Saturday, December 18, 2010

Subah ho gayi, mamu!

In the big run-up to my Final Final Final exams, we've been visiting our wards for what must be the absolute last time before we finish our degrees. Needless to say my entire batch has turned into Supreme Worrywarts and have been thronging the wards, taking cases feverishly, eliciting signs, jotting down findings.

All this has rather irritated the patients, who provide the aforementioned cases to the point of great anger. And one patient, such as the one I was examining today afternoon, to the verge of hypochondria. This poor man, fancy case of Peripheral Vascular Disease, had been examined by atleast 50 people since morning. He asked me if something was seriously wrong with him, was that why he was receiving so much attention.

I told him that all the people examining him were merely students getting some practice before the big exam day and that what he had was the condition we were likely to be asked in our examination. He looked a little flattered when I said this and a little put out by the fact that my batchmates were doctors-in-training and not doctors.

In the very first year of our clinical rotations, an exceptionally brilliant professor had clearly instructed us to let the patients continue to labour under the illusion of being treated by doctors. Or else they won't "co-operate with you guys if you tell them you're just students".

And while this may be true with some, I've found the advice of a more senior and more considerate doctor more useful. "Try to be as honest but as reassuring as you possibly can. Do not forget that that is live human flesh underneath your fingers." and "Every individual has the first right of control to his body, you as his physician only come a distant second."

I've always told the patients I deal with that I am a student and that I require their help for my study. And not one single person has ever refused. Except for I think a woman suffering from a bout of fever. But that's a lot more kindness than I wud show if I were ill.

Today, watching my batchmates auscultating chests while excitedly discussing murmurs made me wonder how we'll ever learn how to balance the affect of our excitement against the solemn bedside manner that we are expected to adopt.

I dont think I wud be right to be flippant, but I also dont think I'll ever manage to look cheerless. I wonder if people really prefer poker-faced, stoic doctors over smiling, cheerful ones becoz they believe their special conditions deserve more serious consideration.

I dont really believe I'll ever be able to pull the poker-face off. So I've given up trying. I think I'll likely end up being a doctor of the Munnabhai persuasion. :D


Niti said...

Well smiling doctors are a rarity. It definitely would be a pleasant change to have more smiling and cheerful doctors. The relationship between a doctor and patient is that of trust. And I am not sure if not smiling helps that part at all. :)

All the best!

Tangled up in blue... said...

Thanks for that vote of confidence, Niti! And awesome blog you got there..I follow now! :)

A. said...

I think you would make a wonderful doctor of the smiling, happy persuasion. =]

Tangled up in blue... said...

Orange, :) you're a sweetheart! :)

Ketan said...

By finishing degree, you did not meant to include your internship? :)

Anyway, I get what you say. In fact, I myself used to get repelled by the fact that I was disturbing the patients. In Loni (where I did my MBBS) there used to be lot fewer patients, which meant even greater per capita load of students. Somehow, I used to feel very hesitant to harass these patients and treat them like objects (the way other students would). In fact, I suffered also in a way because of my (over)conscientiousness, e.g., I could make out the transition between systole & diastole only in the third year! :D

But I got sufficient opportunity to examine patients during my internship in Shirdi (in a charitable hospital), and might I add, I ended up better at physical examination than most of my peers.

Also, while I was in the college (as against during internship), I used to be so tense about managing to speak in broken Marathi that I used to break sweat instead of smiling! :D Fortunately, I got comfortable enough speaking Marathi during internship & I could finally become a smiling doctor. :)

You don't need this kind of endorsement, but am really glad that at least some people who will earn the medical degree will be conscientious (and more important, considerate) like you are. :)

Take care and all the best again!

Tangled up in blue... said...

Thank you, Ketan! And no, I dont include internship becoz obviously that comes once one has finished the MBBS course ;) and I am so looking forward to actually doing something practically important, than just troubling the patients for no reason. :D

pankaj said...

the cheerful friendly communicative doctors are always preferred! However, that white coat does immediately give you an air of importance and superiority even if you are a cheerful kind.

best of luck!

Tangled up in blue... said...

I understand, Pankaj. Thank you. :)

Unknown said...

A cocktail, madam! A cocktail made of 'Munnabhai spirits' and the 'juice' of your incredible intellect! That's what you shall be, excellent apothecary! :D

Tangled up in blue... said...

Thank you, Rohith. That was a most delicious thought! :D

Srishti said...

Haha, TUIB, the way you describe all the dilemmas in being a doctor, I never thought they even existed! For some reason, I always assumed doctors to be grumpy, scary, stern people with very hard skin. Until I met my orthodontist! God, that lady can talk like ANYTHING! Thats why I don't understand people's fear of dentists!
I have a very cheerful image of dentists.

But if you ask me, I would definitely want you to be a cheerful doctor, one in which I would immediately have faith in and be comfortable with. And if we happen to hit it off, even better! :D

Ketan said...


Beware, these are times of intense competition. There is very little that a patient with no knowledge of medicine has to decide between two doctors. Smiling & general vivacity (along with other things) are frequently used as shields to hide incompetence & most dishonorable motives. In case of serious disorders, for selecting a doctor, warmer = better can be a very dangerous idea.

I don't know what else to say. I shudder to think what many times patients think of & expect of doctors & what actually is in latter's minds. :(

Tangled up in blue... said...

Srishti, my dentist is a very surly old man but he's very good for my teeth and I've been going to him since I was a three year old kiddo :D he's my mum and dad's dentist, too. But he's actually really nice. If you have teeth in perfect health he gives you an Eclairs ka box. :) Thank you. And I'm sure a lot of people grapple with several dilemmas in their respective professions, too. But somehow ethics assumes huge proportions in ours. So, the repeatedly questive posts I suppose.

Ketan, I do agree partially with what you are saying. I've seen people use polish, razzmatazz and showiness to their advantage to give an impression of being superior to more simply dressed doctors like my own father is. A neatness and cleanliness of dress is to be expected, but not outright dress equals stature. This projection of hospitals as hospitality centres and patients as clients is truly dangerous.

But that default correlation of warmth and cheerfulness with incompetence is precisely what worries me. The appearance of solemnity does not and shud not lead to the immediate and automatic presumption of intelligence. That is a fallacious and equally dangerous presumption.

Ketan said...


I knew I was leaving something unsaid. Actually, I never meant to relate warmth with incompetence (and in fact, I haven't). I was just pointing out that warmth can be feigned and pretty successfully too. [Also, I deliberately did not venture into the glittering things, like appearance of the doctor and hospital/clinic, etc.] You might not realize, but you perhaps are a very good mind reader [and I consider myself the same! :D ], but I have seen most patients fall for this feigned warmth.

What I have been really struggling to chalk out is a formula that patients could use to determine if a doctor is ethical or not. Also, it would be good if the ethical doctor is also competent. :) I think medicine is such a profession that a conscientious doctor would try to keep themselves updated (and perhaps, I can equate that just about with competence). But it seems there is no such formula. :(

I have realized over time that having a doctor in a family is really a great asset. Those who do not have one, face a real risk of being duped of their money as well as their health.

Ketan said...

And yes, I think perceptions differ a lot based on a patient's background. E.g., I was told in Shirdi that a doctor who is nice with patients is not taken seriously (for the same reason you mentioned). I also noticed that those who are very less educated (say from rural areas) would want to have lots of medicines for themselves. Whereas, people from urban areas who think they understand medicine would be so wary of drugs that they would skip drugs simply because they might believe in 'natural healing', which proves detrimental many times. I also think, urban patients like to undergo lot of costly investigations! :D

Take tips from me, if you want to earn well using *these* means! :P