A patient from out of town was in the clinic the other day with complaints of an unyielding fever and chills. She was a diabetic and usually was under good control. She was also obese and was considering bariatric surgery. On examination, she seemed to be fine other than the fever and a mild congestion. She was put on antipyretics and told to follow up again in a day or two.
She came back and the fever was higher. It had not gone down to normal at all. This time, we were sure that we had to find the focus of infection, it had to be somewhere. We did what we should have on the first day. Took a more detailed history and did a complete physical examination.
It was carefully tucked away, hidden by her overweight thighs, at the perineum. It was an acute perineal abscess. It was inflammed, almost pointing, gasping, waiting to be let out. She needed an incision and drainage and we knew it. Her blood sugar was high (as expected). We did the surgery, she felt better and was able to travel back to her home town in 2 days.
The question here is, should the patient have come clean about the boil she knew was festering in her perineal region (undoubtedly a very private place but....) or should we have insisted on a complete exam? The thing is, in India, where cultural influences are so strong, almost all women and most men will still not feel comfortable about their bodies being exposed even if it is for medical purposes!
In the west, I assume the Doctors are more cautious, what with the malpractice race closing in on them all the time. Here it's more the patient's unwillingness to admit something could be wrong in "that" region.
I would love to have a middle ground and say that its our duty to inform the patient that a complete medical examination is required, but how many would agree to strip down completely for 'just a fever'??
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