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Showing posts with label doctor. Show all posts
Showing posts with label doctor. Show all posts

Sunday, January 14, 2024

Links to educational resources

Please find the links to all of my recommendations for students on educational resources (click on the links below to open in a new window).


Professional resources:

Lectures for medical students on major topics in Psychiatry (click on link to podcast under each topic)

Patient education videos on common psychiatric conditions

Advice to aspiring students on whether to join the medical profession: video and article


Writeups on mental health issues: 

Article on stress

Article on dementia

Two articles on ADHD: one and two

Article on homosexuality


Books written by me on mental health issues:

Lake Amidst The Seas: An account of resilience in the face of mental adversities








Aham: Short stories of the Mind

[With explanatory notes on the mental issues covered in the stories]


Aham Paperback: Publisher's StoreAmazonFlipkart






Further reading: 

My book recommendations for all medical students

My book recommendations for students of Psychiatry



Further viewing: 

My film recommendations for all medical students

My film recommendations for students of Psychiatry






Thursday, November 18, 2021

Should I become a DOCTOR?

Medical career is such that it sucks you in and never lets you go.  Basically, once a doctor, you are always a doctor.  It is very rare for somebody to be both a doctor and a high achiever in any other field, be it another profession or even a hobby.  

The thing is, medical education demands so much of your time and attention that there is hardly any time left for you to upskill yourself in any other field.  If you do manage to achieve this, it is often through compromise; you might have to cut down on your medical practice significantly to attend to your other interests, or vice versa.  

Students are often misled into believing that the medical profession is glamorous (as shown in films or media) and/or one can get name, fame and authority just by becoming a doctor.  First of, it is anything but glamorous.  If anything, it involves getting your hands dirty and being ready to attend to a person in distress at any time of the day or night.  This means being groggy eyed, disheveled, harried, and running around like a headless chicken most of the times.  

Name and fame are to be gained; they will only come to you after you have been through the grist and worked your way up to a position of some authority, if at all.  I have had instances during my days as a junior doctor when patients have refused to see me because I was not a consultant. 

I also believe that many enter the medical field due to false notions of grandiosity; just to prove to their extended family and friends how special and intelligent they are.  These people typically hanker after multiple PG degrees to put after their names, and to spruce up their CV, and to exert authority over their hapless juniors and nurses.  It wouldn't be farfetched to suggest that their ego is directly proportional to the number of letters they put after their names!  

Students also make the mistake of assuming that they will go on to become neurologists, cardiologists, pediatricians, orthopedicians or radiologists, even before they enter the medical field.  Such preconceived notions are bound to lead to disappointments because only a small percentage of them get such coveted specialties; the rest have to 'compromise' and settle for other less lucrative specialties.  

I have seen parents becoming depressed because their son did not get the coveted seat even after several years of studying for PG entrance exams.  Finally the family had to sell off property to fund his higher educational desire. 

Actually, MBBS is the easy part.  Even though you might think that cracking the NEET/COMED exams is challenging and the subjects taught in the UG course are difficult, you are likely to breeze through the 5-6 years of MBBS course because you are so involved with friends, studies and extra-curricular activities.  It is what happens after MBBS that is most daunting; that's when the harsh realities of medical life sink in, and you will be caught between the opposing prospects of working in a medical setup on the one hand, and studying for PG entrance exams on the other.

Please also be open about the possibility of NOT getting to work in a clinical field.  That is, you may not get to work with patients in a clinic or a hospital.  Depending on your performance in the PG entrance exams, you may end up in a pre- or paraclinical field, such as Anatomy, Physiology, Pathology, Pharmacology, Community Medicine or Forensic Medicine.  In that case, you might have to take up faculty/teaching post in a medical college, or do lab/research work, depending on the field.  

Mind you, pre- and paraclinical careers are equally respectable and rewarding, but it's just that students never consider these when they think of entering the medical field.  I am reminded of a friend who had to give up his ambition of becoming a surgeon only because he was a Hep-B non-responder; that is, he was prone to contracting hepatitis from his patients.

I often recommend a trimurti, or a holy trinity, of entry criteria that aspiring medical students should consider before taking the plunge into the medical field: super rich, super intelligent, and from a family with a medical background.

It helps immensely if your family is already endowed with wealth to fund the seemingly never ending and financially draining medical education.  This wealth will come in handy particularly when 'management seats' are the only options left after your underwhelming performances in the entrance exams.

You can alleviate this financial burden somewhat if you happen to be super intelligent, or, as is required for medical exams, if you are smart enough to learn the study techniques necessary to ace the PG entrance exams, and can walk through the seat selection process with a plum specialty.  Easier said than done.

At the very least, it is helpful if you have an understanding father, mother, brother or a sister who is already an established doctor and is able to understand your predicament, and is willing to support you through the tough post-UG phase until you make it.  It is much easier to explain why you need to burn the midnight oil studying for PG entrance exams after finishing MBBS to a family member who is a doctor than to one who has no idea of how medical education/career works. 

If you feel that you are deficient in these criteria, please look for an alternative career.  Do not go through decades of struggle only to realize that this profession is not for you.  And don't ever listen to anybody, not even your family, when it comes to your course/career: your career, your life, your decision!  Nobody is going to come to your aid later on when you are disillusioned and despondent and stuck in a career that they wanted you to take up. 

I have raised these issues in this video in English with text in Hindi and Kannada:

https://youtu.be/DrfGigouuRs

Quite apart from the issues mentioned above, I have also written about a couple of other bugbears of this profession: assaults on doctors and draconian rules and regulations that govern the profession.  Read them too, just so you are aware what you are getting into.

Having said that, not for a moment am I suggesting that nobody should become a doctor.  If you are absolutely passionate about the medical field, if you genuinely care about the human condition, if you have the aptitude to deal with the issues discussed above, if you can put your ego behind and prioritize your work and career development for the sake of patient service, you can do wonders in this field (note the key words/phrases in red).  

If you are confused, seek professional help from a career counsellor.  Also consider taking an aptitude and/or personality test to see if you are cut out for this profession.

If, in spite of doing all that, you still have an iota of doubt about entering the medical profession, my sincere advice is: DO NOT!




Resources:
Background music: Wave in the Atmosphere, Dan Lebowitz
Pictures: 
https://pixnio.com/free-images/2017/04/03/2017-04-03-10-02-15.jpg
https://cdn.pixabay.com/photo/2016/09/29/19/55/doctor-1703644_1280.jpg 

Saturday, November 25, 2017

Who wants to be a doctor (in Karnataka)?

So the dust from the recent doctors' strike has settled, and the diluted Karnataka Private Medical Establishments Act has been enacted quietly.

But Karnataka has got to be the worst place for a medical practitioner.  And the KPME Act has nothing to do with this.

The KPMEA is only the latest in a long list of insults that have been meted out towards the practitioners of the 'noble profession.'

As though the tough-as-nails medical course were not enough, each of us doctors has been through hell and high water to try and eke out a living.

Find that hard to believe?  I don't blame you; especially in these times when news channels proclaim striking doctors to be 'Yama's agents.'  

Consider the odds stacked against us: difficult course that one manages to scrape through; even more difficult PG entrance exams; bottle-neck in the form of dime-a-dozen medical UG colleges, but not enough PG seats; capitation fees to get into UG and PG courses; sleepless on-call nights; dog's work in the wards/OTs/OPDs; climbing mountains to establish oneself as a 'sought-after' doctor, assaults on doctors, non-recognition of foreign PG degrees, etc, etc. 

During all this, family/social life goes for a toss and you can pretty much forget about hobbies, alternative interests, and life outside the daily medical grind.  By the time you get round to your hobbies and interests again, you are well past your prime. 

One can't even change jobs like those in technical professions can.  Once a doctor, always a doctor.  You got to struggle on endlessly, even if you earn a pittance in comparison to the IT-BT lot who easily earn twice or thrice as much. 

It is a strange dilemma that a doctor finds him/herself in: deficiency in the midst of plenty.  Indian economy is up and running, but the healthcare professional strangely finds him/herself left out of the Indian success story.  


Setting up a private practice is a case of hit or miss.  You may or may not click with the patients, who can be rather fickle when it comes to following up with you, and loath to pay consultation charges.  In any case, it takes years to make a name for yourself. 

In the hospital set up, you need to tow the line of the management, and accept a pre-set salary or 'cuts' from the consultation charges, which are rather like seedless peanuts!

So you are left with a job that you do not enjoy, and that does not provide you with anything substantial to set up home and raise a family.  This is especially true if you happen to live in a high-living-cost city, such as Bengaluru. 

The effect of all this?  Disillusionment; burn out and drop outs.  I have seen many doctor friends leaving the country in search of a better deal.  Some have altogether dropped out of the profession and started business ventures.  Some have contemplated suicide.

Yes, we have encountered and are still putting up with many 'KPMEA's in our lives as doctors. 

Basically, the recent fiasco from the state government has highlighted three issues, as I see it:
  1. the general public wants first-class service at the lowest cost, preferably free of cost
  2. the doctors want a fulfilling career that provides them with financial security on par with other vocations
  3. the government (in the ideal world) would want a seamless primary and secondary care service that satisfies both stakeholders; public and healthcare professionals
At the moment, none of these three issues are being addressed, even with the implementation of the KPMEA. How can one put a cap on healthcare services without capping other non-essential services that are being allowed to jack up prices wantonly.  Go, for example, to a multiplex and see for yourself how much you have to shell out for the ticket and food. 

What is the solution?  There is none that is perfect, but we are looking at a scenario where the medical service is free to the public, but at the same time, the hospital and the healthcare providers are compensated suitably.

The state owned NHS of UK (even though many in that country find faults with it) comes to mind as a service that achieves just this.  Free healthcare funded for by the taxpayers' money that is deducted at source.  

On the other side of the pond, the US healthcare is largely privately provided, with insurance system covering the cost for the patient.

We need to look at these and other models to decide the best suitable healthcare delivery system that can be adapted to our conditions.  Mindlessly capping fees and charges in an increasingly capitalized and corporatized society is not going to cut it.

Somehow, I cannot see the present government of Karnataka making any thoughtful, pragmatic changes in this regard, given the fact that it has its eyes set on the upcoming state elections.

So, dreadful, populist measures such as Indira Canteen and KPME Act will continue to be inflicted on the unsuspecting populace, as this government attempts to revive the dynasty that has clearly done its time.  

Governments will come and go.  The doctor in Karnataka will continue to suffer.

Please also read article on assaults on doctors, and who should become a doctor in this article and video.



Image source: http://images.newindianexpress.com/uploads/user/ckeditor_images/article/2017/5/18/Consulting.jpg

Saturday, March 25, 2017

Assaults on doctors: what can be done to prevent them?


Sharire jarjaribhute vyadhigraste tathapare|
Aushadham Jahnavi toyam vaidyo Narayano Harih||

(When the body has lived its duration of time, and has been caught up in the diseases therein, 
The medicine is Ganga water, and the doctor is Narayana who takes away suffering.)

The above Ayur-vedantic injunction which accords a godlike status to doctors is both at once uplifting and troublesome in our country.  

It is uplifting because it can draw aspirants to the field, motivate a medical practitioner to always perform at his or her best, and ascribe a sacred quality to the patient-doctor interaction, which is unlike any other professional interaction.  

It is troublesome because it implies that the doctor can do no wrong.  From a patient and his family's point of view, a doctor is an infallible and magical creature who can provide panacea to all maladies.  

In actual fact, there is probably no other profession that is as underrated, taken for granted, vilified, victimised, targeted and condemned as the medical profession.  

Let us, for the time being, leave aside the mess that is medical education today, the incompetence of the chief medical governing body of the country, non-availability of postgraduate seats, and non-recognition of foreign postgraduate degrees, and look at the immediate problem that is facing the medical fraternity today: assaults on doctors.    

It is the second troublesome aspect of the injunction above that is largely the reason behind the spate of attacks on doctors in the recent times.  Of course, attacks on medical personnel is neither a new phenomenon, nor is it unique to India.  But why do these attacks occur?  And how is it that other countries seem to be very successful in managing this problem?

For this we need to understand the problem at a deeper level.  Let's consider some of the issues at play. 

As a disclaimer, let me also add I am not justifying malpractice of any kind.  The medical professional is not above law, and not for a moment am I suggesting that there are no cases of medical negligence at all.  If anything, the medical field is one of the most error-prone professions and is definitely not an exact science.  There have been horrific cases of medical negligence, and unethical practices that need to be addressed through proper channels.  Even then, taking the law into one's own hands and resorting to violence are definitely unacceptable.

There are, no doubt, several measures that doctors and hospitals can take to help the victims of wanton attacks.  Representative bodies are already looking into these, and considering legislative and legal alternatives as well.

The purpose of this article is not to 'firefight', but to look at how to mitigate the risk of attacks altogether.  In keeping with the oft repeated medical truism, 'prevention is better than cure', the purpose is to look at preventing these attacks from occurring in the first place.  

So, who are likely to be assaulted?
Statistics suggest that junior doctors; on-call doctors; those working in high risk areas such as casualty, ICU, CCU, PICU and NICU; doctors working in lonely setups and remote areas; and those in government setups are most prone to being assaulted by patient's attenders.

Who are likely to assault?
Those with a short-temper; proneness to violence; those in nexus with powerful people; people from lower socioeconomic strata; and those under the influence of alcohol and other substances.  

What might be the possible risk factors for assault?  
Sudden and unexpected bad news, such as disease and death; loss of a child; deaths from road-traffic accidents; failed resuscitation attempts; and death on the operating table.  

When two or more of the above situations coincide, the imminent risk of violence is very high.  Analysis of the individual cases of assaults that have occurred thus far will confirm this.

What can be done to prevent these attacks?  
This is by no means an exhaustive list, but here are a few suggestions:

1. Communication:

Medical profession is concerned with the human condition, and involves daily interaction with patients and their families who have varying levels of awareness about medical matters.  

The Medical Council of India includes the topic of communication skills in the two-month foundation course that precedes the medical undergraduate course, in addition to making it a part of the core competencies expected of Indian Medical Graduates.  

However, to what extent this implemented across various medical colleges, in addition to the core subjects that comprise the medical course is not known.  From what I have seen, junior doctors are not very competent communicators, and what they say in certain situations may easily be misinterpreted, or worse, may sound derogatory and patronising to a patient or his relative. 

Take for example the phenomenon of grief reaction.  Elisabeth Kubler-Ross has described its five stages: denial, anger, bargaining, depression and acceptance.  While the entire process of grief and bereavement may last up to six months, the first two stages, denial and anger, which frequently occur together, can lead to an immediate flare up when the news of death is broken to the patient's attenders.  The need to ventilate the sudden outburst of shock and angst takes over, and the nearest 'punching bag' - the doctor who gave the bad news - has to bear the brunt.

It is also worthwhile remembering that grief does not have to progress according to these stages.  Each one of us is unique, and so are our reactions to adverse situations.  Therefore the initial emotional shock may manifest in any manner, depending upon the presence or absence of the risk factors listed above.

Therefore there is a very real need for training in communication skills to be inculcated at an early stage in the medical career.  Trainees should practise these skills again and again to get them right in real life situations.  

Breaking bad news is an art in itself, which not many doctors are good at.  It involves several steps that are frequently not followed: setting the scene, assessing the patient's/attender's knowledge about the illness, breaking the news gently, taking an empathetic approach (for example, generous doses of 'I am sorry', and offering water/tissues), and providing further help/assistance as necessary.

2. Hospital policies:

Issues such as working conditions, infrastructure, working hours per day/week should be looked into.  High risk areas of hospitals should be equipped with counselling rooms with CCTV monitoring and presence of security personnel, especially at the time of breaking bad news.  

There should be a zero-tolerance approach to violence towards medical personnel.  In all cases of assault, as a standard practice, legal route should be pursued by the hospital administration.  Statistics from western countries suggest that successful prosecutions go a long way in reducing the risk of violence towards medical personnel.  

3. Legislation:  

According to a recent report, 53 cases of assault on doctors have occurred in India over the last two years, but there hasn't been a single conviction.  Contrast this with Australia, where a prison sentence of up to 14 years is meted out to the offenders.  

But then again, why would there be any convictions, if the representatives of the highly honourable judiciary of the land issue statements such as:

'if doctors do not want to work without security, they are not fit for the profession',

and

'you are not factory workers who resort to such protests...shame on you!'

This is rich coming from a system that is known to be corrupt to the core, sits for decades on hundreds of thousands of pending cases, and finally delivers judgments which can only be described as gross injustice, or in some cases, ludicrous.  It has been rightly said that there is a lot of law in the courts, but not enough justice.  

Many judicial office bearers are high on ego, and are a cantankerous lot who make loose-cannon statements such as those listed above.  They frequently take a highhanded, judgmental and condescending attitude towards all that they look down upon from their lofty perches.

It is time that the legal eagles and their bosses are asked to account for their shortcomings.  

I hope the government of the day will bring about some amendments to reform the legal system, and will also strive to improve the lot of the doctors.  


I am forwarding this write-up to the Prime Minister's Office as a mark of protest, and as a request for his affirmative intervention in the matter.  

Please also read other articles on harsh rules governing the medical field and who should become a doctor in this article and video.



References:
1. Ayurveda-vedanta: The Vedanta of Life Science, Atmatattva Dasa, Tattva Prakasha, Volume One, Issue Nine - November 9, 2001 (http://veda.krishna.com/encyclopedia/ayurvedanta.htm)
2. Vision 2015 document, Medical Council of India (http://www.mciindia.org/tools/announcement/MCI_booklet.pdf)

3. 53 doctors attacked in two years, not a single conviction, Mumbai Mirror, 22 March 2017 (http://mumbaimirror.indiatimes.com/mumbai/cover-story/53-doctors-attacked-in-two-years-not-a-single-conviction/articleshow/57761708.cms)

4. The 5 Stages of Grief and Other Lies That Don't Help Anyone, Megan Devine, 12 November 2013 (http://www.huffingtonpost.com/megan-devine/stages-of-grief_b_4414077.html)

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