Why a good doctor will insist on examination

How do paediatricians manage to get the best of their patients? I dread my toddler being misdiagnosed for illness.

In these very difficult times, we get many calls from our patients who ask for a renewal of a prescription to avoid seeing the doctor because of the consultation fees.

Often, the patient argues that, “In the last few times, you have given me the same medication.” The doctor then explains that the patient has to be seen for confidence that nothing has changed since last review.

Worse than this are instances when a patient says she has a sister or friend who has same symptoms and would like the doctor to give her the same medication for her friend. Bad doctors oblige, good ones decline.

The reason for this must be obvious. If it is not, then let me state that in a doctor’s mind, “A patient he has not examined has not been examined.” It is not enough for a doctor to hear that so and so was seen and found to have the following symptoms. A doctor takes clinical responsibility for those he has examined.

In this regard, the mental state of President Trump comes to mind. In many social gatherings psychiatrists are asked to comment on the President’s mental health. Because of his overtly erratic behaviour, many lay people have come to the conclusion that “Trump must be crazy.” The New York Times published a letter on October 11, 2019 under the title Trump is mentally unfit. No exam needed.”

The authors of the opinion are distinguished men from some of the most reputable schools of medicine in the US (Harvard, Yale and University of North Carolina).

The three were in breach of their own regulations, by the American Psychiatric Association (APA) which has published the so-called Goldwater Rules.

Briefly, the rule arose from a 1964 incident in which 1,200 psychiatrists stated that Barry Goldwater, a Presidential Candidate, was, like Trump, in the opinion of some “unfit for office”. In 1973, the rules were effected to bar psychiatrists from making a public comment on a person they had not examined.

Whatever I think of the mental state of a public figure, my opinion must be taken as equal to that of a person without training. It is worthless and has no professional effect. Only a person’s doctors may comment professionally on their mental state. Rumours about this or that person who drinks too much are simply that, rumours.

So, whether it is about the politician who seems drunk on the podium or the apostle who removes imaginary demons from people, the opinion of the psychiatrist only crystalises as an opinion upon examination of the subject. Now, back to how a paediatrician is able to “get the best of his patient.”

First of all, a pediatrician is a doctor specialising in the diseases (and health status) of children. After Form IV, it can take up to 10 years or more to graduate as a paediatrician.

During that time, the person is trained in many skills of the trade. For example, history taking. In this part of the training, the doctor is taught how different diseases present.

Some have a sudden onset, others come on slowly. Others have fever, the rest have convulsions. Yet others come with yellow eyes, while in others the patient urinates.

Each disease has its own signature of presentation, and is unique to itself.

Even before the child is examined, the paediatrician with experience already has a good idea what the child is suffering from.

More often than not, the physical examination confirms or rules out what the doctor has in mind.

As long as you choose a paediatrician who is qualified, you have nothing to worry about.

Beware doctors who offer opinions on babies or presidents they have not personally examined. Chances are that they are either quacks or simply wrong.