Medical doctors and self-treatment

by Dr. Lakshman Abeyagunawardene

At the outset, I wish to define who a “Medical Doctor” is for purposes of this article. This definition applies only to this article and nowhere else. By way of explanation, I would consider a “General Physician” (or any physician for that matter) as quite capable of treating any illness that could afflict anyone. But on the other hand, some doctors in the finer specialties like Pathologists, Radiologists and Community Medicine, would not do so with such confidence unless they have made a special effort to stay in touch with clinical medicine.

In general, it is as a General Practitioner that the average medical doctor is called upon to act when it comes to self-treatment or treatment of a relative or friend or in an emergency. Ayurvedic physicians and all other native doctors who are not registered in the Sri Lanka Medical Council have not been considered at all. Neither are Homeopathic doctors although they claim to have their own council. Needless to say, the many thousands of quacks who still enjoy a roaring practice in rural areas, rule themselves out!

Although I am an avid reader of feature articles and letters to the Editor especially on Sundays in the English newspapers, I have hardly seen any material dealing with the subject of “Medical Doctors and Self-treatment”. The reason may be that very few in the medical profession have the inclination to indulge in Sunday reading and the few who are talented and able to do so, do not have the time to engage in writing even as a hobby.

As a rule, I don’t even attempt to treat myself unless it is for a very common ailment. More importantly, what is required is the ability to differentiate a minor symptom from one that would be more serious and call for a specialist’s opinion.

Part time clinical work

There was a time when I was doing a job in my chosen field with absolutely no clinical work. But I always had a longing to stay in touch with patients and clinical work. It was also at a time when private practice for government doctors had just been introduced. I was the regular locum for a friend on most evenings.

My own rule on self-treatment applies not only to my own family but to the extended family as well. There was a time when the first person to contact in the case of my ageing parents, sister and brother would naturally be myself, but that responsibility has dwindled since my parents are now dead and gone, my sister is married with a grown son who is himself a doctor and my brother has lived in the US since the mid-seventies. Since my marriage, I had to look after my mother-in-law who was living with us, but that was only temporarily.

Under certain circumstances, especially for minor ailments, I treat myself and my family. In my own case, it is not difficult to decide when I should see a specialist doctor. But as far as possible, I encourage my family members to seek treatment from some other doctor (often a specialist). A medical doctor should also be well versed in first aid.

Follow-up of patients

To me, my part-time work was not merely a job that brought in extra remuneration. I often went out of my way to follow-up patients that I had referred to the major hospital in the area. Unlike the regular GP, due to the part-time nature of my work, I had much fewer patients to deal with. Thus patient follow-up was conveniently done, particularly as my own place of residence at that time was very close to the Colombo South Hospital to which the more serious patients were often referred.

Executive in distress

This is a little story that I will not forget easily and well-worth recalling when writing about my work as a part-time family practitioner. A middle-aged male patient was brought in very late one evening when we were about to pull down shutters for the day. He had laboured breathing and a noisy wheeze. But despite his apparent distress, he looked smart and was well-dressed. At first sight, even a qualified doctor would be inclined to think of the typical asthmatic that is regularly seen with the same symptoms.

However, a little bit of the history ascertained from the accompanying family members, often make the doctor think twice before coming to any conclusion regarding a probable diagnosis. In this case, the patient’s wife kept telling me in fluent English that her husband had never had such a problem before. That proved to be a crucial point. A quick physical examination and use of the stethoscope virtually confirmed my worst fears. The blood pressure being elevated, I was already thinking of a more serious condition than an ordinary attack of bronchial asthma. Having suspected acute left ventricular failure (LVF) commonly referred to as “cardiac asthma”, I lost no time in rushing off the patient immediately to hospital. I was well-aware of the limited facilities and resources available in a GP’s clinic to tackle such emergencies, and that time was of essence.

Without washing my hands off the case, I followed the patient in my own car as I was heading home in that same direction in any case. The doctor in the OPD at Kalubowila Hospital confirmed my tentative diagnosis, and after administering the urgently needed treatment in the OPD itself, admitted the patient to a medical ward immediately. Being a former employee of the hospital, I was able to facilitate the entire process.

The Consultant Physician who happened to be a friend told me later that the patient would have definitely died had treatment been delayed any longer. The heart condition that manifested itself as a full-blown illness at such a relatively early age was due to undetected, untreated and hence uncontrolled hypertension (high blood pressure), which he had been living with for several years. The patient (who made a full recovery) and his wife were later virtually falling over each other in expressing to me their genuine appreciation and gratitude. Some years later, I heard that my patient, who was a top executive in a reputed mercantile establishment at the time of his illness, had later been made a Director in the same company!

Ulterior Motives

Under normal circumstances, such unusual dedication to the welfare of patients would have obviously aroused suspicion in the mind of the established doctor under whom the “locum” doctor worked. More often than not, “locums” did that with ulterior motives, “cultivating” patients for a practice that they themselves were planning to set up in the same area undercutting the erstwhile employer. But in my case, the employers being my personal friends who were well-aware of my life’s goals, ambitions and future plans, were convinced that I had no such ideas or tricks up my sleeve. My “follow-up” of patients only helped my friends with their own practice.

A few years prior to that, I consulted a Consultant Dermatologist who went through the routine of prescribing steroidal creams in the usual ascending order in terms of strength, and in the absence of progress, then went on to investigate further to rule out conditions like Bowen’s Disease (a form of skin cancer). The Consultant did a skin biopsy and various blood tests and although they proved to be negative, I was relieved. My objective right along had been to rule out such more serious condition. I stopped consulting the doctor, and was without a Dermatologist for a couple of years. I resorted to self-treatment again as I knew very well that skin ailments are difficult to treat and the best I could do was to keep it under control.

Summary

In summary, a medical doctor whatever field he or she has specialized in, should be confident enough to treat his or her own self initially and offer appropriate advice to family, friends and neighbours, including first aid. If not, the five years of training a medical doctor undergoes, would be in vain. I should know because when flying, I have heard that familiar announcement many times, calling for volunteers from medical doctors to help out the cabin crew as they have a passenger who is ill on board the aircraft.