developments in his speciality. On the other hand , look at what a patient can do;I once had a lady in mid seventies, obese, suffering from diabetes & hypertension for last 30 yrs; which she largely neglected& came to me for Osteoarthritis knee with backache.An important part of Orthopedic treatment would be exercise(Physiotherapy).Which she plainly refused & said.Look at my wt. my age & my diseases, how can you expect me to exercise.Just give me a tablet to relieve pain first.Ofcouse some of these chronic patients are also in depression & need Psychitric care besides other things.Now who is negligent.Some might say ,why Doctor treating her hypertension & diabetes not make sure about the exercise part.Well, Doctor is not like a jail supdtt., he can only advise treatment not enforce it. But its not that all the patients are negligent & lack the Will to fight. A well known example is Prof. Stephan Hawking. He suffered from Motor Neuron Disease in his early twenties.Motor Neuron Disease is a devastating disease with no cure(now stemcells are offering some hope.) in which the patient loses control over his limbs gradually, eventually becoming bedridden.But not Prof.Hawking, He not only had a successful career becoming Professor of Physics in Cambridge University, but also wrote many well known books on Physics & Cosmology.I have had a good friend Jarneil Singh who suffered from a similer disorder for last 30 yrs. of his life.But because of strong will ran a successful construction business, had a family& lived up to ripe age of 68 yrs. due to his strong will.It is really a case of mind over body.When the body says No, the mind should say Yes. Now I will like to repeat the title of this Story “Patient heal thyself.”The patient is a very important member of the team which is fighting the ailment. I would like to put a small addendum to the statement displayed in doctors office “I treat, He cures & I take the fee & thanks.” Our bodies are meant to degenerate & eventually die.everybody begins a unstoppable march to his grave right from the moment of birth.we might make small detours on the way like going to school, or going to job but the march to grave is, it makes sense to get your illness treated as soon as it appears & not store them for oldage.Some patients are disturbed out of proportion,because they do not understand this fact & want to be young forever.Like a 65 yr. old man complaining “I used to play football & was member of my college team & now I find difficult to walk inside my home.” This is not any disease but a natural process of ageing & one need not be disturbed by it.For this type of patient taking healthy diet & some light exercises may suffice. I had the opportunity & goodluck of working with a highly qualified& very experienced Orthopedic Surgeon in Tripoli ,Libya.I sent this article to him for review.I quote Prof.Murad Langhi verbatim, ”Man ,Machine, &Technology contribute to our good health, but God is our Healer.

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