Thursday, 3 May 2018

The Heart Sound Quandary

Dr. Jitender Kumar (Fictional Name) was appearing for his final MD (Medicine) exam in AIIMS, New Delhi. Being a brilliant student he was the favourite resident of the Head of Department (HOD) of Medicine.

In the MD (Medicine) practical exam. Dr. Jitender Kumar was allotted a patient suffering from damaged heart valve.

For Non-Medicos: There are four heart valves, two each on right and left side. Abnormality of this valves can produce abnormal heart sound know as murmurs which can be heard with the use of a stethoscope (the Y-shaped tube like thing which doctors put in their ear to listen to your heart and lung). Murmurs produced when the heart is pumping out blood are known as systolic murmurs. Murmurs produced when the heart is filling with blood is known as diastolic murmur. Knowing if a murmur is systolic and diastolic and whether on right or left side of the heart the physician can diagnosis which heart valve is damaged even without other investigations such echo-cardiography.

The Head of Department of Medicine, AIIMS, New Delhi and another examiner, the external examiner, from a different medical college were jointly taking the viva in the practical exam.

When it was Dr. Jitender Kumar’s turn to present his case; the discussion reached to what type of murmur the patient was having? Dr. Jitender Kumar replied, “Sir, the patient is having a systolic murmur.”

The external examiner listened to the patient’s heart sound with his stethoscope and raised his head in amazement. “What are you saying?” inquired the external examiner, “the patient is clearly having a diastolic murmur!” Turning to the HOD Medicine he requested, “Sir, Kindly listen to the patient’s heart and confirm it is a diastolic murmur.”

The HOD – Medicine was in a quandary. A systolic murmur is as different from a diastolic murmur as sunrise is from sunset. If he confirms it is to be a diastolic murmur, it will be difficult to justify passing his favourite resident in front of the external examiner after committing such a blunder.

The HOD – Medicine applied his stethoscope to the patient’s chest, listened for few minutes and gave his verdict, “It is a systolic murmur.”

The external examiner was surprised, to say the least, “Listen again carefully, Sir,” he demanded, “It is a diastolic murmur, not a systolic murmur.”

The HOD – Medicine looked at the external examiner and said, “You and I have become old. Our hearing is not what it used to be. If the candidate is saying it is a systolic murmur, then it must be a systolic murmur. But if you are having any doubt then let us call the cardiologist to find out what type of murmur it is.”

So a message was sent to the cardiologist on call with the instruction, ‘Come and listen to the patient’s heart and whatever the murmur is, say it is a systolic murmur!’

So teachers go to extreme length to protect their favourite students. Lucky are the students who get such teachers. Having a good relationship and creating a good impression on your teacher can prove quite beneficial in the exam.

 (Based on a true incident)

— ND

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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behaviour 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 behaviour 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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