“The cough is bad, yes it’s sad…
The patient said to the doctor looking lost like in Rome!
But you look fine to me says the doc!
Oh! Tis not me with cough but my wifey at home!”
You are seriously examining one patient and in the middle you get a question from the bystander, “Doctor, cough is very persistent”
You suddenly get shocked that the person never spoke about Cough; persistent or not!
Then you realise that he or she is speaking about himself or herself!!
Welcome to the world of side consultation!
read on!
Remember that in this day and age, it is difficult to spend time and effort to come with a patient for his or her visit to the doctor!
So it is natural that some ‘incentive’ is sought!
When a bystander is not very forthcoming then it is actually ok since only the patient knows what he or she feels!
The bystander would only repeat what the patient says or many times confuse the patient more!
A big issue is that suddenly the bystander feels that he or she is an important part of patient’s life and asks questions which the patient had already asked or you had already explained to the patient in this or the last visit!
Of course when suddenly a payment is needed you can see the disappearing act!
But the most difficult scenario is the side introduction of the bystander as a patient!
Since I have been in a government hospital before, this was not an issue since everyone is seen there as a patient and like a triage we have to select the ones who are more serious.
In a private or a corporate hospital though you have to tread the lines very carefully!
Suddenly they would stretch their ears to be examined by you in the same line of examining the patient or draw out their chest and may be cough a bit!
It is a big dilemma since as a Human/doctor you cannot refuse to examine but as a doctor in a corporate or a private hospital, examining without a proper consultation entry is not only wrong but it is also illegal!
Yes! It is illegal!
This is because when the patient makes the payment and his or her name is registered in your system; the very fact that he or she is making the entry means that he or she is consenting to be examined by the doctor!
Also the fact that his or her name is generated in the system with or without a payment means that now the consent is ‘official’!
Only after such a procedure can you examine the patient. In fact if you have to do any additional procedure and process; you have to add another layer of consent and only then you can do the procedure!
Even if you are not charging any fees like say in a medical camp; there still must be a registration which is like the official consent!
This is the first major issue of side consultation!
Another most important thing is that you will never have full attention on his or her symptoms! It will get mixed with the original patient and be a big mess!
On top of that if the bystander actually needs a medication then what can be done! You cannot simply add his or her medication or test on the original patient’s list and tell; right, the numbers 1 to 4 is for the patient while the 5 to 7 is for your bystander! It does not work that way!
This is where experience is a big issue! No bystander would ever ask such doubts to a senior doctor who is always serious or irritable! It is usually for the junior ones or those who seem a bit too friendly!
The best thing is to gently urge them to register or if you are lucky ‘meet’ another specialist. It is a difficult task in most cases but rest assured, if the problem is severe enough for the patient it is obvious that he or she would consult properly as soon as possible!
Your aim is usually to slowly get all the attention which has been distracted to be back on the ‘original patient’ as soon as possible! It will be like a tug of war going back and forth and you have to win at all cost! If the symptom is mild which it usually is then the ‘reset’ back to the patient would be faster! If the symptom is severe or the bystander is persistent then it is a difficult task indeed!
Some would generously say that they will register and then you will have a gasp of relief! It is also possible that they would have been testing you with the test subject of the ‘original patient’ to see if you are ‘worthy’ enough to be spent money and consulted or not! Then all is well!
If you do see and announce all is well, then it is actually an ‘act’ because everyone knows that it was only a superficial consult! Unfortunately if you see without registration it could be reported to the management and they may not be ‘patient!’
Then again if you outrightly refuse, then you can expect a review of being a rude and unpleasant doctor! It is a proper double edged sword and there is no escape without some cut!
But all said and done, the side consultation is akin to meeting doctor in the middle of the hallway or a lift and then asking about your symptom! It does not work! It is always better to seek a proper consultation which shows how serious anyone is about his or her health!
I still remember how one day in the examination chamber of my chief where forget doctors, even patients would not dare to speak much; one bystander suddenly tracked a side ear block and pain consultation! We were all shocked on how chief would react!
He calmly told him to ‘go’ with the junior doctor which was ‘me’ and told ‘him’ to register and do a couple of tests along with an x ray and hearing assessment! It took him half a day and some big ‘amount’ to get everything done! After all that when he went back to the chief with all the reports and now with the upgraded post of a proper patient; the chief merely glanced at the reports and stated, “everything is normal! No need to do anything more!”
I had never seen a patient so upset on being told that he or she was normal! But I am sure that he would never do a ‘side’ consultation in his or her life again!
That is the power of experience! Experience also reminds me of the famous poet of an even more famous son who also had a not so famous grandson! Ok ok, the celebrity is Harivansh Rai Bachchan!
One of my most effortless sketch done in less than 5 minutes in heavy rush but luckily no side consultation!
Have a good night!
Shubh Ratri!
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