Sunday, August 9, 2015

An Irritation

Usually I try to accept this world as it comes. There are many things that I like and some that I don’t. But there is nothing much I can do about them. I try to appreciate and enjoy what I like and gloss over what I don’t. Some people, some attitudes, certain behaviours, some of the happenings irritate a bit more. I am sure that me and some of my actions are a source of irritation to many. We (I mean all of us in this society) usually share these likes and dislikes with those who have similar views and get it off our heart. I also put some of them down in this blog. They may not merit a mention anywhere but I feel better once I put it out of my head. This was one such irritation. Sorry for a grouchy post.

The referral letter said,

Dr Raghunandan,

Ref  Mr XYZ , with periosteal abscess for needful.  Treatment Given, Baycip TZ 1+1 and    
 Mahacef 200  1+1. 
Sd  Dr ABC

This letter was from one of my medical colleagues and was brought by a patient with a swollen face and tooth ache.

I have great regards and respect for all my medical colleagues.  It is a fact that they have a better qualification, a better understanding of the human body and its functions, and are much more capable in dealing with it.  At the same time it is also a fact that a majority of them hardly have any knowledge of dentistry.

(When I was in my final year BDS, there were a number of my higher secondary batch mates who were in final MBBS.  They were doing clinical rounds in various departments and they had a fifteen days posting in dental college. Usually the dental posting was considered a lean time during their grueling clinical schedule and it provided them with a chance to catch up on the morning shows in the ‘Apsara’ theatre next to our college.)

This patient reported to the doctor with tooth ache and swelling four days back. He was given Ciprofloxacin + Tinidazole. Patient returned after two days with increased swelling.  Cipro+TZ was discontinued and Cefixime started. Another two days and the patient came back with an even bigger swelling and unbearable pain. That was when he was shunted off to the dentist.

 It was an abscess alright but not periosteal abscess. We call it alveolar abscess. And evidently, both the antibiotics prescribed were not at all necessary and absolutely useless.

The patient spent four agonizing days and a considerable amount of money, which he could ill afford, on consultations and medications which were not at all required in the first place. A daily wage worker, he missed work and consequently the wages for all the four days.

I drained the abscess and I will have to extract the tooth sometime later. If I had seen the case first, I would have removed the tooth then and there and the patient would have been fine within a few hours and with two pain killers, if at all.

The doctor knew that this was a dental infection, did not have the required knowledge or skill to treat it but still attempted and persisted in treating it with medicines which were not at all indicated.

This is not a stray case. I am writing this after seeing many such cases in my clinic. I can understand a practitioner prescribing medications for immediate relief before referring the case to the right person. But I can't understand this persistance.

Why do they attempt/ feel compelled to treat these? It certainly is not ignorance. Is it the fear of losing a patient? Is it because they feel that it is a ‘mere dental infection’ and nothing beyond their capabilities? Is their ego coming in the way of referring the case to a dentist straight away? What is it?

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