No! You Can't Follow-up Your Old Patients!

I am not sure since when this phenomenon has prevailed. I picked up this comment while I was sitting in a combined clinic (obstetrics and general medical clinic) in my hospital.

After becoming a physician, I was posted to a district hospital pretty much near the vicinity where I live. Considering myself lucky, I accepted the 'offer' quite happily.

It has always been my style that I'd like to review patients that I've seen earlier on, so that I can keep track of their clinical response to treatment and intervention. I have been doing this alright with no problem at all..until I met with this old lady obstetrician in my district hospital.

It was a fine day. I walked into the consultation room. Happily browsing through the folders that laid in front of me, I asked one of the nurses: "How many patients are there for us today?"

"Why?!" The old obstetrician raised her voice, even before the nurse managed to throw in an answer. For a moment, I thought she was not yelling at me. I ignored.

"Hey, why?!" She blurted again, much in a stiffer tone of voice. I had already start noticing some gestures from the nurse.

"Oh, I would like to know the progress of the patients that I've seen during the last visit."

"No, it is IMPOSSIBLE!" She dragged the word "impossible" as though as I would not understand the word if she hadn't done so.

I walked away, went into another room sitting with another obstetrician and start seeing patients. I asked the nurse in the room for a favour: "Could you please walk to the next room and look for the cases that I've jotted down 'to see me on TCA' and bring them to this room?"

The nurse went. Minutes later, she walked back with 2 folders.

I went according to the queue number and saw the 2 patients in turn.

I had a short discussion with the O&G head of department later regarding the incidence. He was more approachable and agreed on my move to review previously seen patients.

There are 2 points to highlight in this particular incidence:

1. Following-up patients with regards to their management and outcome is just like doing a small 'cohort study' whithin yourself. It not only benefits the patients, but also the clinician himself as it invariably sharpen their clinical acuity over time.
2. 'Chronic' specialists residing in the districts can become complacent with time as their decisions tend to become 'unquestionable' by more junior colleagues. This cultivates a sense of false superiority in them. I call it the pseudo-superiority complex, as it collapses easily upon careful scrutiny by more experienced consultants from tertiary centres. I hope, one day, she will be scrutinised.