One of my good friends Mr Y, a senior IAS officer rang me to fix an appointment for a journalist friend, Mr A, of his. Mr A's 12 year old son had been running high fever for last 42 days. He has consulted almost every physician of Chandigarh region, undergone a lot of tests and received the 'best' of oral and intravenous antibiotics, but to no avail.
Next day, the middle aged couple with their young apprehensive son with an intravenous cannula (a device through which the injections are given) in place on his left hand came to my office.
I asked the history in detail (about the fever and other associated symptoms) and examined him. Going through the 'thick' file, I could see prescriptions of 'all kinds of specialists' and found that almost every possible antibiotic (from amikacin to vancomycin to meropenem) has been pumped into the young body.
After 20 minutes of 'clinical' session, it seemed to me that in pursuit of a 'bigger' diagnosis, Malaria had been a too simple diagnosis and had perhaps had been missed. I told them that for the time being, the child just needed to take 5 tablets of Chloroquine over the next 3 days.
The parents, understandably were not amused and looked towards each other conveying "what a waste of time and effort'. They had come all the way and expected a rare 'big' diagnosis from 'a renowned doctor of AIIMS'. I could read the expressions and reassured them that I am available in the city and would definitely take a relook after 3 days. They just needed to be patient. They agreed on this option as perhaps they didn't have many left.
After 72 hours, I received a call on my cell from Mr A and could know what he would say from the tone of his voice. " Sir, you are genius, my son got rid of his fever for the first time in 6 weeks. I am so................". As I was listening to the phone call, the prophetic words of my par excellent teacher, Prof AN Malviya, Head of Department of Internal Medicine at AIIMS, New Delhi in 1990's, echoed in my brain " I would crucify (fail) you if you make a diagnosis other Viral or Malaria in a patient with fever of less than 7 days duration".
Clinging to these lines, I have found myself on the right side so often and so often, have seen physicians making a diagnosis of Typdoid or TB in a patient of fever with only 3-4 days.
Common sense is of paramount importance especially in Clinical science.
The great, Sir Robert Hutchison, wrote in British Medical Journal in 1953
From inability to let well alone;
from too much zeal for the new and contempt for what is old;
from putting knowledge before wisdom,
science before art
and cleverness before common sense;
from treating patients as cases;
and from making the cure of the disease more grievous than the endurance of the same, O Good Lord, deliver us.
Next day, the middle aged couple with their young apprehensive son with an intravenous cannula (a device through which the injections are given) in place on his left hand came to my office.
I asked the history in detail (about the fever and other associated symptoms) and examined him. Going through the 'thick' file, I could see prescriptions of 'all kinds of specialists' and found that almost every possible antibiotic (from amikacin to vancomycin to meropenem) has been pumped into the young body.
After 20 minutes of 'clinical' session, it seemed to me that in pursuit of a 'bigger' diagnosis, Malaria had been a too simple diagnosis and had perhaps had been missed. I told them that for the time being, the child just needed to take 5 tablets of Chloroquine over the next 3 days.
The parents, understandably were not amused and looked towards each other conveying "what a waste of time and effort'. They had come all the way and expected a rare 'big' diagnosis from 'a renowned doctor of AIIMS'. I could read the expressions and reassured them that I am available in the city and would definitely take a relook after 3 days. They just needed to be patient. They agreed on this option as perhaps they didn't have many left.
After 72 hours, I received a call on my cell from Mr A and could know what he would say from the tone of his voice. " Sir, you are genius, my son got rid of his fever for the first time in 6 weeks. I am so................". As I was listening to the phone call, the prophetic words of my par excellent teacher, Prof AN Malviya, Head of Department of Internal Medicine at AIIMS, New Delhi in 1990's, echoed in my brain " I would crucify (fail) you if you make a diagnosis other Viral or Malaria in a patient with fever of less than 7 days duration".
Clinging to these lines, I have found myself on the right side so often and so often, have seen physicians making a diagnosis of Typdoid or TB in a patient of fever with only 3-4 days.
Common sense is of paramount importance especially in Clinical science.
The great, Sir Robert Hutchison, wrote in British Medical Journal in 1953
From inability to let well alone;
from too much zeal for the new and contempt for what is old;
from putting knowledge before wisdom,
science before art
and cleverness before common sense;
from treating patients as cases;
and from making the cure of the disease more grievous than the endurance of the same, O Good Lord, deliver us.
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