It was a busy Friday for Surgeon Rakesh Desai (name changed) and he was aching to reach home as the time neared 10:30 p.m. As he swerved his car into his residential parking slot, a familiar face waved out from the second floor balcony. Avoiding any conversation, Dr. Desai waved back and rushed into the building entrance. About 15 minutes later as he was digging into his dinner-plate, the calling bell rang. Aha, it was the neighbour, Mrs. & Mr. Shah who had earlier waved at him. They took their seats while calling out, “Doctorsaab, we are

in no hurry; you can finish your meal!”

While Mrs Desai frowned at her husband for the unwanted interruption, the generous surgeon whispered to calm her down saying that it may be emergency and that he is duty-bound to help. They hurriedly finished their dinner and Dr. Desai was beside the couple in a few minutes. Mr. Shah began by pointing to his wife saying that his wife is troubled by a severe pain in the foot and that there is a lump. As Dr. Desai awkwardly examined the lady’s foot on the sofa, he came to an instant diagnosis: corns. Dr. Desai politely requested them to come to the consulting room the next day. However, the next thing they uttered made him blow his top. Most of us can guess the obvious question that Mrs. Shah would have asked: “Can you do something now?”

This is definitely a common scene for most of us. Be it a cardiologist, a surgeon, ophthalmologist or a dermatologist a home consultation during the odd hours of the day or night is unavoidable. When there is a genuine emergency, no physician irrespective of his speciality would hesitate to do his duty willingly. Doctors do not have to be reminded of their Hippocratic Oath in such a situation and they understand their responsibility to society. On occasions they may even miss their consulting hours (causing discomfort to regular patients waiting in the clinic) while tackling a neighbourhood emergency. Yet, what disturbs every physician is the neighbour who takes the doctor for granted and abuses his leisure time.

There are numerous examples like Mrs. Shah who barge into doctors’ homes, at unearthly hours, for corns that have troubled them for weeks together, for a child running high temperature for several days or a mole on the face which has been growing since childhood! They force themselves on the physician and point to the face, eyes, nose, throat, arms, fingers, toes, feet, nails and even the teeth.

In the early days of practice the beginner is blinded by his desire to develop enough goodwill so as to build up a modest clientele. Besides, the young doctor is badly inexperienced to deal with a neighbouring chipko aunty.  He or she feels that it is rude to refuse help to a troubled patient. Sometimes the financial necessity during the initial years makes the physician ignore the intrusion into his personal space and time.

Party Scene

There is another scene enacted when a doctor attends a social function or bumps into a patient at a theatre, shopping mall, car park or the corridor of a building. Even before the poor physician recognises the patient the latter greets him with: “Doctor, how are you? Recognise me?”  Depending on the situation the physician may or may not remember the patient in detail. Quite often the physician remembers the face but not the diagnosis and therefore any clinical questions that are showered on the unsuspecting physician is met with confusion. The physician then has to wriggle out of the situation so as to avoid embarrassment in front of other family members who are also attending the party.

As they say. doctors and lawyers never retire! And even more than that, a doctor is a ‘healer’ for all 24 hours of the day – whether he is at home, on the road or at the clinic. While it is a flattering thought and the doctor tries to live up to this reputation, he is sometimes hounded by people even when there is no urgency. It is this fact that troubles the physician the most.

Worst hit

General practitioners, consulting physicians and dermatologists are pestered the most by patients at places outside the clinic. Sometimes the dermatologist has to face the embarrassing scene of a lady delicately lifting up her saree to reveal some ugly eczematous patch on the ankle even as others look on.

Dermatologists often complain that people expect them to “just write me an ointment for this itchy patch” as he gets into his car to rush to his clinic.  Little does the patient realise that the doctor may need some minutes of time to explain what the condition is and how long the treatment has to continue for recovery.

There have been instances where an elderly relative visits a dermatologist at home and points to a classical, hairless, hypopigmented patch on the arm while the poor doctor is petrified to give away the diagnosis. After all, a diagnosis of Hansen’s disease cannot be made casually in front of other family members while sipping tea. With the stigma surrounding the disease, the specialist needs to be careful how such news is broken and he has the added responsibility to counsel her about its cure only on completion of the entire course of multi-drug therapy.

Dealing With Nuisance Makers

Tackling such situations requires a great deal of tact and skill which comes only with experience. The physician gradually learns that once his practice grows there is no need for him to pamper people who do not respect his privacy. That is the time he actually learns to put his foot down when patients make unreasonable demands. Also, as he gains in seniority the commitment of his time to his spouse and children increases. The family too pressurises the physician to refuse unnecessary consultations at home.

In the final analysis, there is no shortcut to avoiding an irritating patient who intrudes into the physician’s home late at night. A few solutions, some of which may not be easy to put in practice, are presented here:

• It is quite perturbing for a physician to face a query concerning medical science when he is at leisure or when his mind is on something else. The physician may be enjoying his favourite newspaper column when a neighbour barges in with a health complaint. One of the simplest ways to avoid a non-emergency consultation is to politely state that it is not the right time. Yet this is not easy when facing a well known neighbour. An alternative approach would be to say, “I do not have the necessary instruments to examine you. Why don’t you come to the clinic this evening?” It would be a simple way to invite him to the clinic.

• I know a senior doctor who bluntly says, “I would surely have examined you but unfortunately I have not brought my spectacles along.”

• Some stubborn neighbours can be put in place with a careless examination of the affected part followed by: “This thing may require a biopsy.”

• Dermatologists are hounded very often at home and at social occasions and one of the ways of escaping from the scene is with the remark, “oh! the lighting is so poor that I can barely see anything.”

Suggesting a home remedy which is well known to everybody is another way of ticking off the offender. For example: “Why don’t you apply some coconut oil over the patch. It may disappear.” Or “try some saltwater gargle for the sore throat”

• If the patient is smart enough to tell you that the he or she has already tried the home remedy and that it does not work, tell him/her: “Do it for one more week, your stratum corneum needs more persuasion!”

• Another way to put him off is to ask: “What are you applying? And if she says, “Soframycin” (or something harmless) respond with “Oh yeah, that’s good…just continue applying for 10 more days…and let me know.” The response should not change irrespective of the disorder or name of the cream/ointment applied!”

• However not many people can do what one smart chest physician once did. He was once confronted with an acquaintance at a wedding reception. The acquaintance appeared very friendly and bombarded the physician with questions relating to his heart and blood circulation problems. As the ‘patient’ started talking, the physician slowly started walking towards his car. Finally, the physician neared the car; he quickly sat in the driver’s seat,
  his right foot planted on the accelerator and before the
  unsuspecting patient realised it, he went Vrrroooooom!!!

• At a public event, a gentle hint by a physician that the patient needs to undress for further examination usually takes care of some queries.

• The award for the best response to a corridor consultation goes to a gastroenterologist who once retorted to a outstation neighbour who pointed to some discoloration on his neck and queried, what it was? He barked, “Oh you have poststreptococcal glomerulonephritis! The shocked neighbour was not prepared for such a ‘big’ disease appearing so innocuously on his neck!!! Consequently, he never dared to question him again!

Are all physicians equally troubled by such demands from their friends and neighbours? No, not everyone. The fortunate doctors are the ones who deal with highly personal matters, private parts of the body etc. They are the sexologist, STD specialists, Proctologist, Gynaecologist, Psychiatrist etc. from whom people may actually stay away in a public place so as to avoid a situation where someone would ask the patient, “How does the doctor know you?”

What a practicing doctor needs to do when faced with an unreasonable enquiry is to prepare a frank and forthright reply without getting irritated. Only a smiling face with a quick, witty response would help one to win back the patient the next day. And umm…by the way, I can spot my Ophthalmologist neighbour, Dr. Hema, entering her residence. Let me quickly drop in before her dinner and find out why my eyes are looking red!