Friday, March 18, 2011

I need some drugs (for my patients)

Today I mark my 19th day as a Doctor. I’ve dreamt about it since years, implied I already was since I got into medicine & now that I finally have the title, it feels surreal. It still hasn’t sunk in entirely, but there’re everyday moments now that make me feel proud; like the grinning uncle of patient whose wound I dressed or the day the residents insisted I add the “Dr” before my name in hospital documents. I'd like to share in small parts, my thoughts & opinions in my “practice”. 

The curious case of the doctor without drugs:
Every 2nd patient I’ve seen these past 2 weeks was told by me that one important drug in their prescription is unavailable at the hospital. I wouldn’t really mind if it was just Paracetamol or Avil which we generally prescribe for the omnipresent cold or fever. The problem is that important medication for seniors like anti-diabetics & anti-hypertensives are not available. Their unavailability is fast becoming chronic much like the diseases they’re meant for. I stress on “Chronic” because most of these patients are either retired with hardly any money or working their feet off (I don’t say socks because they work barefoot). I will never forget the sight of a woman watering up in front of me with a BP of 155/95 because she had just spent Rs.10 for case papers with hope of medication lasting 2 weeks; medication that she hasn’t taken for 2 weeks already because it wasn’t in stock & the situation hasn’t changed now either.

Hierarchy is a funny term:
Everyone in a hospital or medical college knows that there is a certain chain of command which you cannot break. At least that’s what students & interns are made to believe. Funnily, employees that are ideally ranked below us, meant to assist us in doing “our” job, are shouting at full lung capacity about how we’re not supposed to bother them. The dresser asks the patients to go bother the doctor in the OPD to dress their wounds. The nurse shouts because we asked her to let go of her newspaper & get a new stock of drugs. 

There something very wrong in our system because I know the problem is only local. I know of systems abroad where even the head nurse or matron is supposed to report to the lowly intern & cannot challenge him, unless things go grossly wrong. This isn’t to say that every non-medico out there is pain, there’re those who are genuinely nice to talk to, ever-enthusiastic about work. But, they’re few & far between, much like our drugs. I’d like to quote a friend, “Everywhere else in the world, you must pay someone to NOT do their job. India’s the only place where you need to bribe someone to do their job, something they’re already paid for”

Yes, Teacher:
I always remember the advice of my mother who said I should not judge on the basis of what a person has achieved but rather how much they have achieved in their present position & set of circumstances. I’ve never forgotten this when I’m dealing with junior colleagues because I know I was exactly in their position a little while back. I want all the senior residents, lecturers, professors to read this. I want you to know that you reached where you are today after crossing various levels. You weren’t born a doctor; neither did you pass out of MBBS as a cardiothoracic surgeon. You’re at your position with time, & efforts of those around you who chose to pass on their knowledge. I want you to know that when you teach, you’re a part of a tradition 2000 years old where a doctor taught his apprentice. You aren’t doing us a favour & I’m not a burden to you; rather you’re a burden onto me... a worthless weight which I must lug around without reward. Think back to when you were just a measly intern or student. Did you not feel let down when someone “chose” to ignore your existence? I solemnly promise when I’m moving up this ladder, I will hold nothing but respect for my juniors because they have already overcome a lot to be in their position. I will not try to flex my authority over them by demeaning them or making their life difficult. I will teach, without expecting anything in return but time & patience. I shall hold a position to educate, not for the title. I will be a teacher first, not just a professor.

You are not just my friend:
Last week I gave my first IM injection to a 10 year old girl. I’ve seen it a million times, I know where & how I’m supposed to stick the needle. But, I still felt the need for someone to be there with me. After it was all done, I thanked this friend of mine, a year senior to me. It got me thinking about all my other mini-milestones in MBBS, they’ve all happened with an eager senior from college egging me on. And it’s not just in the hospital wards. I can’t recall all the times I’ve been utterly confused, bewildered, devastated by the sheer stress of MBBS when someone who’s already been through it has talked me through the rough patch. To all my friends & teachers, thanks a million for all the practical help, late night SOS calls & a few drinks along the way.

Medicine is quickly becoming westernized:
I know we’re catching up quickly with world standards in medicine overall & technology is greatly improving; but I wasn’t referring to this in the title. While I wasn’t a big fan of the “doctor bhagwaan hota hai” philosophy, but I don’t care much for the inconsiderate, brazen attitude that some patients have come to develop. A few examples are: 

The doctors are out to kill me:
These guys doubt anything and everything you do for them. They will disregard any medicine that they will have to buy themselves, ignore key symptoms, refuse to go for referrals, & purposely hide important facts in history to test their doctors. Guess who they blame if something goes wrong

Guess what? I know what this medicine does:
These are generally the younger patients, who have been fairly educated or are extremely curious about what each drug does. Don’t be fooled, they are budding doctors themselves. No point remembering their faces, they won’t be back soon. Self-prescription is the name of the game.

The ‘chronic’ patient:
These are generally women around 40 years of age with non-specific symptoms that are treated symptomatically. I recently got to know that they hail from extremely conservative families where the only trip to the outside world is when they’re unwell. Apparently, they even swiftly discard the drugs. Thanks a lot for that, we surely didn’t need those!

There’s just so much to say about the spectrum of patients, I think I’ll write another article.

Until another patch of creative boredom,

P.S: Half day at work tomorrow, WOO-HOO !!

1 comment:

  1. The docs are out to kill people!! funny!!! :P

    Also, only medical frnds are thanked!! :O
    thts rudeeeeee!!