The First Tracheostomy Assistance

Dr. Dev (fictional name) was posted in the Department of Cardio-Thoracic-Vascular Surgery (CTVS) of AIIMS, New Delhi, during his rotation posting while doing his junior residency in the MS Surgery course. This posting occurred after his Neurosurgery rotation posting. Both the departments were in the same building, CNS Center, but on different sides of the building.

A patient was to undergo an operation for Tracheostomy/Tracheotomy in the CTVS department.

In the Covid-19 era now everyone knows about the tracheal tube inserted from the mouth if a patient is not able to breathe on his own and artificial respiration given by ventilators. If a patient requires a tracheal tube and ventilator support for a long time, then the surgeon makes a direct hole (incision) in the front part of the neck, exposes the trachea (windpipe), and inserts a tube directly in the trachea through it known as tracheostomy or tracheotomy.

In the CTVS department, the assistant professors used to do the operation of tracheostomy with the Mch Senior residents assisting them.  The Mch senior residents were doctors who had completed their MS General Surgery degree course and now have further enrolled in the super-specialist course to become Cardiac surgeons after clearing a tough entrance exam.

Dr. Dev was on evening duty in the CTVS ward that day. The Mch senior resident on duty informed Dr. Dev to report to the CTVS emergency operation theatre to assist the assistant professor in the operation of tracheostomy.

As those of who had read the previous blog post, https://agnipathdoctors.blogspot.com/2021/08/the-first-tracheostomy.html

Dr. Dev had done many tracheostomies independently without any assistance during his neurosurgery posting, yet he was excited to observe firsthand how a faculty member perform the operation so that he can learn some fine points of the operation.

When Dr. Dev reported to the operation theatre, the assistant professor got angry on seeing that a junior resident had been sent to assist him. He angrily phoned and asked the Mch senior resident why had this under-qualified junior resident has been sent to assist me instead of an Mch senior resident. He made his displeasure clear to Dr. Dev who was shocked by his behavior. During the operation, he found fault in Dr. Dev’s assistance multiple times and reprimanded him for it.

Dr. Dev felt angry and sad at the same time. At one point he even felt like saying to the assistant professor, ‘Sir, you stand aside and watch me perform this operation without any assistance better than you’ but kept quiet out of respect for the faculty member.

He pondered on the irony. In the same CNS building, in the Neurosurgery department, Dr. Dev was performing the operation of tracheostomy independently without any supervision, and in the other end of the building in the CTVS department, he was considered not even fit to assist in the same operation.

In the same institution/company/corporation different departments and divisions may have a different policy regarding who is qualified to do some work. We have to mold ourselves and accept accordingly.

Sometimes you may be caught in the crossfire of inter or intra-departmental politics. At that time things were not so cordial between that Assistant Professor and the Head of the Department of CTVS as he was demanding an independent operation theater slot. It is probably because of this a junior resident was sent to assist him instead of a senior resident. Some of the anger of the assistant professor was due to this and not personally directed at Dr. Dev. Well, this is life.

People may form a judgement on your qualities and capability based on your post or background without trying to bother to find out your competence. In this case, the Assistant Professor got angry on learning Dr. Dev’s post as a Junior resident instead of finding out his previous experience. Accept it and take it as a challenge to prove yourself.

Read about the experience of an Mch GI Surgery aspirant when he was judged more on from where he had done his Master of Surgery (MS) degree course rather than his personal ability. https://agnipathdoctors.blogspot.com/2019/02/the-gi-surgery-viva.html

Read about the experience of a faculty member from AIIMS, Delhi, in the UK who was judged more on which country (India) he was from rather than his professional competence. https://agnipathdoctors.blogspot.com/2018/07/the-beginner-eye-surgeon.html

— ND

(Based on allegedly true incident.)

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DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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 purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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 norms. 

 

First Relation Later Operation

 In this day of specialization, there is loss of family doctor and their firm rapport and trust with the patient. It is quite common that a patient may consult a specialist doctor for the very first time with a complicated or complex disease condition in which there may not be simple or single treatment plan or solution to the patient’s disease or condition.  

  In such patients coming for the first time, one of my fellow doctor 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. They are likely to consult other doctors and compare what each of these doctors have advised. There is no point in going in detail with such patients on first visit, wasting theirs and his valuable time. Starting a complicated or difficult treatment plan without proper trust on part of the patient frequently leads to problem and litigation for the doctor if any complication occurs or if another doctor suggests a different management plan. Any decision making needs the trust and understanding on the part of patient.

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.

He operates on the patient only when he thinks a relationship had been established with the patient and his relatives and they have full faith in him as a operating surgeon.

— ND

(Based on allegedly true incident.)

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DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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 purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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 norms.

 

Holistic Medicine: A Brief Intro

 One of the first duties of the physician is to educate the masses not to take medicine. — Sir William Osler

Holistic medicine simply means taking a broad view of the patient and disease. Treat the patient as a whole and not as a 'disease case'. In holistic medicine, the aim is the comprehensive care of the patient in all areas, such as physical, mental, emotional, spiritual, social, and economic aspects.

The word is derived from the Greek ‘holos’ which means entire, complete, whole. The word is not related to holy which means sacred or religious. It is not sacred or religious treatment, a common misunderstanding. I have seen an advertisement by a famous epilepsy clinic, which claims to cure epilepsy by 'pavitra' (holy) treatment.

It is not exclusive to any particular system of medicine but how a doctor practices his system. An allopath may practice with a holistic outlook, whereas a ‘vaidya’ (Ayurvedic medicine practitioner) may not.

For example, a person may come suffering from acid peptic ulcer disorder. The conventional practice may involve giving him a drug to inhibit the acid formation or to neutralize it, whether allopathic or of another system, such as Ayurveda. A holistic approach will be when along with drug treatment other factors are also considered and treated such as a change in lifestyle, diet, job, family or job counseling, stress management, etc.

A common confusion is with the term alternative or complementary medicine. These are medicine or therapy systems different from the accepted or conventional system. It may vary from country to country, e.g. Ayurveda is recognized by the government as one of the mainstream treatment systems in India but is classified as an alternative in other countries. Acupuncture is classified as an alternative or complementary therapy in most countries but in China, it is recognized as a mainstream therapy system.

The holistic approach is already enshrined in WHO definition of health given in as far back as 1948:

          "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity".

Therefore ideally we should pay attention to the mental, social and spiritual aspects of illness in addition to just the physical ones.

Although this definition of health by WHO is quite old, why is holistic medicine in so much limelight now? The answer lies in the increasing incidence of lifestyle-associated diseases. In them, even with the best possible medication, there is a ceiling on effect. We need to address the faulty lifestyle for optimum effect. For example, in hypertension or high blood pressure, diet, exercise, mental relaxation, abstaining from tobacco, etc., plays an important role along with medication to get optimum control of the raised blood pressure and prevention of future complications.

There are many problems being faced by doctors in practicing holistic medicine. The most important problem is the lack of time by Indian doctors burdened with caring for such a large population. Another problem is the lack of training. Medical education by and large places most emphasis on the physical aspect of disease and its treatment by drugs or medicines. Some training is imparted in PSM or Community Medicine classes, but there the emphasis is more on maternal-child health and diseases under the national health programs.

The practice of medicine in a Holistic manner should be the goal of all medical practitioners regardless of whether belonging to the allopathic or other medical systems. It does have some concrete benefits for the patient and is not just something exotic or fashionable.

— ND

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DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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 purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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 norms.