DrSalunkhe Shivaji Profile picture
Oct 2, 2020 10 tweets 2 min read Read on X
#Cliniciansdilemma
When doctor faces trust deficit, a part of clinician within each doctor is undermined at times resulting in unnecessary & insane tests usually at the behest of patient who's anxious to rule out Diagnostic delusion
Clinical Dx is a challenge to any doctor
Inspite of informing to patient gravity of situation we risk everything esp when unexpected inevitable occurs
When we're prudent to patients impending situation at times patient disappears as they perceive exploitation/undue fear mongering
Patient expectations counseling dilemma for essential but costly test, prescribing specific drug but informing inbuilt risk, procedure advice and risk of comorbidities & anesthesia related complications, advising various Rx modalities admissions need & their cost implications
Essence of life
Single cell that journies from the moment of inception onward into multicellular organism which ultimately mean regresses into death
Immortality is an illusion mortality is real that's ignored & camouflaged due to survival instinct as doctor lets beware of fact
clinical Dx is an art recognize evolving construct fast & apply highly diligent skill of pattern recognition with precision Start with patients body language, ominous vibes we see on evaluation, relatives approach to problem, expectations, affordability, trust & willingness to👂
Knowing what not to do is crucial by defining our boundaries as per competencies than doing what we know
Always offer limited warranty in any given context with obvious rider of comorbidities & never a guarantee
Recognize triggers that brought patient to us from the high pedestal
Document findings prioritise critical signs anticipate/focus on consequences, prognosticate & manage with essentialism We must always take relatives into confidence collaborate depending upon severity, teamwork is must as per facilities & capabilities venture out or timely refer
patients compliance is uncertain due to trust deficit, inconveniences, bias, intuition, financial misery, ease of 2nd opinion & non existent system We must probe past as patient can conceal past Rx, to avoid labeling & they tests us, inquire to patient what brought them here
many doctors in tier 3/4 town are conservative while serving for living but within short span of a decade with activism situation changed, now scenario has gradually shifted to avoid individual critical work & early referral sought thus trend of institutional practice is on rise
Aggressive, unyielding, vip, doubting thomas type patients are red flags mostly iffy difficult to convience or drain us unnecessarily A class of patient requiring multi disciplinary institutional care are usually referred on time to relieve their misery as prudent peace strategy

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More from @YDrshivaji

Aug 29, 2020
W Maharashtra
#covid19 has reached hinterland in tier 2 /3 cities & beyond becoming uncontrollable as all beds in different designated centers are occupied full with covid19 person
Admitted either due to breathlessness requiring oxygen or comorbidities abound requiring vigilance
Pandemic Decipher
1/25
covid19 is an attack on our distorted might In our #Variedresponse most will overcome, some would suffer protracted misery & sadly unlucky few, FEW won't survive

We must empathize, urgently mitigate & strive best to protect humanity as we face this menace
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Pertinently this virus is a #Stresstest to physiological, psychological & immunological competency, challenging each individual until present time
Testing our multisystemic resilience, developmental journey, comorbidities, immune memory & subjecting us to scrutiny of viability
Read 26 tweets
Jul 30, 2020
Attack on doctor
Patients psyche ingrained by doctors
Favourable outcomes are easily attributable to care doctor provide some pride (variables forgotten) also sole reason why patient pay for results w'out realising input cost, efforts also expect compassion,kindness from doctor
Lead from front Asses setup capabilities, most important don't be adventurous have policy decision & stick to it
Evaluate patient, relatives & their depth of social delinquency use social worker
After clinical assessment weigh in their expectations & outcome failure & then decide
Unfavourable/grave outcome when occur, some relatives assume to believe it could have been averted with another or better care, here counselling failure is usually primary reason as an astute clinician empathise of doing our best keep them in loop don't predict outcome else refer
Read 4 tweets
Apr 2, 2020
Lets respect #COVIDー19 waging lone battle for own survival,while most of us are alive & contained in our secure abode to flatten the curve but in denial about action to other species pushing into oblivion~extinction exceptional species will rebel to thrive in survival battle1
viral phobia,madness leading to social & physical distancing is yet to set in, once this happens the actual & avoidance response will transform resulting in real impact that will be realised with lag effect, hygiene consciousness will set in as top priority2 #CORONADISTANCING
collectively we need to establish remedy to minimise human casualties putting aside our differences by pro nature policies, although authorities eager to unleash grandeur ambitions w'out any urgent & long-term precautions would be risking vulnerable as bait to this lethal virus3
Read 7 tweets
Mar 24, 2020
#lockdown
This pandemic is given us opportunity to care & tend to the aged in our homes
Start at home looking after the vulnerable especially those with whom we have lost touch, reconnect with them
This isn't time to dwell but protect & amend help the needy to keep them well
#keepelderlysafe Be watchful focus within family for any chronic ailments in geriatric populn with HTN, DM, CKD, tumour remission
Hx past operation, focus on dementia, mental health, single, bed ridden & neurovascular conditions,
chr respiratory ailments do medication top up
Consult your doctor for any doubts don't feel helpless spend quality time with them, once taken care look at your nearest neighbours needing help, form cohesive team especially during clampdown be vigilant & monitor new case addition important follow rule of law & @MoHFW_INDIA
Read 4 tweets
Mar 23, 2020
#motherhood is cradle to ontogeny,enduring nature's ingenuity to propagate evolving distinctive life form with universal precision to genetic hierarchical dominance
Her subtlety to creation,resilience,tenacity & evolution no modern innovation can match efficiently & benevolently
prior to embark'g on sacrosanct lifelong parenthood both must accept basic premise to embracing vow to respect, share-care & survive mutual harmony & hardships
Reciprocate with emotional maturity & integrity to family, making life pursuit meaningful & respect gender equality1/24
initiation is a surprising uncertainty to physical & psychological transform'n for the greater good,expecting to get over unscathed through whole process ASAP
Concerned partner need to support & empathise with her to endure & empower her during tiredness & morning sickness 2.
Read 25 tweets
Mar 23, 2020
#COVIDー19 is dominating everything today for obvious reasons we have to be responsible & will be subjected to
Flight and fight response
Remember first priority is to survive this crisis
Social construct like economy, enjoyment ..will be taken care of when we're out of wood
Be Responsible by
self control & be minimalist practice general activity inertia to reduce spread by hand washing when touch to every fomite & public surface No,no to spitting, cough with precautions, self segregate when ill & consult,self immobilise follow minimum touch policy
Survive infodemics and pandemic
Practice physical distancing try reducing your BMR, self restrict oneself to writing, reading books, gardening reduce clutter, meditate, hobbies
Pandemic survival; matter of luck is very important your immune response competency will be tested
Read 7 tweets

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