Revelations

         I started working as a teacher in the department of surgery at a private medical institution in my home state. A month has passed and I understood two things, relevant to situations, which I never encountered previously. First thing is related to my views about teaching in medical profession. Second thing is about hospitality and patient communication in a private setup.

          Regarding teaching as a profession, this short period has opened my eyes wide. The difficult part of teaching is not transferring the ideas, but maintaining discipline and motivating. Sometime before, I had written, that education is about making people capable of thinking at a higher level.  I developed this clarity about my profession only after some years after entering college. It is very difficult to make a young man or woman open up their mind. They remain unfocussed even after repeated advices. Taking classes for the undergraduates is very easy. I know what I am teaching. I have the experience of treating patients. I know how to conduct a good session on any topic related to my practice. But guiding the students to think out of the box, or motivating the house surgeons to go to the bottom of a treatment plan, is a herculean task. Teaching is easy, but educating is not easy. That is the feature, which keep some teachers apart from the rest. It also requires being strict with the rules. Students and house surgeons are in the constant process of thinking how to avoid responsibilities and how to disappear from the duties. The capability to motivate the students, the capability to make the students think of their own; It’s like starting a campfire from damp wood. Until it gets going by its own, one has to struggle a lot. I now realize why teaching is considered as one of the greatest professions in the human civilization.

           Second revelation was about the hospitality, while practicing in a private setup, where the patients pay for the treatment by themselves. Except for a short period as a casualty medical officer, I had always worked in government run hospitals. I had developed a reasonably good communication skill and I considered myself good at explaining about diagnosis and treatment plans to the patients and relatives. I remember most of the patients were happy with my communication. But there used to be some patients, mostly patient relatives who are unsatisfied with the logistics or discontent with the functioning pattern of the hospital facilities or staff. In such situations, I used to defend the hospital and staff pointing out how good we cared for the patient regarding the disease management. But in a private hospital a whole new realm is added to a doctor’s practice- hospitality. Now sometimes, I have to keep my pride away and talk like a customer relations manager in a showroom. I have to make them feel like; the staff in a hotel or some kind of tourist center treats them. We are not supposed to fight with them. We are not supposed to make them correct. Only thing we can do is to make them happy, make them feel they are served right and decide what they want. Now I am working on it.

The Wikipedia doctor meets the Wikipedia patient

In these modern days in which everything is available on internet, the case of medical knowledge is also not different. Even me, a resident who is supposed to read original literature from big fat books find it easy to Google it.

I am not ashamed to say it, but I have become a big fan of Wikipedia. Even though I am not sure about its accuracy, it is easy it get a superficial idea about a subject from it. But I have to assure you that it is just literature. The real skill of a doctor comes from practice and not by literature alone. So definitely it is not going to be a substitute for doctor for treating illness.

Sometimes you get irritated by patients who come to you saying” Doctor, I read in Wikipedia that the medicine you prescribed is effective in only 5 percent of cases” or “the treatment option you suggest is a failure in fifty percent cases”.

Once a father of a boy asked me to comfort his boy suffering from hydrocephalus who was being taken to operation theatre for a shunt placement. It was his third surgery as previous two eventually got blocked.

So I asked him “why are you so worried? You have already undergone two surgeries and you know the usual procedures.”

He said to me “I know. But I read in Wikipedia that this surgery is associated with fifty percent chance of getting permanently paralysed.”

But he was smiling. I thought to myself “brave boy”. He recovered uneventfully from surgery that time.

Another time a young gentleman came to me when I was in Emergency room. He was having some intermittent pain or burning sensation in penis or sometimes in abdomen at some nonspecific points. All this started in two months and only factor I could pick out is his marriage was fixed around the same time. He has already undergone ultrasounds of abdomen, scrotum, urine cultures, microscopic examinations and NCCT abdomen, which were all normal. Then I assured him, “don’t worry, you don’t have any serious illness.”

Still he kept on asking “What is the reason for this, there must be some reason for these symptoms.”

The only thing that came to my mind then was “You can try searching in Wikipedia”

Dietary advices to avoid recurrence…

 

         This happened few days back. A college girl and her boyfriend came to Emergency Room. She was having nausea, vomiting with bloating and stomach disturbances. Just to mention she had her periods recently, regular and normal. She had taken food from a street vendor some hours before the onset of symptoms. Most likely diagnosis of an Acute Gastritis was put forward and she was treated accordingly. She got relieved after some time.

While prescribing some oral medications the senior resident told her “Please avoid food from outside. Try to stick to home-made food and purified or boiled water.”

Next question from her boyfriend was “Can she take some ‘Fanta’ now?”

Senior resident “!”

Patient c/o Nonsignificant symptoms.....

      As a general practioner you will always come across patients complaining of nonfocal pain in abdomen, limbs, whole body, complaints of gas and related gaseous problems, burning sensation in every possible surfaces and orifices in body, lack of well being, decreased apetite, an array of urinary complaints and toilet complaints.
      We will do a clinical examination, which wont dig out anything in 99 percent of these cases. Then we go to our array of lab and imaging investigations. This may reveal some unrelated hidden pathology in its early stages ; like a fatty liver or prostatomegaly or a small fibroid or a mild splenomegaly ( even called scanomegaly) and blood reports will follow the bell shaped curve of normal distribution. Marginal reports will end up in repeating the test to confirm whether its normal.
     Multiple urine cultures, sputum microscopies, chest xrays, ECGs, CT scans, USG s by different radiologists- all being reported in various levels of normalcy.
    Sometimes the GP has to pin up the cough to a small umbilical hernia or dysuria to mild splenomegaly or hiccups to fibroid, so that the patient could be distracted and  directed to some specialist. Now a days Gastroenterologists doesnot wait for the Psychiatrist to start for antidepressants when they find no reason for the bloating and dyspepsia after required tests and PPI trials. Good thing is that so many of this symptoms get relieved too.
   But it actually takes little experience with patients to divide their complaints to significant and non significant. I think its always better to leave the decision to an expert in the field of suspected disease. Expert doesnot necessarily mean a doctor with degree, but one who sees a lot a such cases.
    My professor always tell, never ignore a complaint made by a patient. Its unlikely that any person in normal mind will complaint of a pain anywhere in body, unless there is a clear advantage of malingering. Everybody wants to be in goodhealth. But somany times we cannot explain the cause of these symptoms or to be exact, find a  treatable cause. Many of them are attributed to neuropathy. Naturally it should be, because most of these sensations are transmitted by nerves only.
   I had many instances like that. Instances when  I could not comeup with a diagnosis which explains the symptoms or treatment that could alleviate the symptoms even after an array of checkups, logical thinking and lab tests. Then I tell the patients " I am sorry that I am not able to find a specific reason for your symptoms. But I can assure you that, you dont have any serious illness that you should be worried of. So take these medicines ( probably painkiller or vitamin placebo) and hope rest of it will subside of its own ( which means you have to live with it....and now getoff my clinic !!)" Majority are happy to hear that, but those with that 'psychiatric face' or with peculiar personalities will be  unhappy.