Saturday, June 16, 2012

The' sixth sense'

You must have heard  story of some old doctor who could just by looking at a person or by just feeling the pulse of the patient could diagnose his or her medical condition.I have heard of it.Is it possible?Or just another Indian story of mystic and magic.Even I used to think.
My brother Dr Shamsher Dwivedee who is a neurologist by profession was at my place.He is known in his circle as an excellent clinician who hardly prescribes any investigations.His students have so many time told me his stories when he used to make a clinicial diagnosis on examinaton with hardly a test or two for which any other routine consultant would have prescribed many more to come to the same diagnosis.That is his clinical sense.Last week he was at my place in Gurgaon.A men came to meet him for some official work.After sorting out the work,suddenly my brother asked him,''so you drink alcohol every day.Isn't it?' That guy was taken by surprise and after few seconds admitted that since last 5 to 6 months he was drinking every day.Then bombarded my brother,you are about to spoil your liver and in no time you will be bed ridden,Go get a scan done and that will show a fatty liver.Poor thing he went for a scan that very day and it did show fatty liver and haepatomegaly.
I was surprised.I asked him,bhayia,did you know he drinks so much.He said ,no.Then I asked did he smell of the alcohol because to me he looked quite sobre and I couldn't smell any alcohol.My Bhayia said..........nope,he didn't smell of alcohol either.I said then what?He smiled and said that is clinical sense what people misunderstand as the sixth sense.He said that after observing patients for years you can judge and observe the various features,body habitus which gives the dcotor a clue.
He told me story of British doctor Dr Brain,who on looking at a lady advised Laparotomy.On laparotomy ovarian cancers were detected and Dr Brain had thought her to be a patient of paraneoplastic syndrome.
For a while we talked about the progress the science of medicine and how much it has developed ,but with development of the science of medicine the arts of medicine is dying away.The clinical sense is the arts of medicine.
Dr Shamsher Dwivedee awarding an ISCR award winner
Last month a couple came to me.that lady was having some vague breast pain.I examined......axillary breast tissue.Asked her if she could be pregnant.Both of them looked at me surprisingly.Not possible.Have not even missed my periods.Had sex only once or twice.just not possible.I still advised to have a urine pregnancy test if she missed her periods.Within 10days they were back..........UPT was +VE..................Clinical sense :-) They went for a TOP though !!

No comments: