Complaints While Treating a Patient
Often a patient, who is under
improves, confirming your diagnosis. But
during one of his follow-ups, he gives another complaint, unrelated to his original
one. Then how do we react?
Given below are two such examples:
1. A young man, who was being treated for MDR Pulmonary Kochs (HIV negative)
saw me again after three months. He had gained 6 kg weight. His fever and cough
had subsided. 50% of the shadows had cleared on X-ray Chest. Though he was happy
with the results, he had a new complaint of nausea, specially related to meals
(despite which he was eating). Occasionally, he vomited after meals. He was
on five anti-Kochs drugs, one of which was PAS granules. I discontinued that
drug and he immediately improved because that was the cause of the complaint.
2. A 78 year old patient presented for pyrexia and very high ESR. My final diagnosis
was Pulmonary Kochs, which behaves oddly in elderly patients. He showed excellent
recovery with AKT and nutritive diet. After six months, he gained 8 kg weight
and the X-ray chest showed 90% clearance of the shadows. Two months later, during
a routine visit, he complained of discomfort in the right hypochondrium since
2 weeks, often related to meals. I convinced the relatives to do further investigations
like sonography and endoscopy. At the age of 78, a new complaint unrelated to
the side effects of my treatment called for these tests. A diagnosis of duodenal
ulcer was made.
What I want to stress is, that when a patient under your treatment comes with
a new complaint, think of an iatrogenic cause first. But, if he is an elderly
patient or has risk factors of any disease, do not hesitate to ask for investigations
to diagnose a second disease. In private practice, often the complaints are
due to the drugs or a diet prescribed by you, or the dos and don’ts advised
by you, or a bold diagnosis of an illness like hypertension, which the patient
has not accepted mentally.
TREATMENT-INDUCED BREAST CANCER
Hodgkin’s disease is a success story for cancer treatment. Use of intensive
radiotherapy and chemotherapy regimens has ensured that more than 85% of patients
are cured of their disease. However, development of secondary cancers is a serious
long-term side-effect of treatment - women treated for Hodgkin’s disease
have a risk of developing breast cancer up to 136 times higher than that of
the general population.
Lancet Oncol 2003; 4 : 207-14.
(Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof.
of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008)