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Dr K K Aggarwal

Should doctors smile while talking to their patients?

By Dr K K Aggarwal
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Bhagavad Gita 2.10

“Tam uvāca hṛṣīkeśaḥ prahasann iva bhāratasenayor ubhayor madhye viṣīdantam idaṁ vacaḥ”

Tam—unto him; uvāca—said; hṛṣīkeśaḥ—the master of the senses, Kṛṣṇa; prahasan—smiling; iva—like that; bhārata—O Dhṛtarāṣṭra, descendant of Bharata; senayoḥ—of the armies; ubhayoḥ—of both parties; madhye—between; viṣīdantam—unto the lamenting one; idam—the following; vacaḥ—words.

Translation: “O descendant of Bharata, at that time Kṛṣṇa, smiling, in the midst of both the armies, spoke the following words to the grief-stricken Arjuna.”

The answer comes in Bhagavad Gita, the first text book of counseling. When grief ridden Arjuna approaches Krishna, he starts his counseling in a happy and smiling mood.

Arjuna was grief-filled, sad and rebellious. Yet Krishna smiled. The word in the Gita is prahasann, which means to smile before laughing (beginning to laugh).

It was not a weak or full smile or a sarcastic grimace, but a very positive smile.

Half of grief/apprehension is alleviated if a patient sees his doctor smiling or the relatives see a smile on the face of a doctor coming out of Operation Theater.

It also gives confidence to the patient (Arjuna) that his doctor (Krishna) has understood his problem fully and has a solution to his problem.

Buddha is also shown smiling and Goddess Kushmanda is also shown with a smiling face.

(Disclaimer: The views expressed in this write up are my own).

Forgetfulness and Age

By Dr K K Aggarwal
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By the time we cross 40, most of us suffer from minimal cognitive impairment and have a memory loss of very recent events or objects. This is age related and should not be confused with dementia.

This can also happen in patients who are vegetarians and vitamin B12 deficient. People often have difficulty in naming objects and name of the people.

Just as a computer hangs up while doing multiple tasks, so does the human mind. When you handle multiple projects at the same time, you may experience thought blocks, which is natural and not a sign of a disease.

When we introduce ourselves to a new person, we often tell our name first. It is possible that by the time you finish your conversation, the person may forget your name. Therefore, one should either introduce themselves last after the conversation is over or introduce oneself at both times i.e. at the start and at the end of the conversation.

Some people introduce themselves before the conversation and hand over their visiting card at the end of a conversation. This is also taught in how to market yourself.

As medical doctors, we face these difficulties quite often. People send SMSs without their names or call without telling their names. For example, I once got a call “Malhotra Bol Raha Hoon Pehchana Kya?” As a doctor, we may have had hundreds of Malhotras as our patients and it is not expected from us, especially, after the age of 40 to recall a person just by his surname. Unless we are given complete information by the patient on phone, mistakes can be made, especially, if it is a phone consultation. In any way, phone consultation needs to be avoided. Even Supreme Court in one of its judgments said that giving phone consultation may amount to professional misconduct on the part of the doctor

Never tell a patient that you are suspecting a diagnosis of cancer

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Informed consent and a premature communication can be dangerous. Communicate the diagnosis only after it is confirmed that too if it is necessary, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation ofIndia and National President-Elect IMA.

Suspicions of a cancer or any serious illness should not be communicated unless it is confirmed as it can cause more harm and the harms can persist for years, added Dr S Arulrhaj Past President Commonwealth Medical Association.

A prospective cohort study reveals that negative psychological consequences of false-positive findings on screening mammography may persist for at least 3 years after the initial diagnosis. Women with false-positive findings had similar psychosocial outcomes to those diagnosed with breast cancer at 6 months in the study. At 6 months, psychological testing showed that women who received false-positive results remained as upset as women who had breast cancer.

Three years after the false mammography results, women still exhibited greater psychosocial consequences compared with women who had normal mammograms Dr John Brodersen and Dr Volkert Dirk Siersma, PhD, of the University of Copenhagen in Denmark wrote in an article published in Annals of Family Medicine.

The reported frequency of false-positive mammography results ranges from 20% to 60% in the U.S.and Europe, said Dr Anita Kant Senior Gynecologist at Faridabad.