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Importance of the Figures 20% and 50% in Private Practice
O P Kapoor

There are two conditions in private practice, when figures are to be presented to patients to impress upon them the importance of spending money on investigations as well as management of the case (even if this includes a biopsy or an interventional/surgical procedure).

DVT (Deep Vein Thrombosis) is an extremely common condition in private practice. Not only the public, but even the family physicians are afraid of pulmonary embolism as a complication. So much so, that many a times, their talk ends up with the patient going for a second consultation and changing the doctor.

Therefore, the figures of 20% and 50%, mentioned below are worth remembering. The family physician can speak confidently to inform, either:

  1. Intelligent patients, or
  2. Patients, who cannot afford to spend more on their illness, or
  3. Patients, who are affording but are avoiding expenditure, thinking that it can only help the prognosis, and not the diagnosis.

DVT is extremely common in small calf veins and can be easily missed on doppler sonography. Most of these patients do not develop serious or fatal complications. The reason is that in only 20% of the cases, the thrombosis will extend to the ileo-femoral segment of the vein. Once it extends there, 50% of such patients will start throwing emboli in the lungs. Half of these emboli, which are not clinically significant, might be even silent. It is only among the other half, when the emboli thrown are clinically significant and diagnosable, that the fatalities are common.

The second condition - PMR (Polymyalgia Rheumatica), though uncommon, is a serious illness. Although patients of PMR recover in less than a week, after administration of 10-20 mg of prednisolone per day, the family physicians should remember that 20% of these patients can develop temporal arteritis. Patients who develop temporal arteritis have 50% chances of developing sudden, permanent blindness, which is vascular in aetiology. Not only that, apart from blindness, they may also develop any other neurological complications of the brain due to vascular blockage. The only way to prevent patients from developing these complications is to start them on a dose of prednisolone, which should be 1 mg/kg body weight. The physician should fully anticipate grave side effects, because normally these are elderly patients.



An Editorial this week discusses the case and emphasises that prevention of HIV is still the best way to fight the disease, but warns that the "just say no" approach from conservative religious groups in the USA could hinder such progress.

The Lancet, 2004; 1003, 1031.