THE MASTER

Yet Rajendran is a great friend of mine .Rather I would opt for the word mentor ,no ,I would rather go to the extend of admitting that his word is final as for as his mastery over English and neuro sciences in that order ,.So it was with great hesitation or fear of rejection that I submitted one of my blogs for his scrutiny .I can proudly claim that I had the honour of being his classmate for about 8 years from Predegree onwards from the great Maharajas college ernakulam , till we finished our medical school together at kottayam .We used to fondly call him HIPPIE for his ruffled hair style , his attire and off course his English too ,not to forget the fact that he was brilliant in his physics and nobody ever imagined he would land up in a medical school and later turn to neurology and epileptology ,N A S A’s loss was boon to the convulsing lots .
So as I stood before the great man awaiting the last judgement .I could discern the tinge of disapproval emanating from his eyes as they scanned the pages in a furious pace and the unlighted cigarette tapping the dining table in an irregular mode making me sweat in my palms .The trial by fire is over as he calmly places the printed material on the table and as he calmly looks at the non existing cob web over the ceiling, the wrinkles over the forehead deepening, compounding my mounting agony .Now looking at his half eaten thumb nail , he clears his throat and the results are out. ‘hari ! I cannot say that your blog is bad, for a beginner’. Now I watch his mouth for the crucial 2nd part ,the real verdict and lo here it comes. ‘man! The problem with you is not in the contents ,but your English is atrocious ,no – no I am very frank with you ,you being my best friend, I don’t want to misguide you, but there is scope for improvement, You need to put in effort and has to begin from the beginning and age is on your side .It is the adjective part that I am more concerned with , not to leave behind the construction part .Why don’t you start ahead with Rennen Martin once again. Also you need to improve your vocabulary by starting with the Hindu cross words column daily .Regarding the contents , your thoughts need clarity and cohesion .The focus is not there .You cannot just let your thoughts run amok . 'Control' and I once again reiterate 'control' should be your mantra .The matter should be so delicately handled that the readers should get a tinge of confusion but yet should get an impression that they have understood it , but not fully, it’s that critical gap which will fetch you their adulation .I hope you have read my paper on ‘Co-morbidity Of Erectile Dysfunction In Epileptics in the Age Group 80 to 90', which was published in the journal of Neurology in Vienna ,the manuscript of which is still kept in the archives in the Paris museum .It is not that I have lost hope on you yet .You can still do it’. With that he dismissed me with a glance.

SILENCE PLEASE

You want to be a good patient,no? No I am quite serious.You deserve the best care,the maximum output for your money you are dolling out to that white coater.So you better listen to this old man.Can you give me 15 minutes of your ear? O.k,then take out the pearls from the sand.You deserve it.
1.Before you enter the consulting room,set aside 15 minutes for composing what you are going to spill out to that idiot regarding your so called disease or ill health,I mean the history proper which means your symptoms,on the basis of which hangs his diagnosis 7 out of 10 times,so better watch out what you are going to sing out.take three deep breaths and find out the main or core symptom which has brought you to his consulting room.Wait a minute,you have decided no? Now recollect since when you started having the same,1 hr,12 hrs,3 days or 3 months or 30 yrs as you please. Now ,come out with the nature or severity and the periodicity,meaning whether it is continuous or intermittent,how much time it lasts,the symptom free period in between and the exact location,be specific.Now comes the turn of associated symptoms accompanying the main dish,the nature,when and periodicity and where ,I mean the location of the affliction.Now that you are in your 2nd gear,you can spill out the precipitating and aggravating factors contributing to the same.
2.You can enlighten him about your past history of any similar affliction and also your known previous diseases like diabetes,b.p,tuberculosis,trauma or allergies.
3.Don’t waste your time about which all doctors u have consulted and what all nonsense he has come out with especially his diagnosis of your paranoia.If u have any prescriptions or details of investigations you can submit the same with out your comments.don’t dump the laundry of the previous physician over to the next one.
Now that you have sufficiently confused the poor fellow,leave him to rest.Never exaggerate your symptoms to get his sympathy or down play to show how cool you are. If you have any family history of similar disease, it may help him.Regarding the symptoms,don’t come out with standard terminologies which others use with out knowing what they are talking about.So let him know what exactly you feel. Never use medical terms to show off your knowledge nor give an impression of being a fool as well.Always remember that you are giving him vital clues to your disease and that certain things which you feel irrelevant may prove too costly in the end.
A classical example of a precise history was a young man who complained to me that since 1 week he was having an abrupt dimness of vision of his one eye as if a drop of water in plane of his vision,the diagnosis was over after that simple sentence and what was left off for me was to confirm my diagnosis by few tests.it can be as simple as that.
He may give you maximum of 5 to 10 minutes for your history,so be precise,and convey maximum information after which he will cross examine you for the data he needs. To know when to stop your rantings.note when he yawns or interrupts you with a counter question.
For eg. Most of the patients who attend my clinic will complain of head ache for some time,unable to read,some doctor has given specs 10 yrs back,I visited many doctors,so many prescriptions,no use.It takes me 15 minutes of cross examinations to know that the patient has a head ache for the last 5 years getting worse,recurring type with a periodicity of 3 to 4 times a month lasting for 4 to 6 hrs or until sleep. He gets the eye strain only during the days of attack and is associated with vomiting or nausea and also that his head ache worsens with loud noises and he prefers to lie in a dark room and also that the head ache is precipitated by travelling in a bus or after a cinema and that the specs prescriptions has not helped him.Now even before examining him I know that he has a migranous type of head ahe and his eyes are not the culprit.Now I can proceed with my clinical examination.This patient had not given any useful information and I had to waste 15 minutes and there are 20 similar patients waiting out side,how do you expect me to be calm and cool and smiling ALWAYS?