The Timing – Part 2

Dr. Ramesh Bhargava (fictional name) was a senior renowned physician of his city. His consultation timing in the hospital where he used to work was 9.00 to 1.00 p.m. After coming from the hospital he used to see patients at his residence from 1.00 to 2.00 p.m. and again in the evening from 5.00 to 7.00 p.m.

          For the convenience of the patients he had put a board outside his residence announcing his consultation timings: Afternoon 1.00 to 2.00 p.m. and Evening from 5.00 to 7.00 p.m.

         

          One fine day, when Dr Bhargava reached his residence cum clinic from the hospital, he found an army captain, pacing like an angry caged panther in his waiting area.

          Looking angrily at Dr Bhargava the army captain demanded, “Doctor, what is the time now?”

          Taken aback at this sudden questioning Dr Bhargava looked at his watch and replied “It’s 20 minutes past 1 o’clock (1.20 p.m.).”

“And what time is written here?” asked the captain pointing towards the board bearing Dr Bhargava's consultation timings. Dr Bhargava glanced at the board and said, “1 to 2 p.m.”

“Believing the timing written on your board I have been waiting for you since 1 p.m. here.” informed the captain.

Dr. Bhargava explained, “Err, I was having consultations in the hospital till 1.00 pm today. It takes 10 to 15 minutes to reach here from the hospital.”

“If you cannot be here at 1 o’clock then why have you written your timings as 1.00 to 2.00 p.m. here?” demanded the captain.  

Dr Bhargava was speechless. He realized that like many other doctors he had failed to keep some time for commuting from one hospital to another. His new consultation timings were now from 1.15 p.m. to 2.00 p.m. reflecting the average time taken to travel from the hospital to his residence.

It is common to see doctor’s timings as 8.00 to 9.00 a.m. at home, 9.00 to 12.00 noon at hospital X, 12.00 to 2.00 p.m. at hospital Y, 2.00 p.m. to 3.00 p.m. clinic Z, even when the hospitals or clinics are far apart. This may lead to embarrassment and angry patients.

It may also pose a risk to the doctor and others if the doctor tries to rush in high speed on the road from one hospital to another. Let us all resolve to have realistic and practical timings.

 (Based on true incident)
— ND
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

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The Timing – Part 1

Dr. Dev (Fictional name) newly joined a private hospital as consultant surgeon. Dr. Anurag Sharma (Fictional name), a famous and busy Urologist was also a consultant in the same hospital. (Urologist is a specialized surgeon dealing with surgical problems of kidneys, urinary bladder, etc.)

Dr. Dev admitted a patient of appendicitis in the hospital for operation. He planned for the operation of removing the diseased appendix in the noon as the Operation Theater (OT) was occupied by Neuro-Surgeon in the morning. After finishing his OPD at another clinic at around 12.30 pm, he phoned the OT staff to know whether the OT was now free for his case.

The OT nurse informed him that the neuro-surgery operation has just finished and they were in fact just going to phone him regarding when he wanted to take his case.

Seeing, that it was just 12.30 pm, Dr. Dev thought it is better to hurry and do the operation now and have relaxed lunch afterwards.

To save time, Dr. Dev, keeping in mind the average time taken by him to drive from the clinic to the hospital, instructed the staff nurse to shift the patient from the ward to the OT and ask the anesthetist to start the pre-operative preparations, saying that he will reach the hospital within 5 to 10 minutes.

When Dr. Dev reached the hospital around 6 to 7 minutes later, he changed and entered the OT, expecting to find the patient lying on the OT table.

To his amazement he found the OT empty, the anesthetist and the OT staff in the side room enjoying hot cups of coffee in a relaxed mood while the patient was still in the ward.

Dr. Dev demanded the explanation why his instructions were not carried out. The OT staff and the anesthetist explained, “When Dr. Anurag Sharma (the Urologist) phones and says I am coming in 5 minutes, he takes at least half hour to reach the OT.” “When he says I am coming in 10 minutes, he never reaches the OT before an hour.”

“So when you said I will reach the hospital in 5 to 10 minutes, we assumed that you will come to hospital only after half an hour to an hour later. So, we were just passing time, and did not take your instructions literally.” “But, now that we know that you mean 10 minutes when you say 10 minutes, we will respond accordingly in future.”

Many of us do not tell the exact time when asking others to wait for us. It may be due to embarrassment to ask another person to wait for say a hour. A 10 minutes wait may sound reasonable but if you do not reach within 10 minutes then soon people will stop taking you seriously.

Conversely, when joining or working at a new place it may be better to know what a colleague or co-worker may actually mean when he says 5 to 10 minutes.

 (Based on true incident)
— ND
© Author. All rights reserved. 

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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

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The Unknown Doctor

Dr. Dev (fictional name) asked his friend to drop him off at the hospital as his car was in service center for maintenance service.

His friend was driving and he was sitting in the front passenger seat.

When the car entered the hospital gate, the parking attendant stopped the car and demanded parking charges from Dr. Dev’s friend.

His friend looked with surprise and anger at the parking attendant and remarked while pointing towards Dr. Dev, “How dare you ask parking charges from us?” “Don't you know this is Dr. Dev, senior surgeon of this hospital?”

The parking attendant, who had not paid any attention towards the passenger side seat till now looked at Dr. Dev.

Dr. Dev calmly told him, “I am a faculty member in surgery department at this hospital.” “You can see my ID card if necessary.”

The parking attendant recognized Dr. Dev and said apologetically, “Sorry Sir, I did not notice you. Please go ahead.”

Turning towards his friend who was angry at the attendant for stopping and demanding parking charges from them, Dr. Dev said, “It is not the parking attendant's fault that he didn't recognize me. It is my fault that I am not so famous that everyone recognizes me.”

It is great ego buster that you are not recognized at your work place especially if you are in senior position and that too in front of others. Instead of getting angry or embarrassed just take it lightly.

After all it is rumored that even Napoleon Bonaparte was stopped once by one of his soldiers from entering his own camp due to lack of identification papers. And there are not many of us who can claim to be more famous than Napoleon.

 (Based on true incident)
— ND
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. 

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Sir, What is the Diagnosis?

Please Note: This article is intended for medical undergraduate and post-graduate students.

I had the opportunity to help in organising several practical exams for the Surgery undergraduate students at various levels. When allotting the case for workup, the student invariably asks one question:

Sir, what is the diagnosis of this patient?

Why do they ask this question? Do they think that some cases are simpler than other? Or, are they not confident enough to tackle any case given to them? Is their knowledge limited to just few conditions? Do they think that on giving a diagnosis they will pass (or perhaps even top) the exam? Do they think that they will get marks only if they diagnose exactly what the person is suffering from?

If the answer is yes to any of the above question, then they do not understand the examination system and the mind of the examiner. Before appearing for your next exam, please read and understand (not just mug up) these few rules:

1) No case is simple and no case is difficult: In so called simple or straightforward cases, the examiner is more likely to expect more out of you. If you do not answer satisfactorily to his questions in a simple case, you are more likely to get fewer marks than if you got a complicated case. Generally, the examiner keeps in mind the difficulty of the case, while asking questions and giving marks.

2) Before going to exam you should be well prepared to tackle any kind of case allotted to you. Remember in undergraduate exam, you performances will be mainly judged on you history taking and examination skills, which will only come by repeated practice in wards before the exam. Your career is precious, do not gamble and prepare only few limited cases.

3) Just reading about the cases generally given in exams should not be the aim of a student preparing for exams. They should approach their studies with the vision in their mind that someone’s life will depend on their knowledge. A broad breadth of knowledge is also necessary for clearing the exams, as you never know where the twist and turn of questions may ultimately lead.

4) Does telling the diagnosis, will ensure that you will get full marks? NO. The clinical exams, especially surgery exams, is not a MCQs paper, where if you tick mark the correct choice, using hard work, educated guess, wild guess, using your telescopic vision to see the answer from other’s answer book, tossing a coin, etc. you will get full marks. You have to justify your answers. You have to explain what points in your history and examination justifies your diagnosis. If you give the correct diagnosis but are not able to explain how you reached the conclusions, the examiner is going to conclude that you have either looked in the patient’s file or have got the diagnosis from the senior resident allotting the cases. In any case, he will assume that you have cheated and he is liable to deduct your marks, no matter how correct you are.

5) Now we come to the million-dollar question: In practical exam, do you have to find out what the person is actually suffering from? Or do you have to find out what the person appears to be suffering from? There may be great difference between the actual diagnosis of the patient and the diagnosis that can be logically reached or justified on the basis of history and examination.

For the clinician managing the case it is most important to find the actual diagnosis. For this, in addition to the history and examination, he may employ various methods such as fine needle aspiration cytology, radiological investigations, etc.

In contrast, in exam you are supposed to make the diagnosis only on the basis of history and examination. The senior resident allotting the case may know the actual diagnosis, but he may not know what the most logical diagnosis can be made on basis of history and examination.

If you say the actual diagnosis, without the support of history and examination findings, you are bound to fail. So give a differential diagnosis that appears most likely and not what is the actual diagnosis. These you can only reach if take good history, do a comprehensive physical examination, logically analyse the clues you get them from them and reach a logical differential diagnosis list, without the bias of knowing what is the actual diagnosis.

For example, one student in AIIMS, New Delhi, worked up a case of kidney swelling one week before the exam. He has seen all his investigations from which he found that the final diagnosis in this patient was of renal cell carcinoma. The patient had presented with lump in lumbar region for last 3 years. The student got the same case in exam. He gave a diagnosis of renal cell carcinoma in the exam.

The examiner asked him, how do you explain that the patient is alive and healthy with a renal cell carcinoma for the last 3 years. In view of the long duration of history, the first diagnosis should have been made of that of benign non-malignant kidney lump. The student was failed, because he gave the actual diagnosis, which was not clinically appropriate and that he could have reached only on the basis of investigations.

So remember, forget the diagnosis and concentrate on working up the case with an open mind in exam and do yourself and your teachers proud.

(Based on true incident)
— ND
© Author. All rights reserved. 
If viewing from Mobile, switch to Webpage view to see a list of popular posts and index of topics of previous posts.

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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