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As you say, doctor...

But I had come for laparoscopic surgery...

Consumer Protection

Got two minutes, doctor?

"How many stitches?"

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Too good is bad!

Why "Baap-Dada"?

Window Surgery

But I had come for Laparoscopic Surgery..

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 surgery!"

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 form carefully.

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 benefit."