a rookie doc's rants and raves

Sunday, January 28, 2007




Surgery week 2:

Monday (minor OT)
Was really hoping there would be something posted for surgery where I could assist. But there were two cholecystectomies and one gastrojejunostomy (for stomach malignancy) and assisting in these kind of operations is the stuff of my dreams….wait a minute! Doing (leading) in these operations is THE stuff of my dreams. Anyways, the first gall bladder had around 30-35 small yellowish black stones and the procedure took about 2 hours and 4 people operating. The second gall bladder had a single large black stone and took only an hour for the complete procedure, courtesy Dr D (THE consultant) who removed the gall bladder in some 20-25 minutes from the time of incision. He taught about thinking about the next step in operations, to improve on procedure timings and to have a smooth flow during the procedure. Had the privilege of seeing him operating from close quarters, makes surgery look like a poetry recital.
In the evening I went out with class mates for the movie ‘Guru’ at starcity. Good movie but could’ve been better (3/5)

Tuesday (ward rounds and minor surgery)
Just did the collections (blood draws) and went. Went out with a couple of friends to ‘Five Spice’ and gorged on crispy chicken, Mongolian pot rice and (drumroll) brownie with hot chocolate sauce and icecream………ymmmm. Watched the movie ‘Blood Diamond at ‘New Empire’. Its an Amazing movie (4/5) with fabulous performances. If only the seats were comfortable, but then who can complain if the upper stall seats were only for Rs 55/- (believe me I need every paisa after buying the book ‘Tales from the firozsha bag by Rohinton Mistry)
Less work + bought book + good movie + good food + (most importantly) great friends….. I think it was a perfect day

Wednesday + Thursday (emerg and post emerg)
This was one of the worst emerg duties I have attended. Lots of admissions in OPD and patients wit major acute conditions trickling in throught the day and night. Because of this the elective procedures who were waiting for days, got stalled. Besides the operation theatre is closed this Friday because of republic day (we’ll be a third world country even 50 years down the line…. This sucks). Dint get a wink to sleep and the trauma reg took advantage of me…………………….before your imagination runs wild, he made me do sutures, catheterisations, blood draws when I was supposed to be somewhere else. Unlike last week, I made 4-5 trips to the CT scan centre which really ‘fired’ the night. I really doubt if the scans help in patient management considering the machine is located about 300 meters from the trauma centre, scans are postponed if the radiology people are in the middle of meal not to mention the bumpy ride because of old rickety stretchers and Indian roads. Had a bad time doing the post emerg collections (total 25… that’s a lot for surgery department). Dint report after the collections were over and went straight for home at 10am. Slept the whole day and the night.

Friday
I celebrated independence on the republic day and dint go to the hospital. There was no work and no teaching scheduled.

Saturday
On the houseman’s special request I went early (7:30 am) to the emergency ward for morning collections. Reaching there, I found that the collections were of a different unit. I grumbled a little (mostly to myself) but feeling my conscience prick and my registrar stare I did the job quicky and reached the ward for MORE collections. Left the hospital after that. Went to the STRAND SALE with a couple of friends and found the book I was looking for since a while, COMPLICATIONS - Dr ATUL GAWANDE, notes from the life of a young surgeon. I hope to get some insights on surgery and surgeons through this book. Then we went to chowpaty beach and were thrilled to see an air show by the Indian naval air force. We were at the right place at the right time. Had strawberries and cream at the sea face (I’m having way too much fun and consuming way too many calories for my own health).

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Sunday, January 21, 2007


Surgery week 1:

As this is my first choice in terms of speciality, I have been waiting for this posting for months. It got delayed a bit because I have taken 2 week repeat and will complete half of my central surgery posting in march. I feel bad about this for two reasons. One, I did not use the two weeks off for any great purpose. Two, I’ll have to do the remaining two weeks in march.


Day 1 (15th Jan – Monday)
Schedule: minor/single table OT

I reached the OT at about 9 and was in two minds as to weather I should enter the OT. This is because the interns are usually made to run around for tracing reports, ward work etc. This would involve getting in and out of ‘changes’. Still, I entered hoping against hope of such an occurrence. I met the housesurgeon and he introduced me to the registrars, lecturer and the head of department (lets call him Dr D). It was really funny the way the HOD asked me to lower my mask so that he can see my face. HODs are rarely interested in recognising interns by face. Apparently the unit had shortage of staff and I was asked to ‘wash up’. Wow, this was turning out to be a productive exercise. I assisted the housesurgeon in three hydrocele operations (lord’s procedure). I could barely believe my luck. Actually I almost did the third procedure myself. I’m promise I would be given the next hydrocele procedure completely to myself, provided time permits. The unit was pretty impressed with my assisting skills and concluded that my primary interest is in ‘general surgery’.

Day 2 (16th Jan – Tuesday)
Schedule: ward rounds and minor surgery

I went in a little late to avoid doing blood collections. The HO complained about it and asked me to come earlier the next day but I have no intentions of obliging. I know this sounds nasty as I should reciprocate the opportunity to assist given the previous day. I was sent to the minor surgery dept so that a doctor is present there if anybody asks. Not that I can manage even the minor procedures myself. Saw the mama do dressings, suture removal (did a few myself) etc. Attended the rounds with the Dr D, who is considered one of the GODs of surgery, in my institution. I absorbed everything he said like a sponge. Then I, the reg and Dr D went to the canteen after the rounds. I’m told this is the tradition of my unit. The three of us have coffee which Dr D pays for…. Wow! free coffee! He also inquired about me. Where do I stay?... etc The advice Dr D gave will stay with me forever.


Day 3 and 4 (17th Jan and 18th Jan – Wednesday and Thursday)
Schedule – OPD and Emerg

Reached OPD at 9ish. Saw a few cases like hydrocele, hernia and ulcers. OPD was heavy. I was sent to bring a patient to x-ray dept for she was scheduled for a T-tube cholangiogram. Again saw a few cases in OPD before leaving for lunch. Went to Emergency Medical Services section at 2.30 pm. Couldn’t contact my HO as my mobile service is down due to non submission of some document in a hutch shop. This sucks majorly as it creates many problems for the unit and me in maintaining contact about my whereabouts. Had only one patient to accompany for CT scan. That’s good news in surgery emerge.
A final year medical student came in with injury over the big toe. Half of her toe nail was avulsed and needed to be removed. Tried my best to placate her while the HO did a fine job in nail removal. LA was not used as it would involve multiple pricks of the needle and the nail removal seemed a 20 second job.
Saw orchidectomy of a patient with swelling of the testis…. His only remaining testis... Quite surprising was the reg joking about it with the patient (what will you do with the gun now that you have no ammunition). It was appalling.
Slept about 90 minutes in EMS and 90 minutes in lobby of medicine dept. Thank God for a single CT scan.
Had some 25 collections in the morning which went smoothly.
Was not feeling sleepy so attended rounds with Dr D and then to the canteen for free coffee… again, had a healthy dose of words of wisdom from the chief.


Day 5 (19th Jan - Friday)
Schedule – major/double table OT

Again assisted in hydrocele(bilateral). I’m told that if time permits, i’ll get the opportunity to operate a hydrocele by myself with the HO assisting. Looking forward to it. Saw cystoscopy done on two patients. Had to run to patho dept in between to trace a patient’s biopsy report.


Day 6 (20th Jan – Saturday)
Schedule – post OT/ward rounds

Was made to take two patients to USG dept for sonographies of chest, abdomen and pelvis for fluid collections. Was tough with only one porter helping patients, both of whom were taken on wheelchairs. Took a long time (about two hours). What a waste of a day.

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Sunday, January 07, 2007




Reservations in medicine, back fired?

Finally the bill for reservations in higher education including in medical colleges is passed and quota for SC/ST/OBC would be implemented from the 2007 academic session. All the efforts of the anti reservation campaigns, the morchas, the beatings, arrests and thousands of man hours amounted close to nothing.

Also, this year, in Maharashtra, the rural service bond of 1 lakh was implemented. More over, completion of medical officership or breaking the bond (paying one lakh) was made the criteria for students of 2001 batch to give the post-graduate medical entrance exam. This led to a flurry of students arranging for the bond money (one lakh) as most of them wanted to have shot at the entrance exams. The government disclosed the amount of money collected just from the 2001 batch as 10.06 crores. There are many students who have not broken the bond but will break it in march-april. Moreover, students who will apply for foreign universities will have to pay one lakh extra. The basis of this extra one lakh is till date, unexplained. This inflow of cash from broken bonds will continue every year. All in all it is evident that there is going to be an influx of hard cash in the BMC in the coming years.

The reason the government gives for their right on this money is that they spend an equal amount on each medical student for the course. The government has never disclosed the amount of money it spends on medical education. So the amount of the bond money fixed at one lakh is baseless. Besides, how will this money, which is supposed to be used for medical education, be of any use to the rural health? One cannot escape doubting where this money will end up!

Medical graduates on the other hand state that taking up the medical officership will not make much difference to the rural health as the facilities and equipment available at most government primary health centres is grossly inadequate. Many centres don’t even have the basic drugs to treat conditions like fever, malaria, cough, cold and respiratory infections including tuberculosis.

Now, the government/BMC has to shoulder the responsibility of spending this acquired money on developing the quality of medical education which is below standards, to say the least. Medical students should demand the details of the money spent on them over the last past 5 years.

Over the past year, problems plaguing medical education like quota and service bond will give rise to two other problems. One, a good student aspiring to become a doctor will be persuaded to change his career options and he/she will find fields like engineering, management etc to be much more attractive. Two, many medical graduates will leave the country and go to USA, Australia, UK for postgraduation and subsequent immigration.

Infact, according to a survey the applicants for GRE and USMLE (for United States of America) from Mumbai city medical colleges have doubled in the recent few months. Are these healthy signs for the future of society’s health? Will this benefit rural health? Are we ready for a new wave of medical brain drain? We know the answers to the above questions. Unfortunately, the government doesn’t.

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Tuesday, November 28, 2006




BLOODY ENCOUNTERS




in march i began my first major internship rotation in central medicine . in my unit, the houseman used to give me the list of patients whose plbs was to be done at 1pm, about 2 hours after they have had their lunch.


there was this elder man with uncontrollable diabetes who had tobe PLBSed every noon. my houseman who was a real prick (pun intended)had not used spirit for his collections before me joining the posting. as a result he had developed skin infections one one of his arms. i dressed the ulcers and used aseptic techniques to collect blood henceforth. the guy's daughter who used to take care of him was really impressed with me as no further ulcers/infections developed. all went fine and the patient was discharged a week or so later.


i'm sitting in the casualty in casualty posting(duh!). and the same man is brought with dizziness and fainting. on hearing the history of severe DM the CO admits him. the med housie takes the history and orders the intern posted to collect blood samples. this lady comes running to me and begs me to come over to do the collections. although i felt happy that she remembers me, i was sad the next moment thinking how cruel some pple can be (my ex-housman). i was just doing my duty.


(circa november) passing through dharavi, i was crossing the mahim bridge where i saw a familiar face. on looking at me she seemed like she saw one too. we recognised each other. she asked about me and i asked about her dad. it was really heartwarming to be remembered like this. guess who was smiling on his way back home?

Sunday, November 19, 2006

YOU THINK MED SCHOOL IS TOUGH, EH!

ADAM Huber is a medical student at the University of NSW. He is also homeless and lives in a park as he struggles to pay the annual $33,000 tuition fee.
The 24-year-old American international student survives on a diet of peanut butter, tuna and crackers.
At night, a small tarp and blankets provide his only shelter from the elements while possums share his bush hideaway.
Mr Huber has been homeless for most of the 18 months he has been studying for his Bachelor of Medicine/Bachelor of Surgery degree at the Kensington university.
His situation has been so dire he has resorted to eating food out of a rubbish bin at the back of a supermarket and begging for leftovers from local cafes.
"At times I didn't know how I was going to make it," he said.
More a victim of bad luck than bad planning, Mr Huber believed he had won a scholarship in which his tuition and living expenses would be paid in return for working on a project researching prostate cancer.
But when he arrived in Sydney at the start of 2005, he was told the research grant had fallen through and he'd have to find the $33,000 up-front payment.
"My uncle sponsored me a flight to Australia and I was really excited to start, then I lost this grant so I had no idea how I was going to pay the fees," he said.
Faced with losing his spot in the medical school, he took a job at a sleep disorder clinic, working night shifts while trying to keep up his study during the day.
Mr Huber said: "I worked 18 12-hour overnight shifts in a row once because they weren't going to let me sit the final exam and I needed to come up with the money.
"I was able to pay off 50 to 60 per cent of it but I wasn't eating - I had to sacrifice food to pay off my fees - and I still had to take out a loan because I couldn't make it."
Mr Huber said the Faculty of Medicine, which is aware of his situation, has repeatedly threatened to block his results and take away his access to the university buildings, library and all other services. He has been told to "drop out" and sent to see a psychiatrist. The university union was similarly unable to help.
"I've received letters that I will be sent to a collections agency and I've also been told that by not paying my fees I am in violation of my visa and would therefore be reported to immigration," he said.

A spokeswoman said UNSW was unaware of the scholarship. She said UNSW offered programs, including low-cost housing assistance, through a student affairs co-ordinator.
"These opportunities have not been taken up," she said.

"Any student is able to defer studies [and return to their home country], should they choose to do so, in order to earn more money to support themselves through their studies."
But after passing all his subjects last year - despite not owning a single textbook - Mr Huber is determined to get his degree and go on to work for international medical humanitarian organisation Medecins Sans Frontieres.
"My will's pretty strong. I know what I want to do, I know who I want to work for and I've never wanted to work in the States," he said.
"In the US health-care system, you're just working for rich people."
He hopes to find a sponsor to help him pay his fees or gain permanent residency in Australia so he can get a Commonwealth supported place in the school.
"I know there's a high need in indigenous communities and an incredible opportunity to work in under-served populations in Australia," he said.
Degrees of difficulty: annual fees
* UNSW Commonwealth-supported students (HECS) - $8170.
* Bachelor of Medicine/Bachelor of Surgery at UNSW - $33,360 for full fee-paying international students.
* Medical degree at Harvard - $46,792 a year.
* Maximum annual fee at all British universities - $7489.
* All Canadian universities - $12,174.
* National University of Singapore - $70,249
--- the above post is takent from another medical blog but i forgot the link/url... please if someone can tell me the source, i would like to give appropriate credits.


FRIENDS AND FOES


MEDICAL STUDENTS:
Primary goal – to ‘see’ as many ‘exam’ cases as possible.
Secondary goal – to do the above in the least possible time and ward attendance.
Friends – registrar who shows them what cases to ‘take’
Enemies – ‘non-exam’ cases, books, exams in that order

INTERNS:
Primary goal – to do the blood collection and RT/ Foley the patient without being given some other work
Secondary goal – to do everything to meet the primary goal.
Friends – co-interns, newly joined houseman
Enemies – externs, experienced houseman.

HOUSEMAN:
Primary goal – to get patient work-up done in least possible time and off-load maximum work to the intern.
Secondary goal – steal some sleep when the seniors are not around
Friends – naïve interns, houseman in other units
Enemies – houseman in same unit, smart interns

REGISTRAR:
Primary goal – learn how to treat patients.
Secondary goal – impress the professors.
Friends – naïve houseman to get the patient work-up done
Enemies – lecturer, because he poaches the patients for surgeries; medical students, because they eat his head to take clinics for them.


LECTURER/ASSOCIATE PROFESSOR:
Primary goal – get maximum experience treating patients and doing operative procedures.
Secondary goal – impress medical students and get your work done by the intern
Friends – professor for his career guidance, recommendations and help in getting research published.
Enemies – registrar with whom he competes for performing procedures.

PROFESSOR:
Primary goal – stay in campus for the shortest amount of time
Secondary goal – ask questions that nobody can answer.
Friends – none
Enemies – too many patients, everybody who is trying too hard to impress him.

The above article is a fictional generalisation and is not representative of a particular groupe. It should be taken in good spirit and good humour to maintain peace. If you loved the above article then something is wrong with you. If you liked it, mail me or message me. If you dint like the article then don’t contact me. If you hated it, then something is seriously wrong with you.



Sunday, November 05, 2006


AN ODE FOLEY


This is one of the most common procedures done by interns. everybody thinks they know how to do this...the anatomy, the steps, 'no touch technique'... most interns take this procedure for granted.. but this will open up your mind and will probably make you feel guilty for all the patient's whose urethras you botched up!!!!!!!....the comments are more interesting than the post.. http://www.emedicine.com/proc/topic80716.htm#Technique

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DO WE NEED SUPERSPECIALISTS

what is the role of a superspecialist in the india healthcare scenario? whats the use of a neurologist if he sends his patient to a cardiologist for the high BP and to a endocrinologist for his diabetes!!! if thats the case why dont we have direct cardiology training, why go through 3 years of internal medicine? super specialists cannot shy away from their duties of treating conditions in which they were primarily trained. there are a lot of risks and patient management problems due to multiple referrals. to read further check out the link http://www.indegene.com/Main/Issues/indIssues21.asp?type=Main
the above post is relevant to the developing countries like india. i cannot comment for other places.

CONGRATULATIONS TO ALL INTERNS OF 2006 BATCH... WE ARE ELIGIBLE FOR BOTH ALL-INDIA AS WEL AS MH-CET..... YIPPEE!..

Thursday, November 02, 2006