Be patient with your doctor

Dr. Eugene Corea, President, College of General Practitioners Resource Personnel - Medicare 2011, National Healthcare Exhibition.

Just how well do you know about your doctor? Are you really getting the service you deserve or aren’t you happy with what your doctor tells you?

Dr. Eugene Corea, the Vice President of the College of General Practitioners, said that, a survey carried out more than a decade ago indicated that nearly 40,000 deaths occurred annually in USA as a result of medical errors. Conscious of the harm that errors in the medical system could cause, the College had set up a Committee on Patient Safety to work with patients and society in an effort to enhance patient safety.

A few steps in understanding your doctor will shed more light in making your trip to the doctor not only a better, but even save your life and make you return back to health. “We made a few recommendations about which characteristics good Family Doctors should have and we aim to have many posters in qualified GPs’ practices for the benefit of patients” said Dr. Corea.

“The first thing is that you should know is whether your doctor is registered with the Sri Lanka Medical Council and whether the doctor has the proper qualifications to practise” said the doctor. He added, “If they are not registered with the SLMC you should be careful and look for one who is.”

The next thing is to do would be to ensure that the doctor has a good attitude when it comes to the appointment. “Frequently when a doctor is angry or rude, many patients tolerate this without being aware perhaps of the harm that poor communications can cause to patients and even doctors,” said Dr. Corea. He further commented, “Always talk with doctors, see if they are not stressed or fussed because at the very least they should give you your monies’ worth.”

“Your doctor should listen to you attentively and have a positive attitude when talking. If they are overworked or temperamental, it maybe safer to consult another doctor or go to the same doctor later,” he said. Your doctor should always clear any doubts and answer your questions properly to the best of their knowledge. “Take all your records to your doctor to give a background history so that the doctors know how to help you and go with someone else to give additional support” said the doctor. Women should tell their doctor if they are lactating or pregnant.

“Your doctor should explain the steps of management and the follow-up action needed for your health together with the possible consequences” said Dr.Corea. “When taking medicines, it is helpful for patients to be aware of what has been good and bad for them in the past,” said Dr. Corea. Side effects and reactions to certain medicines vary from person to person so it is important to be mindful of this and inform your doctor. Your doctor should clearly explain the effects and side effects of the drugs prescribed and write the relevant instructions legibly.

“Sometimes, patients convince pharmacists to sell them drugs without a doctor’s prescription or get medicine from old prescriptions or even someone else’s prescription. This isn’t proper because the consequences could be drastic” said Dr. Corea. If you develop side effects for certain medicines prescribed by the doctor, stop the medicine and tell your doctor.

“Doctors must give you a good service at an affordable cost,” said the doctor.

When a doctor is unable to solve a patient’s problem, he/she should give a proper referral letter to another doctor, medical institution or hospital. “Any doctor should inform the patient immediately if and when an error occurred during treatment because it is the patient’s right to know” said Dr. Corea. He observed that the patients’ safety committee recommendations even queried saying, “Is your doctor accessible to you in an emergency and are there any arrangements to contact him/her if he/she isn’t on call?” There should be arrangements in place for dealing with such situations. Dr. Corea finally concluded by observing that doctors are only human and drew attention to the somewhat mischievous quote attributed to the famous French philosopher Voltaire “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.” Should we not take Voltaire a bit more seriously with only a pinch of salt?

Cataract and treatment

Dr. Dharma Irugalbandara Immediate Past President - College of Ophthalmologist Resources Personnel: Medicare 2011, National Healthcare Exhibition.

Normally, a person’s eye lens is a clear transparent structure which is crystal clear like a glass of water. However, in cataract, the lens becomes opaque or unclear like a glass of muddy water. “When the lens in a person’s eye becomes opaque, this gives rise to the condition known as cataract” said Dr. Irugalbandara.

In medical science, a cataract is a clouding that develops in the crystalline lens of the eye obstructing the passage of light. If cataract develops in old age, the power of the lens may be increased, causing near-sightedness (myopia), and the gradual yellowing and opacification of the lens may reduce the perception of blue colours. Cataracts traditionally develop gradually causing vision loss and can lead to blindness if untreated.

The condition usually affects both the eyes, but almost always one eye is affected earlier than the other.

“Cataract happens to people in old age and it is also secondary to diabetes which can be worse if the disease isn’t controlled,” said the doctor. Side effects of cancer treatment drugs and long term dependence of drugs like steroids, drugs used by psychiatric patients, following an injury can cause cataract said Dr. Irugalbandara. As a cataract becomes more opaque, clear vision becomes difficult in person with cataract. Contrast sensitivity is also lost, so that contours, shadows and colour vision are less vivid. The veiling glare can be a problem as light is scattered by the cataract into the eye. Every doctor should perform a vision test and if a loss in visual acuity is demonstrated, an eye specialist consultation is recommended. “High-risk groups such as diabetics must get their eyes checked by an ophthalmologist if they see a ‘halo’ around street lights at night, especially if this phenomenon appears to be confined to one eye only” said Dr. Irugalbandara.

Cataracts develop due to many reasons, ageing being the commonest. Other causes include long-term exposure to ultraviolet light, exposure to radiation, secondary effects of diseases such as diabetes, and advanced age, some drugs like prednisolone and drugs given for cancer treatment and for psychiatric illnesses or injuries to eye. Genetic factors are often a cause of congenital cataracts and positive family history may also provoke cataracts at an earlier age if not detected properly. There are various types of cataracts, e.g. nuclear, cortical, mature, and hypermature. Cataracts are also classified by their location, e.g. posterior (classically due to steroid use) and anterior or total.

If the Vision is poor, the treatment is cataract surgery and insertion of intraocular implant. In Sri Lanka, the low income category can request for a free lens through various donors.”

The Social Services Department, Sri Lanka Eye Foundation, some banks and international NGOs are few regular donors”, said Dr. Irugalbandara. She added, “As doctors, we advise the patient on what kind of lens they need. Plus, we can advise on the brands because there are many in the market.” Further, Dr.Irugalbandara said that the main reason why cataract in children is very rare in Sri Lanka because of the extensive and free rubella immunization program.

“I also highly recommend the Rubella vaccination and as we have a high literacy rate, Sri Lankans are educated enough to immunize their children against rubella which can cause not only cataract but other fatal diseases like mental retardation, heart defects, hearing and eye deficiencies”, she said.

The cataract operation is a simple procedure, the preferred option called Phacoemulsification (Phaco). Cataract operations are usually performed using a local anaesthetic nowadays and the patient can be discharged the same day.

Advances in medical science in intraocular technology now allow cataract patients to choose a multi-focal lens to help improve their vision without having to wear reading glasses.

Years ago, the cataract incision was ten times as large as it is today which takes time to heal where the eye was kept shut for over three days. “Today, the operation is quicker and the wound heals quicker as the incision is small” said Dr.Irugalbandara. Through the incision, ultra sound waves are directed and these break up the offending cataract and the pieces are sucked out. The folded silicon lens is inserted and it is folded into two and inserted through the incision.” This artificial lens quickens the healing process unlike earlier where there were many stitches, taking time to heal.

“After the cataract operation, patients shouldn’t let bacteria and germs get into the eye from the first 24 hours to a few days. Once a germ gets in, it’s difficult for the doctor to treat it so the patient should be careful and keep the area around the eye clean and hygienic” said Dr. Irugalbandara.