Appointment

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What this chapter covers

We begin our story in May 2024, and meet our protagonist, Birender Singh. We learn about his walk-in visit to a primary health center (PHC), and the provisional diagnosis made by the PHC's medical officer, Dr. Sood.

This chapter

Birender and his wife, Janaki, had lived in the small town of Tikroul for most of their lives. Birender was 60 years old, with a history of high blood pressure. For the past four years, he had been on hypertensive medication.

Since early April, Birender was waking up 2-3 times a night to go to the bathroom. He decided to go for a checkup to the local primary care center (PHC). His 32-year old daughter, Simran, who lived close by, accompanied him for the visit.

They arrived at the Tikroul PHC at 9:30 am. They were greeted at the front desk by Gayatri Gupta, the PHC staff nurse. Gayatri was a well-known face in the community. Every Friday evening, she ran a health education camp at the local school.

Gayatri searched for Birender's name, and found that he last visited the PHC a year ago. At that time, he was seen by Dr. Biswajit Pramanik, who had been replaced by Dr. Anamika Sood as the MO (Medical Officer) three months ago.

Gayatri informed Birender and Simran that they were fourth in the queue to see the doctor. She proceeded to check Birender's weight and blood pressure. "Hmmm," she said, "Your weight has increased from 77 to 82 kgs, and your blood pressure is 145/95. Have a seat. I will re-check your blood pressure after you rest for ten minutes."

Gayatri then turned to Simran. "How are you related to Birender?" On learning that they were father-daughter, Gayatri asked if she could link their medical records.

Gayatri located Simran's medical record using her Aadhaar number. After linking it to Birender's, she noticed that Simran had another record linked to hers — that of her 5-year old son, Rajat. Gayatri asked Simran about his health and vaccination status. Simran promised to bring Rajat in for a health checkup soon.

Ten minutes passed quickly. Gayatri re-checked Birender's blood pressure, and saw that it dropped to 143/92. She updated the recently created record, with a note that blood pressure was re-checked to give the patient time to rest.

Before Gayatri could ask Birender some screening questions, Dr. Sood completed her last consultation. At the same time, another patient, Himmat Anand, walked in. Himmat is a 45-year old man. He had called the PHC the previous day to make an appointment for 10:00 am, to get a medical certificate for his new job.

Though it was still a few minutes to 10, Himmat was insistent that he see Dr. Sood right away. "I can't be late for the first day of my new job!", he protested. Gayatri convinced him to wait, and sent Birender and Simran to the doctor.

When they entered the office, they saw Dr. Sood peering at her phone. "I have reviewed your last three visits, which stretch over the past four years," she informed Birender, "You have gradually gained weight. And your BP has increased from what it was in 2019, after you started your hypertension medication." Dr. Sood then asked Birender questions about his current health, and the reason for his visit.

On learning of his recent symptoms, she suspected diabetes. She asked Birender to return the next morning, on an empty stomach, for a fasting glucose test and an . She advised him to walk at least two kilometers daily, and limit his consumption of fried and sugary foods, to keep his weight under control. Dr. Sood wrote a note, and asked Birender to show it to Gayatri on the way out.

Gayatri reviewed the note, and counseled Birender and Simran about the fasting test and OGTT. She then scheduled a follow-up visit for the next morning, at 8:00 am. As Simran accompanied Birender back to his home, he received a text message informing him of his appointment the next day.

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Lab test