A "Rash" Decision

According to strict local and religious customs in certain Asian countries, male doctors are only allowed to "see" his lady patients covered by full-length veil. Being a doctor myself, I have more than once ruminated on how it can be done. I think for the thousandth time how lucky I am here and don't have to see my patients behind the curtain.

What we seem not to recognize is that, much to our chagrin, we're carrying out such behind-the-curtain consultation every now and then. Many a time while running into another doctor on the corridor, we have a quick conversation about a patient's condition and then offer our expert opinion. We also give order after hearing few words from our nurses at the other end of the telephone. Truth be told, some of us had trouble with this – me, too.

Once upon a time – just one week ago really – my nurse consulted me because his mum got painful tummy. He didn't bring his mum to see me but described the whereabouts of her pain, "Pain at the right side of her tummy, lasting for two days. She went to see a doc at the government clinic, and then was given a referral letter asking for surgical opinion."

I tried to collect my thoughts. "Did she ever mention problem with taking fatty meals?" We agreed that it could have been coming from gallstones, those little pebbles of cholesterol that plague the gallbladder. Behind the story, nevertheless, lurks one of her mum's uterus cancer, which was operated five years ago. That means her mum's belly had a surgical cut made before. When the muscles become weak over that area, the internal organs can bulge through the scar. The nurse thought that this was a very good suggestion. He actually believed that his mum (and the doctor at the government clinic) felt a lump over the belly. I nodded. "Let's get an ultrasound for your mum and see."

A lot of times I get it right and pride myself on my know-it-all diagnosis. Not always, though. Two days later, the nurse brought the ultrasound images and her mum to see me. His mum's ultrasound did show a few innocent gallstones. I couldn't see why that mattered. In fact, when I took a look – finally – at her belly, there was the telltale angry-looking rash of painful shingles on the right side. Ha, ha, ha.