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Tuesday, June 29, 2010

Is English Important To Medicine?

Language has always been a big issue in India, and more so in Maharashtra and Bombay or Mumbai depending on which side of politics you're on. That it was a big issue in the field of medicine has only just started to receive prominence.I've been meaning to write about this for a long while now, but haven't got that push required. I think this week's post graduate examinations were just what I needed.

A twitter friend of mine is an examiner for Medical Students. The Consultant I work with is also an examiner for DNB (Diplomate of National Board) students. Both these intelligent and hard working doctors give up their precious time and practice to examine students in their viva-voce exams and decide whether they are fit to practice medicine. I always wondered how an examiner felt when coming across thousands of students, some of whom excel at medicine and some who are just about there with medicine but speak English fluently.

I would think that holding a command over the language would give the student an immense advantage over his counterpart who would falter in grammar, no matter where he stood on the knowledge scale of medicine. This comes from personal experience as well. I don't think I was even half as good as other students appearing for their examinations with me, but I could speak English well (almost better than half the teacher's taking my exam) and that gave me an upper hand. 

From a patient point of view, the whole thing takes a rather wierd turn. Some people would prefer talking in their native tongue to their doctor and some would cringe if a doctor didn't know how to speak English well. 

My view on this is that if the books are written in English and the syllabus is taught in English and the exams are conducted in English, the students must, simply must have a working knowledge of the language. That being said, would it be too bad an idea to have a compulsory cut off for English along with the Sciences that we need after college? Should English as a language be a subject along with Anatomy, Physiology and Biochemistry?

I think it should. Please let me know what you think....

Saturday, June 26, 2010

What else could an Umbilical Hernia Be?

As a Surgeon, every time I settle down and think to myself that I've seen a case like this before and it should be routine, God intervenes and reminds me that nothing in surgery is as it seems. Least of all when you expect it to be.

We had a lady who presented with a fairly simple small swelling just around her umbilicus at the lower edge. She had had it for about a year. She was keen on getting it out and got the relevant investigations for the surgery ready.

We took her into the O.T. and gave her the necessary sedation and local anaesthesia and proceeded with the usual 'smiling' umbilical incision. On dissection, we noticed a very well circumscribed localised blob of fat = Lipoma. Could it be?? As simple as a Lipoma? No way.

We dissected further. It wasn't extending beyond the subcutaneous plane. I had not even reached the rectus sheath and it was almost out. I was just about ready to call it a Lipoma and then I reached the rectus sheath. It seemed to be growing out of it. I had to really dig deep into my long forgotten medical school knowledge bank kept at the back of my head somewhere in the pits of my cerebrum.

I showed it to my senior. He confirmed. It was a 'Fatty hernia of the Rectus'. Strange, I thought. That's something I've heard in relation to the Linea Alba. Extraperitoneal fat in the epigastrium is known, but paraumbilical at the rectus?? Anyway, that's what we left it as since there was no sac, so it couldn't be a hernia and it was only fat and the defect was less than a cm in size.


Monday, June 14, 2010

Doctors and Parents!

I am intruding on my son's space but this blog is the first amongst many things I intend to share with him.
There are countless books on parenting telling Mom's what they should do. Very few focusing on what the dad should do, or even feel. 
Numerous books on what to expect, what Mom will be feeling, how to cope with those feelings, how its normal to be emotional etc etc.

Dad's are expected to wing it. Go to work, be the breadwinners, be practical, sensible anything but emotional. Well, we feel it too. Unfortunately, all those books on motherhood and babyhood are written by women. I suspect its because Dad's don't get the time to write or just can't get down to doing it (peer pressure??). Don't close this window just yet...I'm not about to write a book.

This is what I felt in the weeks leading up to the delivery.

When he kicked for the first time - Mom was elated. I felt joy. Immense joy. Not because he kicked. Because she was elated. At that time, he was still a foetus to me. Something I had studied in medical school. The kicking was something we took for granted because we saw pregnant women all the time. But my wife was glowing....and I felt Joy. Immense Joy.

When she started getting Braxton Hicks Contractions - Mom was elated and confused. She had tons of questions. It started to sink in. This was my child. Something I had helped make! My flesh, my blood, possible looks like me. We talked about the contractions. Explained to her it was normal. It's just your uterus getting ready. I am convinced it is an act of God, not to help the uterus get ready or the mother, but for the Dad to realise he's having a baby.

She gets backaches - She felt tired and hassled. It hurt! I said I know. I had no idea. It's impossible to know what kind of pain someone is in unless you've suffered it before. No matter how much you say you know. It was her uterus getting bigger and ready.

She dropped her mucous plug - I was the doctor that my brain is conditioned to be. "It's ok", I said. It's part of the process. I completely missed the fact that this was the first sign of progressing into labour. Of course, it takes days after this for labour to begin, but I am not a gynaec and I missed it. The dad in me began to stir.
I drove slower, much slower. I watched signals with more concentration than ever before. I chose roads according to her convenience. It should not hurt her back. No chances with traffic snarls and accidents. 

She was lying in pain when I got back - I realised this was labour. Dad had kicked in. Spoke to Mom. She was our gynaec. She's the quick thinker in the family. Said lets waste no time. We're off to the hospital. I remained calm. Medicine training kicked in involuntarily. Wife asked can you believe we're in labour. I said yes. It didn't register. She stayed at the hospital from then till delivery. I didn't. Mom did. She would decide progress. I wouldn't.
I went home that night and checked my emails. I had one saying June 20 is Father's day. I thought, "What shall we get dad for this one?"

Then it hit me. Smack in the face. By June 20, I too would be a father. My own child. That I had to care for and worry about. I don't usually worry about things. I'm cold like that. But I melted that night. I believed we were in labour. I understood that I was having a son. I knew that I would do anything for him to be born healthy. It kicked in. 

This was the first lesson my son taught me. Better than any book could ever explain! Better than any other parent could tell me what to feel. Better than my wife knowing before I did. My Son! 

Tuesday, June 01, 2010

Grand Rounds Vol.6 No. 36 - Let the Lol's Begin!

I've had a rather interesting time compiling this post for this edition of Grand Rounds. I must say the motive for the theme being humour and laughter was purely selfish. This is the first time I am hosting here and I knew that if I had to keep up the good work of the previous hosts I would have to be totally involved with the selection process of so many many fantastic entries that this event brings on! The only way to screen them would be to enjoy reading every bit and what better way to do that than over a laugh.

So, in no particular order, here are this week's lol posts!

Every doctor would remember the first day in Medical school for various reasons. In my case it was finally wearing the crisp white apron and carrying around a stethoscope for all the world to see that I was a doctor. Fortunately, for me the first day back home wasn't complicated by a medical question like the one at John's Glass Hospital - The Magic Curtain. He bravely answered questions at home and got hands on into Medicine  early in his internship.

Insurance is more often than not thought of as a necessary evil. In a country like mine, where insurance is just starting to rear its ugly head, we are just about bracing ourselves for the impact it would create on Doctors. Unfortunately, InsureBlog has this burden of pointing out something that the doctor's should have noticed even with their eyes closed. Prompts me to say "What a bunch of arses" Avoid the NHS and travel abroad is my say on the matter!

A simple but sweet reminder -  Mother is always right! Grandmom's even more so. Clearly this ATS Speaker was given a mouthful before leaving home that morning when she went on to announce the simple golden rules to Care for ICU Patients Successfully. Grandma Protocols  almost makes me feel like employing it at my surgery!

Maybe we should all use the Grandma protocols to deal with difficult patients. On the other hand the list given here is almost always bound to take care of those particular cases where the patient is just not going to be happy no matter what. Dr. Woodward’s Checklist is the ultimate how to guide for dealing with difficult patients, be they yours or some other Physicians!

Everyone likes a good reception and waiting area. At ACP Internist, this adorable but albeit serious message of COPD grasping our lungs is nicely displayed over the Exhibit area with Exhibit Hall Silliness.

Doctors are shrewd aren't they! Here's a story about an Ob/Gyn who would be in a win win situation as regards the gender determination of an unborn child. Find out how he was always right in determining the gender with this maybe true, maybe not story at The Sterile Eye - Hedge your bets. Just to add, in India he would be arrested as it is illegal to determine the sex of the foetus due to the rise in female foeticide.

Laika has a wonderful story to tell regarding the perspective of little children towards doctors - even the one's that are PhD's. In this adorable post, the poor Doctor was reduced to a guinea pig's healer by his young daughter. A Strange Doctor Indeed.

Dr. Charles almost got me reliving my comic book days before I became a Doctor. The batman in each of us is so well described here that I feel it should figure in all medical schools and teachings as an inspiration to all medical  students ready to start of their lives as healers.

In India, the art of living is taking on big proportions. In this delightful video blog from Life in the Fast lane,  The Art of Sloughing, they highlight the plight of the poor ER doctor reporting to his attending. Also, check out the UCEM - Utopian College of Emergency for Medicine (yes that is not a typo) and the numerous link in there. All worth many clicks and laughs!

Inside Surgery - A medical information blog carried this rather strange piece of news read on the news wire posted by the FBI - Help wanted by plastic surgeons. I really want to know if this is really possible. Inside surgery also has many step by step procedures lined up - Anterior Cervical Fusion being one of them.

A late but brilliant post is this staunch Diabetic Mommy Kerri lists the things that make her a diabteic mommy with such humour that it is impossible not to leave this blog smiling! Her tag line for the blog reads 'Diabetes doesn't define me, but it helps explain me. She explains herself by that wonderful smiling photo in there. That according to me is the best way of tackling Diabetes. Smile!

Sticking with Diabetes, Diabetes Mine ( Read as Gold Mine for Diabetes) compiles this awesome list of glucose logging software for the mac even though she is now a self confessed PC person. Just a wealth of information here.

Just to end on a very funny note - this is something that happened very close to me. Its equivalent to the great Indian Rope Trick for Colds....

Hope you had a smiling time. I hope this edition was even close to expectations as I can barely claim to have matched the greats who have hosted before me. Meanwhile, keep a lookout for next weeks edition and happy blogging.

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