The Active Resident

Dr. Bruce and Dr. Tony (both Fictional names) were two Junior Residents working in the Department of Surgery in SMS Hospital, Jaipur (Fictional Name).

Dr. Bruce was hard working, always busy in ward work, taking excellent care of the patients admitted in the Unit. Dr. Tony was care-free and his ward work was usually incomplete.

Dr. Bruce noticed that paradoxically the Unit Head use to favour Dr. Tony more than him. Dr. Bruce used to receive sever scolding even over some minor mistake in his work while many blunders and omission of work by Dr. Tony used to be overlooked by the Unit Head. The Unit Head also used to give Dr. Tony more surgeries in the Operation Theater.

Frustrated, Dr. Bruce approached his Senior Resident, Dr. Hansraj Chawla (Fictional Name).

“Sir,” said Dr. Bruce asked Dr. Chawla, “Even though I work very hard in the ward and take good care of the patients, the Unit Head is not pleased by me. He shows definite partiality in his behaviour towards my colleague, Dr. Bruce, even though he is lazy in his ward work.”

“Can you tell me the reason for this?” asked Dr. Bruce.

Dr. Chawla sagely replied, “It is all due to Dr. Tony’s social activities.”

“Social activities?” asked an amazed Dr. Bruce. “I never see Dr. Tony doing any social service work. Does he goes to free medical camps or give time to an orphanage or old-age home?” asked Dr. Bruce.

“You are quite naïve if you think in today’s digital world, social activity means social service work.” Said Dr. Chawla. “I refer to Dr. Tony’s social media activity on Facebook, WhatsApp, Twitter, etc.”

“Dr. Tony is connected digitally to the Unit Head on all major platforms. He is the first person to post greetings on the Unit Head’s birthday, anniversary, etc on his Facebook and WhatsApp account. He is the first person to like and share all of the Unit Head’s post on Facebook. He remarks in most eulogizing terms even to minor achievements of the Unit Head on the social media. Whenever the Unit Head post some surgical achievement on Facebook or WhatsApp, he is full of praises, such as, ‘Only you could have done such a complex surgery, Sir’. ‘Proud to be a student of such a great surgeon, Sir’, ‘Highly lucky to part of your team, Sir,’ and so on. When the Unit Head post pictures of his vacation, he is first to comment such as, ‘Missing you very much here’, ‘You really deserve some vacation time after the hard work you do here’,” explained Dr. Chawla.

Remember in today’s digital world, Social Media Activity may influence your Boss / Head of Department / Unit Head / Supervisor more than your actual Ward or Office work.

(Based on a 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 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. 

You can share this post on Facebook, Twitter, Pinterest, Google +, etc, using the Buttons above 'Labels' and below 'Posted by:'.
Please give your valuable feedback via comments below. Please note that comments will appear after moderation.

You can receive notification on latest post by subscribing via clicking on the bottom of the page on the Subscribe to: Posts (Atom)

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

© 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 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. 

You can share this post on Facebook, Twitter, Pinterest, Google +, etc, using the Buttons above 'Labels' and below 'Posted by:'.
Please give your valuable feedback via comments below. Please note that comments will appear after moderation.

You can receive notification on latest post by subscribing via clicking on the bottom of the page on the Subscribe to: Posts (Atom)

The Axillary Block

One patient suffering from infection of hand came to AIIMS, New Delhi, for treatment. He was seen by Professor Tarun Kumar Chaturji (fictional name) and advised I & D operation.

For Non-Medicos: I = Incision / cut in the skin over the site of infection and D = Drainage / letting out of the pus / infected material.

The infection was in advanced stage and normally require general anesthesia (G.A.) for adequate drainage / operation.

In G.A., the patient is made fully unconscious. For G.A. the patient normally requires blood investigations, a chest X-ray, E.C.G., etc. He has to be absolute fasting for 4 to 6 hours before general anesthesia, i.e. he has to stop taking even take water for at least 4 hour before the operation. He also needs to be admitted and monitored after operation. There is also the slight but definite risk of general anesthesia.

Dr. RG (fictional name) was junior resident at that time in AIIMS, New Delhi. Dr. RG was very dynamic and enthusiastic resident doctor. He was always looking for new ways to serve the patients. He thought of operating on the patient using only regional anesthesia, i. e. axillary block.

For Non-Medicos: In axillary block, a local anaesthetic injection is given near the axillary artery in the axilla (armpit) blocking the pain sensation in hand, forearm and arm.

At that time the concept of regional nerve block was in nascent stage in India. Even most of the anesthetist had not done many of the regional blocks such as axillary blocks. Dr. RG had not done this procedure before although he had studied the theory of the block in great detail and practiced mentally the entire procedure many times.

The patient was bought in the Emergency O.T. (Operation Theater) in the AIIMS, New Delhi and positioned on the operating table.

Dr. RG had especially purchased a book on anesthesia for its detail instructions on nerve blocks meant for non-anesthetist. To make sure the block will work perfectly, Dr. RG decided to follow word to word the instructions given in the book.

Since he had don sterile gloves and was doing the block, Dr. RG asked the nursing staff to read aloud the steps from the anesthesia book, so that he could follow them exactly word to word without any margin for errors.

Following the instructions, Dr. RG gave an excellent block. The patient had excellent anesthesia and did not feel any pain during the otherwise very painful procedure.

Two days later, Professor Tarun Kumar Chaturji called all the residents doctors to his office.

Professor TK Chaturji asked, “Have any of you operated on the patient with hand infection two days ago?” “Yes sir, I did the I & D in that patient”’ replied Dr. RG.

“What anesthesia did you used in the operation?” inquired the Professor.

“Axillary block sir,” proudly Dr. RG replied. His sense of pride was justified as perhaps he was the only surgeon in AIIMS, New Delhi at that time who had given such an excellent axillary block.

“Well the patient’s relatives have complained that you are doing operations while reading from books”. informed Dr. TK Chaturji. “You are treating the patients as experimental guinea pigs.”

While the patient was being operated in the Emergency OT, the patient's relatives were standing just outside the operation theater door had overheard the staff nurse reading from the book. They found that Dr. RG was doing the block for the very first time that too from reading a book.

They were shocked that even at a premier institute like AIIMS, New Delhi, doctors were learning while doing operations and had complained to Professor TK Chaturji for entrusting the operation of their patient to such a novice surgeon.

This raises some important ethical, moral and medico-legal questions. Any doctor has to do all his procedure or operation for the first time some time in his lifetime. Should we expressly tell the patient that we are doing the procedure for the first time? If a doctor does only those procedure / operation that he has done before how will his surgical repertoire improve. 

But why only the doctors? There must be a first time when a taxi driver takes his first passenger on a ride, bus driver drives the bus independently or pilot flies a commercial flight independently. Do we ask or do they tell their experience before getting in a taxi, bus, or airplane.

 

Clear practical guidelines should be made so that doctors doing or learning new procedure does not get unnecessary victimized or criticized depending on the complexity of the procedure and / or the potential for complications.

Tip: Following word to word instruction when doing any new procedure can reduce your chance of committing an error.

Tip: At that time better keep the patients relatives away from the operation theater while doing any operation for the first time (Just Joking).

(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. 

You can share this post on Facebook, Twitter, Pinterest, Google +, etc, using the Buttons above 'Labels' and below 'Posted by:'.
Please give your valuable feedback via comments below. Please note that comments will appear after moderation.
You can receive notification on latest post by subscribing via clicking on the bottom of the page on the Subscribe to: Posts (Atom)