Thursday, December 10, 2015

Why junior doctors should learn asking "Whys" instead of just "Whats"

It was one fine Monday morning and I was an intern at the Surgery Out-patient clinic in the medical school I graduated from. Back in those days, being a government hospital that it was, the surgery out-patient clinic would get extra-crowded on Mondays. The surgeons there had to attend to a large number of cases in a short period of time.

Briefly, I would like to narrate one incident that happened when I was there. An old woman, should be more than 50 years of age, came with complaints of severe heartburn. She was slow to talk and tended to digress on questioning and she often spoke of how life was unfair to her. A little probing revealed she had consumed "Super Vasmol" and got treated elsewhere but her present symptoms had started soon after and didn't resolve. Seeing me spend much time with a single patient, the junior resident nearby ordered me to write a UGIE (Upper GI Endoscopy) and refer her to Psychiatry along with a prescription of PPIs. I was almost about to, while, without me realizing, I asked her one question which entirely changed the medical management to a large extent. 

I asked her, "Why did you drink it?", probably out of a strange curiosity that had, perhaps fortunately, out of nowhere landed on me that day. Later, I ended up sending her to the ENT department on hearing descriptions of tinnitus and disturbing vertigo that sucked out every little pleasure from her day to day life. 

I seriously don't mean to project myself as the super hero of the surgery OP that day. But I am interested in sharing the little that I learnt in the art of medicine that rarely gets taught in medical schools. If you own this book or have a library which has a copy of Oxford Handbook of Clinical Medicine, please head on and read Chapter 1: Thinking about medicine. It describes how asking "Whys" might change the therapeutic objectives in effectively treating the patient. 

You need to ask yourselves WHY until you get to the bottom what might seemingly pose like the culprit. A patient presenting with iron deficiency anaemia needs iron supplementation. But WHY did he develop a deficiency in the first place? Is it nutritional? or or excessive loss, or something else? Once you find it is nutritional, don't be contended to supplement. WHY nutritional? Is it financial or psychological or something else? And so on... 

Doctors often need to think in lot of different perspectives to effectively diagnose deceptive diseases. Medical students at the Yale University are taken to an art museum and shown art figurines to diagnose. The idea is to train doctors to see things from a different perspective. 

Our healthcare at the primary level must address a lot of basic "Whys" that we often don't bother to think about. Medicines are not magical concoctions. Often prescribing medicines treats the doctor. It makes him/her feel in control. There could a lot to discuss and argue about trying to define what Holistic Medicine should deal with. But as doctors in the making, we could contribute a little in decreasing the inefficiencies of healthcare processes at play. Diving one step deeper could give you insights to make better clinical decisions.

Thursday, November 5, 2015

The greatest cash back offer of the year is here!

Booking a bus ticket has been so easy these days; you can accomplish the task with just a few taps. What’s more difficult is choosing the service that provides the maximum discount at that particular time of the year.

Thanks to Google and the numerous coupon sites that have cropped up, I made a quick search. I was planning a trip to my home-town and I had to book tickets two tickets — for me and my wife. It would normally cost 1200 bucks so I was on the lookout for a good deal.
“50% cash-back offer — Limited time” read a particular offer.
I searched no more. I rushed straight to that site and started booking my bus tickets. I couldn't believe my luck! I could get those tickets at half the price, I was like

WOW! WOW! WOW! Oh My God! WOW!

After entering all the details, I finally came to the payment page. I entered the coupon code happily expecting that the prices would be slashed by half after I enter the magical code. The amount I had to pay was Rs. 1200 so I was sure of 600 rupees cash back! The greatest cash back of the year…
What! Wait! Is there some mistake?? Let me try again…
The same disappointing thing happened again.

“You will receive a cash back of Rs. 100 within 24 hours”

I was extremely disappointed. That’s not even 10% of my amount.
Guess what they had on the “Terms & Conditions” page (see below)

Billions and billions of bilious blistering blue barnacles…

Tuesday, September 22, 2015

Here's how a night ride on a bike could go disastrous!

He could barely open his eyes. With all his might, he tried a last time…yet in vain. All that followed was a feeble twitch and it hurt. 

The instrument cluster around him beeped in asyncronous cacophony. I guess he could hear all that. Or perhaps, he simply slept. Or maybe, he was drowsy. Maybe he was unconscious that he was blissfully unaware of…

“Excuse Me”.  I moved away.

A dutiful nurse came up with some injections and loaded them into his vein through a canula which was already connected to two bottles. I could see a small withdrawal reaction on his hand while the nurse administered the medications. Ah, he’s not unconscious, I mused. Or maybe, he is…  withdrawal to pain is a primitive response and might be preserved in some cases. 

I was leaning on the side rails of the Fowler bed on which he motionlessly lay. I stood beside him and tried to decipher what was going on to him. He looked young, by my judgement I would place him around 20-22 years of age. He had a neatly trimmed beard that reminded me of my cousin. Though his hair was ruffled, I could see it was meticulously styled in a parlour. His clothes were smeared with blood and I could see mud sticking to it. From the logo on the shirt, I could recognise the brand, the one I used to love but never bought because they were too expensive.

“Excuse me, doctor”. I turned. 

“Can you please check the dose of Ertapenem for C7? His creat has increased to 3.2”

“Sure.” I moved to C7 to check the reports. Half an hour had passed. I finished my work and left for lunch. 

About 3’o clock, I was becoming restless. I suddenly remembered him. I left my work aside and left for the ICU. He was still there in the same position in which I last saw him. 

There was something about him that bothered me. He was young, looked well to do and very decent. He didn’t smell of alcohol either. It was quite unfortunate for him to be there, after a bad accident he had met last night. I felt sorry for him.

I moved closer. I leant near him, my arms crossed over his bed railing. What was going on in his head, I mused. Was he thinking of his pain? Was he thinking of his parents? Was he thinking of his friends? Or maybe, was he thinking of taking revenge on the one who hit him? Was he praying to become well soon? Was he just surrendering to fate? Giving up on himself in the face of excruciating pain?

A little tear glided down his cheek. I traced them above to find    eyelids slightly open revealing bloodshot eyes. Before I could even more a little, his lips slightly moved. I moved closer to listen…

“If only I had listened to my dad…” a creepy whisper followed.

On that deceptively peaceful night, Ram and his friends had planned to meet at the beach at midnight. There were to throw a surprise party at the beach to Ram’s friend. Ram had planned everything so meticulously. 

11:39 pm, he saw on his Samsung S6 Edge. He slid it down in his jean and reached for the bike keys. His father was awake. 

“ Please go slow ” he bemoaned. “ Don’t be too…

It was too late. Ram had left. The night was cool and calm. The skies were clear and the moon put a beautiful smile. He could feel the cool breeze blow on his face as he sped on his bike. He had always loved driving on his Yamaha. The roads were clear. Being a very small town, the people were in their houses by 10:30 and there was absolutely no traffic on the road. “Why should I not have some fun? Will a little speed kill me?” he laughed in his head as he turned the accelerator. 

“The roads are clear.” he thought.

That is exactly what the 37 year old factory worker thought. He was already very late and half drunk. The thought of managing his angry wife only made him raise the accelerator. 

At the junction near Ram theatre, the traffic lights usually go off at late nights and only the lonely orange would blink unceasingly. There, they collided. 

Luckily for the factory worker, he regained his balance and escaped with few injuries. But for Ram, luck was not his friend. He landed in the ICU.

I do not know what happened to him. 90% he would have died. Even if he lived, he would have to with the pain of severe disabilities. 

Remember: If you are travelling at night, especially within city limits, when the traffic is clear, be extra cautious. Take it from me, it is more dangerous than a crowded street. Don’t overspeed.

P.S. Share it with those whom you know. 

Saturday, September 5, 2015

A Tribute to my Teacher: The Man Who Would Never Stop Encouraging

It's hard to imagine how just a few words could have such an influence on someone's life so much. So much that you tend to go back and play those memories in your mind and remain eternally grateful to that mortal being. 

Those were hard times. Life seemed like one of Robert Frost's poem. The only difference: the road I had taken didn't seem to be the right one. Pitifully for me, there was no way of going back. Pulling myself forward was equally worse. Trying to remain content with what I had often never last long. Everyone and everything around me only reminded me of the harsh reality of how my choices would have been different if I had taken the other road.

Over the years, I guess, I have grown a little wiser (maybe not). I have learnt to go with the flow. I have learnt how life is about living and not, necessarily, having things. I have learnt to enjoy life in my own terms. I learnt to define happiness and experience it to the fullest. I had learnt to let go of expectations that would leave me drained. I had stopped being competitive. Because you lose your confidence in yourself and those around you. Often, such a person is considered to be mediocre. But I still had the fire dormant within. My life was no worse. But I was made to feel worser and worser, every passing day.

And then came this man. He had been my teacher. He had influenced my life earlier too. I had met him after, maybe, 8 years. On seeing me, he recognised me. On hearing my life’s decisions, he was genuinely happy and proud of me. He told be that I would be one of the best in my field.

Sometimes, God sends out his chosen to find worthy people who’ve lost their fire in a cold cold world. Magically they appear and rekindle that little warmth within you, long after you’d forgotten it. They gently rub and polish you and put back that brilliant sheen back on you.

He visited me again on my wedding. He came up with a gift. He looked at my wife and said “You are indeed lucky, He was one of the best of my students”

As that humble human being walked away, I felt awe fill up my heart. This man never ceases to encourage me.

May you live longer! 

May every teacher out there who imparts knowledge & wisdom, who encourages and builds up character, who lights the part and leads the weary ones be blessed. 

I wish you all a happy teachers’ day.