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THE SYMPTOM OF "STARTING TROUBLE" IN PRIVATE PRACTICE
O P Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai,
Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
During last so many years I have heard four types of patients who have used the word "Starting trouble". Initially, I used to laugh it off and I thought that the word was used by the patient due to lack of communication or poor vocabulary or the language or it is their idea of tickling or amusing me.Over the years I have realised that they are giving us a very important hint towards the diagnosis of a disease. Thus in my opinion this complaint is diagnostic of the following diseases :
- Patients having enlarged prostate : These patients invariably have difficulty in starting to pass urine and they use the word "starting trouble".
- Patients of rheumatoid arthritis : All of these patients have maximum problems early in the morning. When they cannot get up from the bed to go to the toilet, they use the word "starting trouble".
- Patients of Parkinson’s disease : Very few books would stress that the Parkinson’s patient finds it difficult to start walking, but once he starts, he can continue walking with good pace. Thus the Indian patient of Parkinson’s disease uses the word "starting trouble".
- Finally, patients having symptoms of erectile dysfunction very often use the word "starting trouble" to describe this type of sex weakness.
There are many things which I have learnt from GPs towards improving private practice but there are also many things which I have learnt from my patients in private practice which have made my diagnosis easy in my clinic.
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