#Cliniciansdilemma
When doctor faces trust deficit, a part of clinician within each doctor is undermined at times resulting in unnecessary & insane tests usually at the behest of patient who's anxious to rule out Diagnostic delusion

Clinical Dx is a challenge to any doctor
Inspite of informing to patient gravity of situation we risk everything esp when unexpected inevitable occurs
When we're prudent to patients impending situation at times patient disappears as they perceive exploitation/undue fear mongering

Patient expectations counseling dilemma for essential but costly test, prescribing specific drug but informing inbuilt risk, procedure advice and risk of comorbidities & anesthesia related complications, advising various Rx modalities admissions need & their cost implications

Essence of life
Single cell that journies from the moment of inception onward into multicellular organism which ultimately mean regresses into death
Immortality is an illusion mortality is real that's ignored & camouflaged due to survival instinct as doctor lets beware of fact

clinical Dx is an art recognize evolving construct fast & apply highly diligent skill of pattern recognition with precision Start with patients body language, ominous vibes we see on evaluation, relatives approach to problem, expectations, affordability, trust & willingness to

Knowing what not to do is crucial by defining our boundaries as per competencies than doing what we know
Always offer limited warranty in any given context with obvious rider of comorbidities & never a guarantee
Recognize triggers that brought patient to us from the high pedestal

Document findings prioritise critical signs anticipate/focus on consequences, prognosticate & manage with essentialism We must always take relatives into confidence collaborate depending upon severity, teamwork is must as per facilities & capabilities venture out or timely refer

patients compliance is uncertain due to trust deficit, inconveniences, bias, intuition, financial misery, ease of 2nd opinion & non existent system We must probe past as patient can conceal past Rx, to avoid labeling & they tests us, inquire to patient what brought them here

many doctors in tier 3/4 town are conservative while serving for living but within short span of a decade with activism situation changed, now scenario has gradually shifted to avoid individual critical work & early referral sought thus trend of institutional practice is on rise

Aggressive, unyielding, vip, doubting thomas type patients are red flags mostly iffy difficult to convience or drain us unnecessarily A class of patient requiring multi disciplinary institutional care are usually referred on time to relieve their misery as prudent peace strategy