From our long stint in the medical profession we know that each
patient displays differently after an acute event. And it is also true that in the case of the response to the treatment also we observe unpredictable variation in each individual. They cannot be compartmentalised into what is called Protocol or EBM (Evident
Based Medicine). When we plan treatment, we have to take into account the history, investigations and most importantly the present condition of the patient. Here I present an account of one of my recent patients who presented to me with history of AMI. He was about 50 year old and a known case of diabetes. But he did not take any treatment at all till then. Since a few days before the present episode he had been having angina pectoris which also he ignored. The previous night while he was at home he developed severe chest pain and was taken to the nearby hospital. ECG showed AMI and he was advised to go to a higher centre. There in the emergency department the doctor advised him immediate admission. Despite having pain the patient refused admission and wanted some medicine and to go home. The doctor there refused any medicine and allowed him to go home. He came to me next day morning. He was having chest pain at the time of my examination and a repeat ECG confirmed the diagnosis. Blood sugar was high. I did my best to convince him to get admitted. But he was adamant. But at the same time I did not want to leave this poor man without any treatment. Without admission, I gave him minimum possible treatment. As advised he came back on the third day and mind you he came by a bus from his distant village and walked the distance of about a kilometre from the bus stand to my clinic without any chest pain and his blood sugar was satisfactory. On subsequent visits he was much better. Now he is OK. He has survived till today. I cannot vouch for the future. This proves my point that just like our finger prints are different, each patient is different in presentation
and in responding to the treatment. Here I am attaching the screenshots of my electronic records of this patient. For your information I have been maintaining the relevant data for all my important patients since 2001.
UA Mohammed

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