I wonder what makes me ask my people questions which are such that every one with a bachelor's degree in medicine would know answers to. What never ceases to surprise me is the result of such questioning.
There was a patient in the antenatal ward. She was quite emaciated. I gave appropriate advise on her management. Then I had an urge to ask a question that belonged to the category described above.
"Suppose we check hemogram of normal gravid women in the antenatal clinic. The first woman's erythrocyte sedimentation rate (ESR) is found to be 52. What will you do?" When no one took any initiative to answer that, I asked my Registrars. When I heard their answers, I was appalled. Then I took an opinion poll of all resident doctors with bachelor's degrees, and MS qualified residents and Assistant Professors. Their answers were as shown in the following graph.
No one with a postgraduate qualification answered correctly. 'On fence' category included those who stated that the ESR was raised in pregnancy, but also recommended further investigations to find out the source of infection even if the woman was clinically OK. It pained me to find that doctors with graduate qualifications gave wrong answers, and it frightened me that doctors with postgraduate qualifications gave wrong answers too.
I did not tell them the correct answer. I am waiting for them to find it out on their own, or ask me what it is. In case they read this post, and also for the readers who are reading it, the correct answer is as follows.
ESR is raised in pregnancy to levels shown in the following table. Since the patient is clinically normal and her ESR is in the pregnancy range, it is physiological elevation and requires no further investigation or management.
There was a patient in the antenatal ward. She was quite emaciated. I gave appropriate advise on her management. Then I had an urge to ask a question that belonged to the category described above.
"Suppose we check hemogram of normal gravid women in the antenatal clinic. The first woman's erythrocyte sedimentation rate (ESR) is found to be 52. What will you do?" When no one took any initiative to answer that, I asked my Registrars. When I heard their answers, I was appalled. Then I took an opinion poll of all resident doctors with bachelor's degrees, and MS qualified residents and Assistant Professors. Their answers were as shown in the following graph.
I did not tell them the correct answer. I am waiting for them to find it out on their own, or ask me what it is. In case they read this post, and also for the readers who are reading it, the correct answer is as follows.
ESR is raised in pregnancy to levels shown in the following table. Since the patient is clinically normal and her ESR is in the pregnancy range, it is physiological elevation and requires no further investigation or management.
Non pregnant state
|
First trimester
|
Second trimester
|
Third trimester
|
0-20
|
4-57
|
7-47
|
13-70
|
