Thursday, June 14, 2007

A little knowledge……

One of the new breeds of patients I’ve started bumping into quite frequently these day is the ‘I’ve done research on this disease on the internet’ type.While some of these patients accede to the possibility that in spite of their meticulous web research ,the good doctor might know something more about the disease ,some others simply know that they know more.
Often this knowledge relates to latest ,often obscure medications for some diseases.I had a kid with mild psoriasis ,his father,a lawyer , was the official spokesperson ,and apparently the he was well entrenched in web acquired knowledge regarding psoriasis.

“ Doctor…we would like to try biology treatment”He starts off without much of a preamble
Duh??? I had to remain composed while getting the rusty gears in my head moving to figure out this unheard of theapy.
“ You mean like …naturotherapy” I query cautiously
His eyes bulge ever so slightly and I can almost read his thoughts “This doc looks like an idiot and speaks like an idiot – so he must be one”
“ No doc …the latest in psoriasis treatment ….they use it in the states”he explains quite condescendingly .
What they do in the ‘states’ is of course by default ,the gold standard for medical therapeutics .
I started seeing the light “You mean biologicals ?”
He too sees a little bit of light “ Yes yes ..that one….shouldn’t we go for that”

( For the uninitiated, biologicals are basically a relatively new group of therapeutic preparations ,many of them based on the concept of monoclonal antibodies .In dermatology among other indications they are used as alternative drugs in the case of severe recalcitrant psoriasis. )

“ Er” Me trying to act the busy / hyper intelligent doctor weighing the available options “Actually ,I think your child can be managed quite well without high-end options like biologicals”

I can see the skepticism dripping from the spokesperson’s face.

“Doctor ,the cost is not a problem at all” Of course it isn’t .The guy was a lawyer after all.Our buddy-brothers in the daylight robbery business.

I wonder if I inadvertently mentioned something about the cost ,which incidentally like many of the newer drugs can burn quite a few holes in your pocket.
“ No’s not just the cost …biologicals have their own unpredictable side –effects ,and like any other anti- psoriatic medication ,they do not guarantee a permanent cure.So I think we can start off with some lesser medications and keep biologicals as a back up”

Who was I kidding ? I don’t think I would have convinced even myself with that insipid sermon.

“Doctor ,why isn’t there a cure for psoriasis ?In spite of all this medical advancement?” our webber shifts gears dramatically.
Uh Oh…the conversation was drifting precariously to verrry verrry uncomfortable waters.
I could have gone on for a bit of philosophy on the limitations of human endeavour
( especially my own ) , but I realized that with this guy every word of mine is going to be met head on with a paragraph.
“ I’m sure they’re working on it in the ‘states’ ” I reply with what I thought was a apt mixture of brevity and sarcasm.
The kid of course improved without biologicals ,but I’m sure that with the next recurrence ,if it occurs , the father will go hunting for another doctor willing to start ‘biology’ therapy
( or whatever is the latest in the ‘states’ ).

PS : On a personal more serious level , I feel it is always better for patients to be more educated regarding their disease.I personally like guiding patients to relevant and RELIABLE web sites related to their disease.It really helps people allay unfounded fears and misconceptions. However it is necessary to understand that the web is at best an aid to knowing their disease better.The doctor remains the best advisor.

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