The Thirsty Senior Residents

Dr. Dev (Fictional Name) while working as Senior Resident in the Surgery Department, at AIIMS, New Delhi, reached the Private Wards at the end of the evening ward round. He felt thirsty. The ward staff nurses were not around. They were most probably in the Private Rooms carrying out the treatment instructions. 

After waiting for some time for the nurses to come, Dr. Dev reluctantly walked to the refrigerator kept in the nurse’s duty room, opened it and picked up the bottle of water kept in there. First, he looked carefully at the outside of the bottle as if looking for some marking or label. Then he raised the bottle against light and carefully examined the bottle against it. Then he opened the bottle and sniffed at the bottle’s content. Finally, he poured some water on the back of his hand. Only then he raised the bottle and took a gulp of the water.

The junior resident accompanying Dr. Dev looked with amazement at his strange behavior. His curiosity finally got the better of him and asked Dr. Dev diffidently, “Sir, what is the reason for your behavior before drinking the water?”

Dr. Dev replied, “It looks like you have not heard about the incidence of the thirsty Senior Residents.” “One senior resident like us felt thirsty in the Private Ward. The staff nurses were not around. He went to the refrigerator, opened and it took a gulp of water from the bottle kept there. The water tasted funny and he spat out the water immediately. The staff nurse had now come back to the nursing duty room. The Senior Resident asked the staff nurse, “Sister, why does this water taste so funny?” On seeing the bottle the nurse becomes aghast and said, “Sir that is not water. That is a patient’s urine!”

Many of the substances in our body are excreted (thrown) out in the urine. Determining the amount of some particular substance being excreted from the body in the urine over a 24 hour period is helpful in diagnosing certain diseases. The nurse had started collecting a patient’s urine admitted in the private ward and had kept the collected urine in a bottle in the refrigerator to avoid its degeneration due to the hot room temperature.

“That may explain you looking for the labels, inspecting the bottle against the light and smelling the contents, but what about the pouring the content of the bottle on the back of your hand?” further enquired the junior resident.

“Looks like you had not heard about the second Senior Resident” further explained Dr. Dev. 

“Another Senior Resident felt thirsty and like the first, he picked a bottle of ‘water’ from the refrigerator when the staff nurse was not around. On taking a gulp of water he instantly screamed in pain.” said Dr. Dev. What he thought was water was, in fact, a corrosive chemical which burnt his mouth, tongue, and lips. “So it is better to be over-cautious than sorry and not eat or drink anything without proper identification.”

(Based on true incidences)

— 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. 

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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The Greedy Doctor

Dr. Jolting’s (Fictional Name) friend had to get operated for a hernia. He had shortlisted two surgeons to get the operation done. He asked Dr. Jolting’s opinion on by which surgeon he should get operated upon.

Dr. Jolting inquired, “Who is the better qualified surgeon?”

“Both are equally qualified.” replied his friend.

“How is their nature?” enquired Dr. Jolting.

“One of them has a reputation for being greedy.” replied his friend.

“Well, if you can afford it, then get operated by the greedy surgeon” suggested Dr. Jolting.

“What!” exclaimed a surprised friend, “What is this nonsense you are suggesting? How come the greedy surgeon is your first choice?”

“A greedy surgeon or doctor in general can be better choice if you can afford him as I had initially stated.”  replied Dr. Jolting.

Dr Jolting further expounded, “A greedy doctor is likely to have a longer working and consultation hours so you will have more flexibility of scheduling a consultation. He is likely to be more available. He is less likely to take vacations and he is more likely to attend night calls in emergency, though he may charge you exorbitantly for it. A greedy doctor is more likely to worry about a patient’s satisfaction as he knows a satisfied patient may refer more patients to him increasing his earning and an unsatisfied patient may spread negative reviews about him driving away potential patients.”

Dr. Jolting further continued, “Although a greedy doctor may order more investigation, but the positive point is that he is less likely to miss any associated diseases. A greedy doctor may prescribe more drugs than necessary, but you are unlikely to be under-treated.” “So, as Gordon Gekko in Wall Street, had said "Greed, for lack of a better word, is good." A greedy doctor, for lack of a better word, is better.”

Quote for the day: If greed is good, then a greedy doctor is better.” — Dr. Jolting.

(Based on true incidences)

— 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 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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The Delayed Operation Appointment

Please Note: This article is intended only for Doctors and medical undergraduate and post-graduate students. Non-Medicos please do not read this article.

In this day of specialization, there is a loss of family doctor and its firm rapport with the patient. In a patient coming on the first visit, with a complex problem, for which any decision making needs the trust and understanding on the part of the patient, one of my colleagues defers the major bulk of discussion to later visits.

He has found that many patients coming for the first time are just 'window shopping' with minimal interest in following the doctor's advice. There is no point in going into detail with such patients on the first visit, wasting theirs and his valuable time. Starting a complicated or difficult treatment plan without proper trust on part of patient frequently leads to a problem if any complication occurs or if another doctor suggests a different management plan.

At the first visit, he does just the routine work-up, symptomatic treatment, and orders relevant investigations. If the patient comes for next visit, it is a sign that some amount of trust has been established between the doctor and the patient. Then he starts discussing the problem and its solution with the patient, in increasing complexity, with the increase in the contact between him and the patient. Unless it is an emergency he only operates on a patient after a rapport and trust have been developed between him and the patient by the 3^rd consultation visit. So, according to him:

Tip: In new patient first visit only basics.

Tip: Second visit more complex discussion.

Tip: Operation / Intervention only by the third visit.

(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. 

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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The Long Illness

A patient suffering from abdominal pain consulted Dr. Jolting (Fictional Name). The patient said, “I am very worried as I am having this pain for last 5 years.”

Dr. Jolting replied, “The fact that you are having the pain for the last 5 years is a good sign. It is the reason that you should not worried about your illness.”

The patient looked at Dr. Jolting as if he has gone mad. “What is this nonsense you are saying? How can my having the abdominal pain for 5 years can be a good thing?”

“What is important in any illness is the cause and not the symptoms” explained Dr. Jolting. “The abdominal pain is just the symptom, i.e. the manifestation of some disease in the abdomen. The fact that you are having abdominal pain and still alive and relatively healthy even after 5 years means the cause of your abdominal pain is not some serious disease like cancer or tuberculosis. It’s most likely a functional problem which will get relived by proper diet and medications.”

“So don’t worry. Psychological worry sometimes plays a big role in abdominal pain.” adviced Dr. Jolting.

It is indeed taught in medical school that malignancy or cancers have a short duration of illness and benign diseases a long course. A long duration of illness may be paradoxically a good sign from a pathological point of view, although a distressing point for the sufferer.

(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. 

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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The Male Chaperone

After reading about the female chaperone at https://agnipathdoctors.blogspot.com/2018/05/the-female-chaperone.html 

Dr. Jolting inquired, shouldn’t female doctors examine a male patient’s in the presence of a male chaperone?

Please give your suggestion.

— 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. 

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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The Female Chaperone

Please Note: This article is intended only for Doctors and medical undergraduate and post-graduate students. Non-Medicos please do not read this article.

Dr. Dev was sitting with his friend, a fellow surgeon, in his consultation chamber. A young lady came to consult his friend with the complaint of a lump or swelling in her right breast. She was accompanied by her mother.

After taking the history, Dr. Dev’s friend asked the mother to wait, while he asked the female staff nurse sitting outside to come inside. It is one of the guidelines that a female patient should be examined by a male doctor in presence of another female only. With the female staff nurse acting as chaperone he examined the female patient in the separate private examination area. Dr. Dev also noticed that his friend also made a small notation afterward on the side of the patient’s consultation slip, Chprn: S/N Margarita.

Once the patient had left, Dr. Dev asked his friend why he troubled the female staff nurse to come and act as female chaperone, when the patient’s mother was already present. Secondly, what is the meaning of the notation he made in the patient’s consultation slip?

His friend explained, I always examine any female patient in presence of my female staff members only and never in the presence of the patient’s female relative. The patient herself may be shy in exposing in front of her relatives.  The relative may not understand what is a necessary part of the examination and what is inappropriate action. In case of some controversy, the female attendant may side with the patient even if you are right. Also, how will you be able to trace and get the female relative to come and give evidence in your favor if necessary?

The note in the patient’s consultation slip was that I had examined the patient in the presence of Staff Nurse Mrs. Margarita acting as chaperone. A similar notation is made against the patient’s name in the registration register at the reception. This acts as a record, so that if any controversy arises even days later, I have the record of which female staff member was present while examining the patient.

Tip: Male doctors should always examine the female patient in presence of your female staff member.

Tip: Avoid examining the patient in presence of female relatives.

Tip: Make a small note of the name of the female staff member in both the patient’s and your record.

(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. 

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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The Good Deed – Part 3

A sanitation worker contacted Dr. Dev (Fictional Name) regarding admission of one of his relatives for operation in AIIMS, New Delhi.

Unfortunately, there was a lot of back-log of patients waiting for admission at that time. Dr. Dev expressed his inability to accommodate his relative for admission and suggested that he may try after some time. As the relative wanted to get operated early they decided to go to some other government hospital in Delhi for treatment.

Dr. Dev forgot about this incidence. A few days later he was walking from his surgical ward towards the surgical OPD. While passing the corridor in front of the AB7 Ward, he heard of enthusiastic greeting ‘Good Morning Sir’. He looked to see the same sanitation worker he was not able to help, greeting him with a warm smile on his face. Dr. Dev was amazed. Here was a person who I had not helped and instead of holding a grudge against me, he was greeting me as I was the greatest person alive to him. Embarrassed, Dr. Dev returned his greeting and continued on his way.

This became a routine occurrence whenever Dr. Dev passed that way. Each time Dr. Dev felt more and more embarrassed that he had not helped such a friendly and respectful person. In time, Dr. Dev started to avoid going that way in the morning.

That sanitation worker working in apparently one of the smallest post in hospital proved to be a person of magnanimous heart who taught Dr. Dev an important lesson of not holding grudges against someone who has not been able to help you in past and still treat them with love and respect.

(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. 

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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The Good Deed – Part 2

A clerk working in the administrative department of AIIMS, New Delhi, wanted to get one of his relatives operated in the General Surgery Department of AIIMS. The clerk was unpopular among the residents for his high-handed and generally uncooperative behavior. The admission in-charge Senior Resident he contacted thought this was a golden opportunity to get even, and told him truthfully that there is a waiting period of around 7 months for admission but you can try again after one month.

After one month the clerk again came to find out the probability of admission of his relative. During this period, the admission in-charge Senior Resident had changed and Dr. Dev had become the new admission in-charge. 

When that clerk contacted Dr. Dev, the first thought that crossed his mind was to give the clerk, a date not seven but eight months later for admission. He then thought if a person working in AIIMS cannot get his relative operated in AIIMS, then where he will go. So, Dr. Dev adjusted the dates and admitted the clerk’s relative within a week and who went home after a successful operation.

Sometimes later Dr. Dev had to go to the same clerk regarding some administrative work. With the experience of Dr. Katherine, The Good Deed – Part 1 he did not have any expectations regarding any special consideration from the clerk. But to his surprise, the clerk received him warmly and with great regards and expedited his work. Now whenever Dr. Dev had any work in the administrative department, the clerk was there to help Dr. Dev with full priority. Helping the clerk reaped rich dividends for Dr. Dev which the first admission in-charge Senior Resident missed in his quest to get even.

Tip: Clerks and similar officials working in the administrative department or other office staff near the centre of power, such as the Boss’s personal secretary, may have a high-handed and haughty behaviour. The Boss’s personal assistant may behave as if he is boss. You may find this offensive especially if you are professionally or academically qualified, but you have to adjust to their behaviour.

Tip: Avoid a tendency to get even in your workplace. If someone needs your help extend your co-operation. It may or may not reap benefits to you later. But unless you try from your side, you will never know.

(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. 

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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The Good Deed – Part 1

Dr. Katherine Chawala (Fictional Name) was a senior resident in the department of anesthesia in AIIMS, New Delhi. Her mother-in-law was in need of surgery. She showed to the consultant of the unit who referred her to the admission in-charge Senior Resident (SR) for a tentative date for admission before the operation.

Dr. Katherine contacted the admission in-charge SR, Dr. Dev (Fictional Name). There was a long waiting list for admission, running into months, but as Dr. Katherine was a fellow colleague, Dr. Dev adjusted the dates and admitted her mother-in-law within a week. She got operated and got discharged after an operation well done.

After her mother-in-law was discharged from the hospital, Dr. Katherine joined back to her duties as Senior Resident Anaesthesia. She was posted to the same Operation Theatre as Dr. Dev’s unit. Dr. Dev and the junior residents who had taken such a good care of her mother-in-law were expecting some warm response and thanks from her. But to their surprise, she paid as much attention to them in the operation theatre as one pays to a waiter at a party.

For a few days Dr. Dev and the other junior residents were amazed by her response, but then they reconciled to the fact that some people just forget any obligations done to them.

Tip: Don’t do a good deed in the world expecting any thanks in return even from your colleagues and fellow doctors. Just help people for the sake of helping people.

(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. 

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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The Collective Skeleton

Please Note: This article is intended only for first year medical undergraduate students. Non-Medicos and others may not read this article.

Now that the story of the skeleton has come to end at the ‘The Blacklist’ (or is it starting?), Dr. Dev recalled the story of his own skeleton, or at least which was one-third his, when he was in his first year of MBBS in AIIMS, New Delhi.

In the first year, the MBBS students have to study the anatomy or structure of the body. An important part of this is study of the bones or osteology. Although in the anatomy practical the bones are shown and their important parts and landmarks are demonstrated in detail, it is very useful to have your personal specimen to study in your hostel room, especially before exams.

Dr. Dev realized this fact late. By the time he contacted his senior to borrow some bone specimens; most of his seniors had already given the bones to his classmates.

Also the specimen of large bones were readily available among students, the complete set of small bones such those of the hand and foot, the different vertebrae, ribs, etc. was not available among the students. Being small, these bones are easily misplaced and lost.

Stealing or ‘Borrowing’ the bones from the anatomy practical lab (dissection hall) was also not possible for him.

At that time an advertisement was placed at the notice board of the anatomy dissection hall, announcing sale by post of unarticulated, semi-articulated and fully articulated human skeleton, by a firm in Calcutta (presently Kolkata). Due to their cost it was not possible for Dr. Dev to buy the skeleton by himself. So Dev got together with two of his friends and they bought collectively a semi-articulated human skeleton.

The study on these actual human skeleton bones was one of the reasons Dr. Dev managed to get comparatively good marks in anatomy exam with relatively less study.

Buying collectively had an another good side-effect that these friends frequently studied the bones together, helping each other by taking mock viva on the bones, etc.

Tip: Having actual bones to study can give a boost to your learning of human anatomy.

Tip: Start borrowing the bones from senior early.

Tip: Buying a set of bones will help study comprehensively for your exams.

Tip: You can buy these bones in partnership with your friends if not affordable by you alone. 

Tip: Choose your partners wisely, so that you can study together without much friction related to the distribution of the bones. Due to the adjustable nature of his friends, there were never any bad feelings among Dev and his friends regarding sharing of the bones. It also helped that the three friends had a different preferred time of the study. One friend used to study early in the morning and day, another friend used to study in the day and evening and Dr. Dev himself used to study in the night.

(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. 

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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