The First Hernia Operation

As an intern, Dr. Dev was posted in the Surgery Department of AIIMS, New Delhi.

For those who are not aware, after passing the final MBBS exam, the students are provisionally treated as a doctor but are required to work under supervision for one year in the hospital in various departments which is known as the internship. After successful completion of the internship, the intern is recognized as a full-fledged doctor and can then practice independently.

By his hard work, inter-personal skill and his clear aim of becoming a surgeon later in life, he convinced the senior resident to let him do an operation of an inguinal hernia as the chief surgeon.

When the patient was under the influence of the anesthesia, Dr. Dev proudly walked and stood at the place of chief surgeon at the patient’s side. On seeing this, the assistant nurse asked the senior resident with dismay, “Sir, are you going to let him do the operation? Please don’t bore me to death and do the operation yourself fast.”

Dr. Dev looked at the nurse with anger and annoyance at the fact that even though she is qualified as a nurse, she is questioning a doctor’s competence. Then he quickly looked with pleading eyes at the senior resident, silently imploring him to not listen to the nurse and let him do the operation. 

Luckily the senior resident stood true to his word and guided Dr. Dev as he performed his first hernia as an intern under the watchful judgemental eyes of the assistant nurse.

The great (and the not so great) among us had to start humbly at some time. The teachers and masters of today were students and neophytes of yesterday. At the beginning of one’s career, one may have to face criticism and ridicule by persons in lower post or less qualified by us. Instead of getting disheartened and distracted by this, concentrate on improving and learning your subject to reach the pinnacle of your field.

(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 Antibiotic Pour

Dr. Baldev Arora (Fictional Name) was a famous cardiac surgeon at a prestigious institute. Like his skills, his temper was also of the highest order.

He was a perfectionist and not used to tolerating any mistake in others. Even a tiny mistake in front of him would earn a verbal blasting from him. During operation, even a fraction of delay between his giving an order and its execution would earn the erring person a severe tongue-lashing.

At the end of a surgery, Dr. Baldev used to pour two different types of antibiotics in the wound before applying stitches in the skin. It was his belief that this helps in preventing wound infection in his patients. 

There are surgeons who are satisfied by pouring only a single antibiotic and many researchers who say this is not at all helpful. The assisting nurse was supposed to take the antibiotics from the floor nurse at the start of the operation and keep them ready to give to Dr. Baldev when demanded.

One day when the surgery was near its completion, Dr. Baldev asked the assistant nurse to give the antibiotics to pour in the wound. The Nurse looked stunned for a moment, but the next moment she handed Dr. Baldev a syringe saying here it the antibiotic you requested. Dr. Baldev poured the antibiotic into the wound and applied the stitches.

When he had left the Operation Theatre, the assistant professor who was watching everything said to the nurse, “I was watching the whole time but I could not remember you taking the second antibiotics from the floor nurse at the start of the operation.”

The nurse replied, “You are right. I did forget to take the second antibiotic at the start of the operation.  So I filled a syringe with sterile water lying on the instrument table and gave it as antibiotic to Dr. Baldev. If I had said that I had forgotten to take the antibiotic then I would have received a severe verbal blasting from him for something which has not been proved to be useful.”

If you are strict then your subordinates may take extra care in the work out of fear, but there may be an occasional instance when they may hide facts from you to avoid your wrath. A moderated approach may be more fruitful overall.  

 (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 Malaria Outbreak

There was an outbreak of malaria in the remote rural part of the district. With the newspapers filled with the embarrassing reports of the malaria epidemic, the District administration and the Health Department got into the action.

They formed a team of doctors from the Medical College to go the remote part of the district worst affected by the malaria epidemic to do a door to door survey of the households to identify the malaria cases, to check the water sources and pour anti-mosquito-larval medicine in any collected water to stop the breeding of malaria-spreading mosquitos.

The team with Dr. Sitaram Meena, Dr. Garry Sharma and Dr. Deepak Goyal (all Fictional Name) reached the remote part of the district. They made their headquarter at the Primary Health Centre (PHC) in the village. Only one staff nurse was posted at that village PHC. There was no doctor posted at that PHC. There were around 20 blocks in the area covered under the PHC.

Dr. Garry Sharma and Dr. Deepak Goyal decided to tackle the blocks at the two end of the area leaving Dr. Sitaram to start from the center of the area and cover as much area as possible. Dr. Garry and Dr. Deepak left on foot burdened with registers to enter the details of the malaria cases and the bottles of the anti-mosquito-larva medicines to spread in the collected pool of waters in the village.

At the end of the day, they came back exhausted, weary, hungry, as they could not get anything decent enough to eat in the field, covered with dust and mud from wading in the collected water and fields. To top it, both of them could cover only 4 blocks each. They estimated that Dr. Sitaram would have also covered four blocks, leaving the rest of the blocks still to be surveyed and tackled, which will entail staying overnight in the village and doing the same work again the next day.

To their amazement, they found that Dr. Sitaram was in the PHC before them and was looking fresh and neat as if had not set foot outside the PHC at all. Both asked Dr. Sitaram how many of the blocks had he covered.

Dr. Sitaram replied, “Don’t worry. I have covered all the remaining blocks. Here is the record all neatly entered in the register, countersigned by the Panchs (locally elected governmental body representatives).” “There is also some food left, which you are free to enjoy.”

Dr. Garry and Dr. Deepak were amazed at how Dr. Sitaram managed to cover an area double the size covered by them, get back before them and manage to look so fresh and rested.

What has happened that in the morning, after his colleagues have left, Dr. Sitaram called the ward boy (who was a middle-aged-man) and giving him some money, asked him about how long was the nurse posted at the PHC. Learning that she was posted continuously at the same PHC for last five years, Dr. Sitaram asked the ward boy that who was her patron at the village which had enabled her to stay at the PHC without getting transferred from here to there.

Dr. Sitaram knew that the nursing staffs gets frequently transferred from one PHC to another. To stay in one place some nurses make some local strong person as their Godfather. This ensures the professional and personal safety of young nurses living alone in the remote villages. The relationship may be entirely platonic. The ward boy informed him that the nurse was having a special bond with the son of the local Sarpanch (head of the locally elected governmental body representatives) who was quite attached to her.

Giving the ward boy more money, Dr. Sitaram asked him to get some food material and cook him a lavish meal, but before that call the Sarpanch’s son to meet him.

When the Sarpanch’s son came to meet him, Dr. Sitaram, took him aside and in a conspiratorial voice said, “I have some bad news for you. As you know a number of cases of malaria have been reported in this area which the media has used to embarrass the government. The Chief Medical Officer and the District Collector have taken this seriously and they have decided to transfer the nurse posted in your PHC to another district.” Seeing his crestfallen face Dr. Sitaram knew that he had hit the right target.

“But there may be way out of this situation” proposed Dr. Sitaram. “If you take the staff nurse with you, go the blocks covered under this PHC, do the malaria survey, dispense the anti-mosquito larva medicines at the collected water and get these registers filled and counter-signed by the local elected government representatives saying that the Medical team had visited the area, had done the malaria survey here and dispensed the anti-larva medications in an excellent manner then I will go and talk to higher authority that the nurse is doing an excellent job here and should not be transferred from this place.”

On hearing this the Sarpanch’s son thanked Dr. Sitaram, gathered the registers and cans of larvacidal agents, and left with the staff nurse riding behind on his Bullet motorcycle. (To be a good Godfather having a motorcycle is a must. The Godfather is able to take the nurse to remote areas for surveys and for meeting at the zonal or district headquarters on his motorcycle where public transport vehicles are not available.)

Dr. Sitaram had a lavish meal prepared by the ward boy, had a siesta after the meal, and finished his work, without leaving the PHC.

Dr. Sitaram used the relationship between the staff nurse and the Sarpanch’s son to get his work done while appearing as if he is doing a favor to the nurse and the Sarpanch’s son.

(Based on allegedly 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 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. 

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 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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Just Some Tonic Please

Dr. Dev (fictional name) was working as junior resident in the Department of Surgery, AIIMS, New Delhi.

A staff nurse working in ward asked him to write some ‘tonic’ for anemia (decrease in red blood cells or hemoglobin) for her. She had noticed that she had become pale in last few days.

The over-worked, tired, Dr. Dev wrote some haematinic and forget about it. After a week, the nurse again asked Dr. Dev to write some more haematinics. Since the nurse asked him informally while Dr. Dev was busy working in the ward, he did not had the time or the inclination to go for  detailed consultation and evaluation of the nurse’s anemia. The staff nurse also just wanted some prescription for her anemia and was not interested in a proper consultation for her anemia.

Few days later, when Dr. Dev came to the ward in the morning, he found the same nurse admitted in the post-operative section of ward, with a Ryle’s tube in nose and intravenous drip lines in both arm.

On inquiring he found that the nurse had severe bleeding in her stools at night and was admitted to the emergency department. To stop the bleeding she had to undergo emergency operation, on which she was found to be suffering from tuberculosis of small intestine (Small Bowel).

This intestinal tuberculosis was the cause for the anemia which the staff nurse was suffering from. If the nurse had come for proper consultation for her anemia, the consultation would have included a history, physical examination and investigations (tests) to determine the cause for her anemia. Intestinal tuberculosis, though very difficult to diagnose without an operation, might have been suspected and she might have received anti-tuberculosis drugs early along with the medicines for anemia.

Beware of the patient asking some friendly advice. They are usually friends, family members, colleagues, chance acquaintances or just some patient wanting to save on consultation charges.

Usually due to feeling of shyness in discussing their medical problems in detail with a doctor who is their friend, relative or colleague, they direct the doctor to just prescribe him/her minimum symptomatic treatment. This may lead inadequate or wrong diagnosis or treatment for which the doctor may be held responsible, even though the fault lies with patient.

When faced with such situation, the doctor should politely but firmly ask the person seeking friendly advice to come for a formal consultation for proper evaluation and treatment of their conditions. Short term prescription of drugs, if done at all, should be conditional to their agreeing for this formal consultation.

In no condition should the doctor prescribe drugs repeatedly without proper consultations.

You may ruffle few feathers in short term but ultimately will find this firm approach beneficial for both the doctor’s and their friends’ and relatives’ welfare.

 (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 Beautiful Nurse

Manish:        “Why did you fire your beautiful nurse?”

Dr. Murli:    “Many of my patients were saying they felt healthy

                       just by looking at her.”

— NKD

N.B. This is entirely fictional.

  

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