Mr Sharma said this as he left my consultation chamber. I knew he would
never come back. He was sent to me for his wife's gall bladder operation.
She had her gall bladder inside the liver, which is a rare defect by
birth. Normally gall bladder lies outside of the liver on it's under
surface. We tie the blood supply, cut the biliary connection and take
out the gall bladder by separating it by blunt dissection from the liver
surface. It is surgeon's delight if a gall bladder has a mesentry and
it hangs below the liver, then the surgery becomes child's play.
The other extreme is, it is buried in the liver substance and you
do not see it at all. Then the question is where should the surgeon
give incision? You need special techniques like per operative sonography
to find out exactly where the gall bladder lies. This is difficult by
means of a laparoscope, as there is no feel. In such cases if no portion
of the gall bladder is seen, we have to convert it to an open operation.
I had explained this to Sharmaji. I also told him so, while taking the
consent for laparoscopic surgery, we mention about the possibility of
conversion to open surgery in all patients.
This is the routine all over the world. I had doubts while explaining
all this to him, whether he was listening to me or not. He was not bothered
about the academic discussion. He interrupted me once to say "Ajay
Bhaiya sent me to you, because you do this operation by laparoscope."
I again repeated "Yes I do. I am one of the few in this town who
do this but your case is one, where I cannot boast about completing
it by laparoscopic method, but I will try. This is going to be the same,
anywhere you go. Since you are known to me and have come through my
friend Ajay, I am not hiding any thing from you, hence explaining to
you in so much in detail."
He said only one thing "But I had come to you for laparoscopic
I was sad. A single tablet of paracetamol (Crocin) can destroy your
liver, it is written in the pamphlet, but should I tell this while treating
a case of simple fever. We say "Let us start with simple Crocin,
better avoid those strong antibiotics." Patient is happy. Should
I tell the patient before sending him for a CT scan examination that
you will be exposed to radiation that is equal to 450 to 500 X ray chests.
I know nobody will undergo the test after knowing that.
When I think of the previous patient's who did not come back for surgery,
I realize that though you should not hide anything from your patient,
but there is a time for everything. I was telling them every thing too
much and too early.
Imparting too much knowledge is dangerous for the patient, not because
I lose my business but because he will not get operated anywhere. If
you properly read all the terms and conditions written in the loan papers,
you will never dare to sign and avail the loan. Similarly if you know
all the consequences related to marriage, forehand, nobody will marry.
It is good that we do not know the Sanskrit language, in which the pandit
chants all those shlokas of the matrimonial ceremony. All those dangerous
consequences and responsibilities are mentioned in them. The great saint
Swami Ramdas listened to it carefully and we know, he literally ran
away from the stage in middle of the ceremony. Similarly, it is good
that most of the patients know less of English and do not read the consent
There can be different squealae to when you tell him about the details
of surgery. If you tell him, just after examination in OPD, he has a
choice to see another surgeon. No problems if your colleague is also
a genuine person like you, he will also keep your version. But usually
it is not so. Better examine the patient, hold yourself from explaining
further, write some necessary investigations and though he is a clear-cut
case of surgery, tell him "we will talk after investigations; may
be I can decide not to operate upon you after seeing those reports."
Funny! Isn't it? But he will be happy. It carries a message, you are
not after surgery. You get some more time to build rapport with him.
Ask the patient's relative to come with reports. You cannot take the
liberty of telling the details of the treatment and result in front
of the patient. If you express this also to the relative, it will further
strengthen your relations. Then gradually I should have taken him to
the theater, again holding myself from leting him know about the chances
of conversion. Finer aspects are to be told after the patient has been
wheeled in the theater. By know they have made up their mind in Toto
to undergo surgery by you. They know you are their well wisher and will
do whatever is good for them. It is then, you tell them in a casual
way about the possibility of conversion. A successful surgeon is,one
to whom patient's say "Go ahead doctor. We have full faith in you.
As far as conversion is concerned, you will do that also in patient's