Do check out Dr. Rohan’s this series.
Must know images in Surgery.
Any guesses how was my psychiatry posting?
Psychiatry was the first short posting in my rotation- 2weeks
I find psychiatry really interesting since I first read it’s textbook. And fortunately psychiatry posting didn’t spoil that for me. In fact after psychiatry posting I have been way more interested in psychiatry now, to the extent where I’m even considering psychiatry for my residency.
In MBBS curriculum in India, psychiatry is allocated 20 hours of lectures, optional clinical posting before the final professional examination, and 2 weeks of clinical posting during internship, followed by most medical institutions in the country in different manner.
Do you know Bhore Committee, 1946, was the first to emphasise the need for training in the social aspects of medicine, the recommendation of setting up of psychiatry departments in every hospital and medical college for undergraduates were also made by this committee. But it took almost 60yrs to consider making psychiatry a separate subject in medical undergraduate training.
In 2011, MCI and Ministry of Health and Family Welfare under Dr. Roy Abraham Kallivayalil’s ( President IPS) leadership took long awaited decision, and MCI decided to incorporated the following changes to the psychiatric curriculum at undergraduate level: (Please don’t ask me about the implementation of the below)
- Teaching hours to be increased from 20 to 40 hrs
- Clinical posting increased from 2 weeks to 4 weeks
- The doubling up of the marks to 20 in the theory exam paper for medicine and compulsory answering of the questions related to Psychiatry
- Internal assessment to be made compulsory for final exams
- Psychiatry posting in the internship period was made obligatory, instead of optional
- The training in Psychiatry to be imparted in an integrated manner with Social and preventive medicine
As I said my rotation was for 2weeks only and if I’m not wrong that’s the case all over India. The first day in the out patient department of psychiatry was a shocker to me. I don’t know why, I didn’t expect that much patient flow. Among all the interns the divisions were made, who will go to wards, enter the medications in the system, take history/notes. There used to be a lot of patients who were just there for a refill, you enter their registration number in the system advice a refill and you are done, of courses if the resident or lecturer says so.
History taking here is way more extensive than any other department and it takes at least twice the time. Leading questions are different and personal history, family history, environmental history holds way more importance in psychiatry. For first 2-3 days what I did was, either stand behind one of the consulting psychiatrist or sat there in front of that computer updating the medication and OBSERVE how they are handling those patients, what sort of questions are they asking. I’ve know this from very beginning that psychiatry is about listening but, internship taught me it’s more about directing the patient towards the significant information very carefully.
Good thing about Psychiatry posting:
- No emergencies for interns.
- Mostly dealing with Out patients only, a few in wards.
- Limited number of drugs. Drug class to be specific.
- You’d learn about your own psychology.
- You will see what mental health disorders look like, and hopefully that helps you to know when you need help and where you are going to get it. According to a global research, medicine is one of the profession associated with highest mental health problems, students and residents being top on the list. Please don’t freak out after reading this and for god sake don’t unnecessarily self diagnose.
- Unknowingly you will improve your communication skills.
- Developing better interviewing skills.
- Best part: Free time.
Not so good things in Psychiatry:
- First and foremost if you aren’t someone keen to detailing, help you god. Psychiatry history and patient management is all about details and details. You need to know everything.
- Sometimes it’s like looking for a needle in a haystack. Connecting the dots. Dots being those needles. Delusional and schizophrenic patients will amaze you most of the times.
- Do not do anything to provoke those patients. Be very calm and only deal with patients in your senior’s guidance if you are unsure. You’d be surprised even a minor thing can be a trigger.
- Be all ears most of the time.
- You will be observing a lot and that’s the only way to psychiatry. One of psychiatrist told the bitter truth “surgeons have their scalpel as a tool to help their patients, I just have myself”. Take it to your permanent memory if, you plan on to become a psychiatrist.
- The timelines is important, in order to come to a psychiatric diagnosis timeline plays a crucial role, e.g: similar symptoms for 4 days is hypomania, while for a week is mania. Less than a month- acute stress disorder/ brief psychosis, more than a month- PTSD.
- Notes. Lots of writing notes.- mostly interns aren’t asked to put down notes but that again depends on your institute.
- Legal stuff and documentation. As an intern if you don’t know that I think it will work just fine till one of your lecture or HOD starts asking you “what’s advance directive? when breach of confidentially is required?” then your completion is a bit dicey.
- lots and lots of Patients of substance abuse and suicidal tendencies- depressing.
I’ve heard and read about a lot of interns and residents for whom psychiatry rotation didn’t go that well, for some of them it was a terrifying experience. You can read this particular article, if you are one of them https://www.kevinmd.com/blog/2017/01/psychiatry-rotation-terrifies-medical-student-heres.html
Out patient department sometimes witness quite low patient inflow.
And you’d be literally counting every passing second.
just an Instagram update, one fine day at psychiatry OPD.
you can also connect with me
My psychiatry posting went really good, it was new learning experience, I’m not mentioning any particular patient story because there are so many. A teenager guy with a false firm belief about his girlfriend introduced me to the world of delusion. A family brought one of the member literally tied up with ropes and chains. And so many patients of schizophrenia. Few medical students came all by themselves seeking help. Over all each and every patient in psychiatry department taught me something new. Some days the out patient department only had a few patients and it became a personality development class for all the interns taken by one of the professor, whom a few of us named the Night king.
Final season of GOT was airing then and one of the House officer in psychiatry OPD will give up the downloaded episodes to everyone😂
Remember mental health isn’t just for psychiatrist, Take care of yourself and who are around you. Seek help from anyone anywhere, technology today gives all of us access to all sort of privileges.
Stay health mental and physically.
So if you have read so you’d know my psychiatry posting was Awesome. Do lemme know about yours..
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I’ve been getting a lot of questions regarding which books to go with, in final year especially about medicine and surgery textbooks. In this blog I’d be answering one of those questions and that’s ‘Best Medicine textbook for undergraduates?’ Let me tell you this in the beginning only all the standard textbooks are great, but you can’t read them all, given the time.
Now, you’d have heard from a Lot of people ‘Harrison is a lengthy book you should start reading that from your 3rd first or second year, if you want to finish it properly’.
I do agree to some extent but, in second year focus on Robbins and katzung that would be way more beneficial. I personally just read Robbins in second year and till date that is my all time favourite textbook.
Undoubtedly, Harrison is the Bible of medicine– I started reading it as soon as I gave my 2nd year final exams. Lemme clear this here only that I read the older version, The new edition came out during my final year, that time I was quite focused on Love and Bailey-Surgery and other final year subjects, I was told by my seniors that if you plan on to read Harrison during your finals be ready to fail the university exams, just like they told me about Robbins pathology.
But lemme also tell you this: I know a lot of final year medical students starting with Harrison’s principles of internal medicine and sticking to it and passing out all their exams with flying colours.
Information in Harrison is given in an essay manner, you’d love to read it but often miss out what’s important for exams. From physiology to pharmacology to pathology there’s everything at one place- that’s Harrison’s Internal Medicine. And with so so so much of genetics.
If your concepts are clear and you have done your base work, Ganong-Physiology, Robbins-Pathology and Katzung-Pharmacology then, Harrison’s text will be a recall for you.
The landmark 20th edition also known as pocket companion, is the latest edition of Harrison, which I’m sure you all know, it has almost 4200 pages and 1600 illustrations, 1200 tables and 200 flow charts.
Those 200 flow charts/Decision trees are the most important ones, if you want to just review medicine in a quick way read those and you are in a better place.
I’d definitely advice you to read the 20th addition, because it’s comparatively short and you don’t have to read everything from it, Read Gastroenterology and Urology from pathology and Surgery, mainly surgery. Robbins is great for haematology.
CVS, CNS, Respiratory and endocrinology should be read properly. While selective reading of rheumatology and infection will do. Most systems are covered in almost in every subject, but the management part comes from medicine.
In short, if you think Harrison isn’t your cup of tea go for any other book Davidson or Mathews- believe me those are good books too, you will hear it from a lot of people that ‘these books are trash’ I’ve heard that countless times too- but that’s not true, not at all. Even if you are going for some coaching notes those are good too, provided you read it throughly.
All said and done. Here’s my final words for all of you who are putting all that trust in me:
Read from any one source in a case oriented way, See patients, take cases and then read about that particular system from any one source and Don’t forget to take a good look on those 200 flow charts from Harrison. For practical purpose Hutchinson as well as Kundu both are great, go for anyone you have and stick to it.
If you are someone who’s even a little bit serious in his/her MBBS days then you should read Harrison’s believe me you can do it. Start system wise, Read it well once and you will know what you have to do next.
Here you can read it for free. Hope this helps! https://accessmedicine.mhmedical.com/book.aspx?bookID=2129#191737034
If you have any query, feel free to ask me @
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Hey there Interns👋🏻
In this blog I’ll be sharing my experience of a minor posting that is Anaesthesia. It’s the 1st minor posting I’ll be talking about. Why it is referred as a minor posting? That’s because you would be given way less time in this department.
Short duration of posting sounds good right? It will be quick and you would be joining in the next department before you’d even know it. My Anaesthesia rotation was for 15days. Quick, easy, fun, non tiring and exciting.
Basically I’d be answering two main questions here:
- What is expected of you in Anesthesia posting?
- What all things you can do during these 15days?
What is the first thing that comes to your head, when you hear you’d be going to Anaesthesia department?
Intubation and spinal blocks? Those were the two things popped straight up in my head as soon as I realised Anaesthesia is next on my rotation. And believe me those were the only two things on my to do list besides of course being able to finish my anaesthesia notes.
What you can do during this posting:
- First and foremost thing ‘Read’, read your notes, textbooks, solve those MCQs. You have 15 days and believe me that’s more than enough for reading or revising this subject the much it’s needed for an intern to know and for all those competitive exams.
Sr. Anaesthesiologist used to give us topics to study each day and will discuss those the following day, this way we were able to finish the topics in an interesting manner, that lasted longer in my memory for sure.
- Observe. Observe it all inside an operating room from the point of view of an Anaesthesiologists. Being a physician you should have a good knowledge of what the anesthetic will do to the patient, even though you aren’t administering it. Observe and study the physiological changes which take place in the anaesthetised patient. Observe the process of intubation and extubation very closely.
- Skills you should posses at the end of your posting. Here’s the list:
- CPR- Basic and advanced
- Maintenance of clear airway
- Bag Mask Ventilation
- LMA or ET intubation
- Starting a venous access
- Preoperative care and post operative care.
- Giving a simple infiltration block, some nerve block
- Performing a lumbar puncture
- Administration of General anaesthesia
- Pain management
- Ventilatory assistance devices – setting, monitoring and applications.
What is expected from you in anaesthesia posting?
Apart from CPR- that I’m sure medicine posting has already taught you, it is expected from you to know basic techniques of maintaining a clear airway, giving assisted or artificial ventilation. P.s. don’t be just hungover the endotracheal intubation. You should also learn how to position the patient’s head, how to hold the chin ( C/E technique) and how to insert an airway.Learn the anaesthetic agents, muscle relaxants, their administration, complication and toxic effects, how those can presents and can be treated.
Learn enough about anaesthetic machines. Believe me those machines and circuits are one of the important topics in all the PG entrance exams and looking at them and then studying is way better than reading it from any book.
In addition to these technical accomplishments, grab the opportunity to administer either general or spinal anesthesia or both under the supervision of senior resident or professor. I talked to my OT incharge the very first day of my posting and the deal was I’d do all sort of work that’s any other resident or anaesthesiologist does and they will teach me and let me perform intubation and spinal or epidural blocks. It worked out well for most of the interns.
The purpose of anesthesia training for medical students is not to make anesthesiologists out of all medical students, but to give students knowledge of basic concepts used in anesthesia and to teach them skills of airway management and vascular access that may be useful to them in other areas of medical practice.
Anaesthesiologist job isn’t just inside the OT, it begins way earlier than a surgery is scheduled. Yes, Preoperative Management. From judging whether that particular patient is fit for that surgery to making him fit, all those adjustments are not just important in the clinical practice but for your PG entrance too.
And in case you are posted under a department of Anaesthesia like GMCH then, you have to learn each and everything about that before you dare to go to the, OT incharge or the HOD for completion and signing of your log book. And that’s fair, because they did teach us each and everyday, whether it was inside the OT where I was monitoring pulse rate and blood pressure, Or in the PACU (Post Anaesthesia Care Unit).
According to AIIMS, New Delhi guidelines, by the end of anaesthesia posting it’s interns should be able to do the following things:
- Know Principal of acute medicine as it is practiced in managing the anesthetized patient in the operating room and in managing the patient in the recovery unit.
- Skilled in resuscitation (cardiopulmonary, cerebral, fluid and others).
- Care of the unconscious patient, including airway and ventilation management.
- Management of blood ,fluid, electrolyte balance , and metabolic disturbances in the surgical patients.
- Manage acute and chronic pain problems.
- Know the concepts of drug interactions, especially as they apply to patients receiving anesthesia.
- Evaluate surgical and anesthetic risk. Preoperative preparation of patients subjected to surgery and anesthesia.
- Various techniques of anesthesiology.
- Pharmacology of muscle relaxant, application and monitoring
- Pharmacology : Basic and applied of local anaesthetics : Various types of blocks advantages and disadvantages.
If it interests you then you can try and learn everything from this list. The least you should know is I’ve mentioned above in the skill set. In most of the hospitals anaesthesia posting for interns turns out an easy one. Not much is expected from you, besides simple monitoring and intravenous canulation.Anaesthesia was one of my favourite rotation during my internship. The one where it felt complete. I learnt something new everyday, I finished my notes and MCQs, I partied, cooked my own meals and slept really well.
I’ve just one last thing to say, even if you don’t do anything in this posting just “Follow one case from Preoperative preparation to full recovery” and you will get the idea of Anaesthesiology.
Be very careful during this pandemic times.
See you in the next blog, till then keep working and keep learning.
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Medicine and writing share some different level bond.
Storybooks and case sheets!
Every patient have their own story to tell, some briefly covering a couple of days, while others are those long reads which take months. Some stories just end abruptly, and some of those give you a heartache for life, while some are just full of pure joy and happiness. We follow them page by page, not to miss a single detail.
Everyday you meet so many new people, and they have many so many new stories to tell, in general, you don’t have to be a doctor to know people so well but, being a doctor you certainly have an edge. Patient turns to doctors in their most vulnerable times and they trust their doctors like nobody else. Isn’t that something extraordinary? Someone trusting you with their life. Being a physician, How does that makes you feel? More confident or that pressurises you?
Everybody knows that everybody dies, but nobody knows it like the Doctor.Tweet
The thing about writing is, you start writing and mostly you don’t know where the story will go, ideas keep popping up in your head, a little mix of fiction. In medicine that unpredictability is there and yes inspiration and ideas may just come from anywhere but it’s mostly a planned route, and no fiction.
A writer asks herself open ended question, because she ain’t sure what is going to be that one turning point in this story of hers, she gotta deduce it. Likewise, a doctor asks her patients open ended questions ‘what’s bothering you? what brought you to the hospital today?’ because the patient doesn’t know what point is of importance and what isn’t. The doctor has to pick the clue for the diagnosis, to give this patient’s story a proper path.
Just like reading and writing gives you the glimpse of someone else’s life, enriches your knowledge of human experiences. Medicine offers privileged opportunities to look into other people’s life, how they experience most human emotions, how they look at the world- it indeed is a privilege.
Medicine and literature are in synergy,
Most doctors are natural writers, (yeah! You can say our exam papers, case presentation or thesis made us one) but honestly, I believe we have the privilege to experience every human emotion so up close that we understand everything so much better. And that enable us to put that into better words.
To become a good writer you have to read more, and to become a good doctor, reading ain’t enough, you have to practice more, much more.
Osler said “it is much more important to know what sort of patient has a disease than what disease the patient has”, so loved this!
I’m not sure, if writing helps me in anyway in being a better physician, but medicine surely helps me in being a better writer.
I met this one physician and awesome writer recently, who told me that I’m so good at separating personal and professional relationships, in compartmentalising and in not letting my emotions cloud my judgement – that gives me an edge in writing and practicing medicine all together. ( I bugged him for like an hour to explain it me what exactly he was trying to tell me). He explained that, he faced this issue mixing both up. Which I honestly didn’t get, maybe because I don’t write fiction. Maybe I’m quite new to this, or ‘maybe he’s right and I’d never face any such issue.‘
What do you think? Do you write?
Does medicine helped you become a better writer or writing helped you become a better doctor?
Do lemme know
What you wanna read next about?
OBGYN or Anesthesia?
What’s up? I’m here with a new adventure to share, the rural posting.
All of us have that 1 month compulsory rural posting in community medicine after MBBS if not more.
We have read a lot about the ‘Importance of community health’ during 3rd year ( haven’t we? or you forgot ‘the park’s textbook of preventive and social medicine’ did you? ), and in various community health journals ( don’t judge me; I love those journals). But in our 3rd year what we all learnt was those definitions of health and epidemiology, goals and objectives.
Quick question: Tell me who’s the father of medicine ? Yeah right you all know that.
Now tell me the father of public health and epidemiology? Don’t google it. Honestly! did you get that right? Don’t feel bad I asked a few dozen people the same question and only 1 of them knew.
Community Medicine rotation involves UHTC, RHTC and immunisation OPD.
Community Medicine was my First posting. On the very first day we reported to the Urban Health and Training Centre aka UHTC. After a quick tour of that teeny tiny hospital we sat in ‘what we called OPD area’. Rules were pretty simple show up before 9am and by 12:30 or 1 pm OPD will be over and you can leave.
It was just like any General OPD, with I think 10 types of drugs atmost in the dispensary and a couple of vaccines that will be given by one of the sisters and a dressing room. Two 1st yr residents who will sit just opposite to us and not only keep an eye on us but, will guide us too. One 2nd yr resident who just came back from a tribal area Medical Camp. Her stories about the camp were pretty inspiring. Two servants (mama and mausi) who will arrive before everyone else. The incharge with whom we barely interacted. To the rest of the staff I’ll just smile, or if I needed them to repair any equipment.(In the name of instruments all we had were a couple of sphygmomanometers- those kept on breaking every now and then). Though there was a lab too. (Working lab, and you have to remember all the investigations those you can order from there, rest refer to the main hospital- which is like 10mins away)
Here we were to learn how to run an OPD with minimum facilities available. Seems like a struggle? Well I’d say it was fun. Not only this posting gave me better communication skills but confidence too.
Types of patients i saw at a UHTC
- Comes with flu, and they know the treatment. They refuse to leave until you prescribe them the medication they want and that is a cough syrup. If needed they will keep coughing (fake) for as long as you want.
- Patients on antihypertensives or on Diabetic medications (only metformin was available) who will show up every week or 15days just to get their blood pressure checked and ofcourse for a refill. God saves your ear and fingers ( syphgomamometer)
- Kids for immunization. Every Wednesday it was like children’s day.
- The itchy ones.(doesn’t mean to offend anyone). Their chief complain will be itching. And you have to give them a lecture on personal hygiene. But they want medications and 1 tablet of fluco once a week isn’t it for them.
- The pill poppers. They want as much as medication they can get. They will bring I think whole of their family with them and explain all their symptoms all by themselves.
- Women for ANC visit. Either they just show up for those hematnics or they’ve got a hell load of questions for them and by they I mean their mother-in-laws.
UHTC was over before I even realized. I felt 6 interns were too much for UHTC and then there was a day when only two us showed up and it all went smoothly. A survey on anaemia in reproductive age group women and A poster making on summer care. These were the requirements for completion.
Immunisation OPD was more or less about giving ARVs, Hep B and Tetanus vaccines. We got our HepB shots too-we gave it to each other. (if you haven’t got yours, get it now). That included a Pulse Polio Camp too.
Rural Health and Training Center.
Aka RHTC, the most awaited posting. There are two type of interns, one who are crazily waiting for this posting, other a bit worried about it (I was the worried one). RHTC was located 40-45km from the city. We took MSRTC bus to get there. It took us almost 2hrs. And by the time we reached there I told my friends I’m not gonna travel daily. I’d rather stay at the hospital for the whole time period.
That turned out to be the best decision for me. We were 12 interns in total. 10 girls, 2 guys. There were two rooms (in liveable condition) for us. Those rooms had a washroom each, which you wouldn’t like to use even in emergency. And 3 hospital beds in each room. Lights and Fan were working luckily. All the girls have to share the beds. I don’t sleep much so that was never an issue for me.
At RHTC the schedule was; OPD everyday and 1-2 emergency duties(30-36hrs). OPD will began by 9am, but you have to be there before 8:45am if you don’t wish the MO to mark you absent, lunch hour used to be around 1pm, OPD shutdown by 4pm. That one hour lunch time was my favourite, calling the restaurant to deliver food and messing with one of my friend to get ice creams for us. Four of us will always eat together if not with others, used to tease each other, along with heated to light discussions, those two guys were always into PUBG but played nice music all the time. Kicking them off the bed which was near the charging point was our favourite thing to do.
In OPD we will see our own patient, and manage. On the very 1st day the Medical officer gave us an orientation, followed by a couple of days where he observed us, later everyone will see his/her own patients.
In the ER there will be two interns at a time and the nursing staff, Medical officer will be around too. Mainly ER used to be flooded during evening hours. If there’s some cases we think we can’t manage(say RTA with serious injuries, Pregnancy with indications of C-section) , we have to send them to the main hospital ( tertiary care centre). What we dealt within the ER was mainly; Obstetrics patient with normal labour mostly; Minor traumas, burns and other injuries; Patients coming up with pain in abdomen, cough, hypertension, hypoglycaemia or hypothermia. Also there were times when patients with eclampsia, hypertensive crisis and MI were managed too, then sent to tertiary care.
RHTC posting was the one where we attended maximum camps. Even at Ambedkar Jayanti we acted like paramedics, spent the whole day in ambulance. Another camp which was huge, really huge- Nathshasti festival, people travelled miles on their feet the visit this particular temple there and we were there to help them if they needed. That 1 week camp had unlimited medical supplies- which was pretty surprising for a RHTC to have. This camp after a couple of days started getting really boring for me so I cut a deal with the Medical officer that I will deal with ER for rest of 5days instead of 6-8 hrs of the camp duty. (Worked out really well for me- I love ER). Remember, be smart, learn what you need to, work where you learn something don’t just waste your time on all the assigned duties- there’s always an alternative.
I don’t know what was the deal with the medical officers there at RHTC somehow for all the camps we three were chosen (none of us were fluent in the local language), though we enjoyed most of the camps, sometimes we felt we could made better use of that time. (For a marathon all of us suggested each other’s name no one volunteered- don’t judge us, you wouldn’t want to run a 3000m or more marathon in the mont of April). My advice for you: Proper time management is must. Community Medicine was my 1st posting, naturally I learnt most of stuff there only, did a lot of procedures for the 1st time there only and mastered them too.
Major take home message for you: Be nice to everyone, I mean it, to everyone, regardless of what they can do for you or their standard. It doesn’t cost you a thing just be nice, treat other people with respect.
What goes around, comes around.If you treat others with due respect, they will respect you too.
Securing an i.v line, putting that butterfly cath, all sort of injections- all these things I learnt better there at RHTC and guess what, No medical officer taught me that, but the nursing staff. I remember asking that one brother to put in an i.v. cannula in a kid’s veins so that I can inject his antibiotics and he did it with such ease, later I’d ask him to stay there and observe if I’m doing it right and he helped me master it, not only that, but all sorts of injections too, which I later taught to my co-interns. The nursing staff have been there for much longer than all of the interns, they know the place better, how it all works there. And if you want to learn- they know, if not more hundred different things that you don’t. There are different ways to do a single procedure and you’d be surprised some of those not mentioned in the textbooks work so much better. Field experience matters a lot.
I remember a few interns use to order the nursing staff really rudely, even a couple of them said ‘I’m the doctor, I order and you follow.’ I mean really? You are the doctor but you don’t have to be so rude about it. Every hospital runs on a balance between all it’s employees, doctors, nurses, clerical staff and the servants. If you think you can work all alone- you are highly mistaken. Team work is the key, and your position certainly doesn’t give you a right to mistreat others. I remember the nursing staff and all other technicians and servants were so good to all of us who were just polite to them, they would even help us doing our job, remind us of things if we missed any, even at times they were so supportive that they’d let us rest and cover for us. While those who were rude to them, they wouldn’t move from their chairs during their ER duties- not even a single nurse. All because we treated them with respect and others didn’t.
Being kind doesn’t cost a single penny, but those kind words of yours can totally change people’s perspective of you.Tweet
I remember this one time, OPD was supposed to be shut that day, but turns out that wasn’t the case. Every other intern went home because it was weekend. Just three of us stayed there because, we planned to go see the beautiful dam there that day. But to our surprise the medical officer knocked on our door telling us, we have out patients working today, and it was almost 9am by then. I put on my white coat, a pen and stethoscope- tied my hair up in a bun as I walked towards the Out Patient Department, in the same clothes before the night. Fortunately, One other intern joined me later.
That one time I dealt with OPD and ER standing at the Nurse’s Station, with two nurses by my side. Overloaded with patients inflow- but we partied the next day like we conquered the world. The medical officers was called up for some official work and that was my and my co’s ER duty, and OPD was supposed to be shut, but that wasn’t the case. So my co-intern decided to go to OPD and I decided to manage the ER (as I said earlier, I love ER). She kept sending patients from OPD to ER for the Medical officer’s consult, little did she know that the MO wasn’t there. I and the real cute nursing couple were unaware what exactly was happening there, we kept on seeing patients but, it won’t just end, and the brother kept on asking every now and then ‘is there no one in OPD?’ I stood there at the nurse’s table wrote the prescriptions, asked whoever needed other procedures to step into the ER, brother did most of dressings that day and the sister gave the injections. I was stitching this one patient’s wound up and a patient (5yrs kid) was brought in, with hot water burn on his lower leg, brother himself volunteered to do the dressing of my patient and asked me to attend the kid. That day was crazy- we were working like anything and when it all ended we could believe it all went so well.
On my next day off, I and those two lovely nurses celebrated that small achievement of ours. I spent a lot of nights discussing politics of Delhi, really interesting cases and lot more with the nursing staff and whenever we happened to ran into each other later after months, they kept telling me I was the best person they worked with, Even the incharge sister who brought her daughter-in-law for delivery invited me over. All that was just because I was polite to them. Which costed me nothing, Instead, got some helping hands.
Overall, this rotation didn’t just teach me the importance of community health, but of a community as well, that town was so small that everyone knew us after a week or so and eventually, everyone helped each other, we doctors medically and those locals to settle us there, from food to groceries everything we needed, those patients told us where to get that from.
Also, community medicine was the one rotation where I had the full responsibility of my patients. I saw my own patients, wrote prescriptions ordered the investigations, updated their charts, followed up on them, took timely rounds, put on the orders on the nursing charts, updated nurses on the new meds or dietary orders I put down in the files. Various MLCs and other cases. Believe me, community medicine will be the one where you’d see all sorts of patients (of every age, gender, from all sort of departments and you have to manage them all, you just can’t refer them to OBGYN or Orthopaedics or Surgery or Paediatrics) and will get the maximum to learn. In short if you are looking forward to Family Medicine as your specialty, this is how your life is going to look like.
Take Home Points
- You’ve got limited time at a certain rotation. Use it wisely.
- Prioritise your needs, what you need to learn and you can skip for now.
- Everyone can teach you something, if you are keen to learn
- Master your skills, practice practice and practice.
- Be kind to everyone- Empathy.
- Learn to work as a team. Hospital runs on a good team, you win when your team works the best.
- Don’t forget to enjoy what you do, take breaks, reboot and get back on track.
Community medicine is going to be your favourite rotation, really light and this is probably the only place where you’d feel like a doctor so take full advantage of it.
Stay healthy, keep learning and keep enjoying.
Until next time…..
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Before I talk about Emotional quotient or empathy, Let’s 1st understand the meaning of Emotional intelligence.
Emotional intelligence is the capability of individual to recognize his own emotions and those of others and being able to label them appropriately, and adjust emotions to adapt to environments or achieve one’s goal. (Proper definition of EI as defined by Peter Salovey and John Mayer is available on wikipedia) Don’t worry, I’m not going to explain those complex models here. Just ask yourself, Do you know how emotionally intelligent are you?
Though this term was first used several decades ago, but it gained popularity only a couple of decades back. ( I wasn’t even born back then)
Now you must be thinking why all of sudden I’m talking of Emotional Quotient and Emotional intelligence . A couple of days ago, someone asked me why my Instagram bio say “EQ higher than IQ”. Why does EQ even matters. I explained it to him, which I must say wasn’t an easy discussion. Later, I was discussing this incidence with my friends and turns out they too believe, emotional intelligence isn’t of that importance. Some of them even said “emotions are overrated. Emotions are useless”. While, Some of them drifted to the ‘EQ vs IQ’ debate. Do you think like that too? What does emotional intelligence mean to you? Does EI has any importance in your life? Do you even know what emotional intelligence is? – Did you ever ask any of these questions?
Before anything else, Get this;
Studies indicate that patients who perceive their caregivers/ physicians as more empathic tends to heal faster and experience less aggressive symptoms.
Moreover, evidence suggests that physicians with higher empathy levels (who are aware of their patient’s emotional needs and respond appropriately to their concerns) experience less stress, cynicism, and burnout than those with less empathy. – A ton load of journals says so; not me.
Empathy is closely associated with emotional intelligence, because it relates to an individual connecting his personal experiences with those of others, good or bad.
Still, I don’t understand; why do we not value emotional intelligence as much as regular intelligence? Empathy, tact, and thoughtfulness can make any sort of work not just doctor patient relationship, much more easy and enjoyable. Not only that, this goes the other way around too. Isn’t is amazing being able to understand your emotions and channel them properly in a productive and non-destructive way. Imagine how much productivity that can bring, how positive that will make the environment. Imagine your work place where nobody’s yelling at you because they started their day bad, you didn’t snap at them because you were able to evaluate their emotions.
Emotional intelligence at workplace too plays key role. Knowing that your workplace is dedicated to diffusing conflict and valuing your individual satisfaction. Isn’t that motivating? Have you ever thought of the impact of emotional intelligence at workplace? Did you try to understand why that one colleague of yours is acting that way, today? why your boss just yelled at you for nothing? Emotional intelligence and mental health goes hand in hand. In simple words emotional intelligence means being able to understand your emotions and others, name those emotions. Don’t you think that will make life much more pleasant?
Then why? Why don’t we value emotional intelligence?
Why do everyone’s just talking about IQ and not EQ? Why my Instagram bio raised a question to the readers mind and not an understanding that emotional intelligence does matter.
I agree, it’s still controversial whether EI is a correct terminology or not. Does that means it’s nothing? What do you think? Do you agree with them or me?
It has been documented that individuals who understand emotions better, tend to be more pleasant, socially skilled and empathic to be around. In addition, they have the privilege of enhancing relationships, personal as well as professional. It is also related to lower level of insecurity, less interpersonal problems, aggression and social awkwardness. Moreover, better emotional understanding allows people to see the multiple perspectives of a particular situation and then take a more appropriate decision.
Now I’m nowhere comparing IQ and EQ, both have their own importance. And one can certainly be great at both.
I just believe getting better grades isn’t it. Having better family and intimate relationships is really important too. In general having EI as a skill makes so much of a better individual.
Let me clarify empathy isn’t just for unpleasant feelings (oh! I feel your pain). You can feel empathy when you see someone happy, too. When someone walks in the room smiling, isn’t it makes you smile too? When you look at a baby cooing isn’t it fills you with immense joy?
Emotional intelligence relates to the ability to manage your own emotions and feeling and your relationship with others. It allows you to control the environment around you in a positive and constructive way. Emotional intelligence at workplace allows you to be more productive and likeable among your colleagues.
Now the question arises ‘how to be emotionally intelligent?
Internet is full of thousands of emotional intelligence tests that you can take to know how emotionally intelligent you are, those can definitely help you identify other’s pain points and figure out whether you are causing them, or if you can resolve them. There are tons of articles available on how to improve your emotional intelligence.
Do lemme know if you want me to write about them.
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I know you’ve been waiting for this one, so here it is…
Those who haven’t read the previous part I suggest do read that, in the link below;
(Days are mentioned as the one I found worth sharing, otherwise medicine is like never ending one; for more reach out to me.)
Emergency duties(ED), that’s always the most hectic day followed by Post ED. New patients- all new work up. I was either dealing with EKGs, labs, i.v cannulas, urinary catheters, nasogastric tubes, or accompanying patients. Taking them for radiological investigations and other department opinions. I never liked doing EKGs in the ward, so I used to ask JR1 to do that and by that time I’ll finish whatever work he was doing. In the ER I’d always do it on my own.(read it before you hand it over to your senior). Also, before you go to the medicine rotation, know how the EKG leads are attached (they expect you to know it, because some of the residents don’t remember the technical work) and even if they do, “still it’s your job not theirs. That’s what you will be hearing from them.” Fortunately, JR1 (Dr. Prabhanjan) I worked with happened to be nice, I’ve to show him how to attach the leads only a couple of times and he would do it.
ENT happened to be my last posting, and there I’ve to record the HOD’s EKG, because the residents said ‘it’s been so long for them that they don’t exactly remember doing it.’ Don’t expect much from everyone. Know the right person and learn from them.
I happened to work with this amiable women too Dr. Neelam, she happens to be the 2nd yr resident in a different unit, in the same ward. She happened to be so down to earth, I never saw her raising her voice at anybody, she never complained, she will do all the work by herself, she even didn’t care whether her interns showed up or not. She and the nurses will always ask why I’m always smiling. And she repeatedly cursed me to get into Medicine (that was nowhere on my list, I’ve always believed general medicine isn’t my thing). Doctors like her makes the work environment cheerful. There were times, when I had to push my JR1 and 2 out of the ward so that I could finish all the workup properly and, they never had an issue with that. It was so much more fun to work those cheerful people. When you interact with the residents, notice their good traits and try to inculcate those into yourself. That day there wasn’t much of work, I attended rounds, filled a couple of discharge papers, sent some investigations and I went home by 6pm to get some rest before the upcoming ER/ casualty night.
I’d always show up before time, that’s the one thing I refuse to give up.(Be punctual, even when nobody cares, even when it feels like it’s useless to be, because it will payoff, also you are just starting out, start out with some solid base) I finished my work by 11am. Now, there was this one patient, who was supposed to get an MRI, I was sent to get the earliest appointment and sometimes when you know people, you get your work done. Radiology department requested resident accompanying the patient. So my unit JR1 went with the patient. JR2 gave me discharge papers to fill in and some others investigations to get done. And she left (JR2 changed as per their rotation), I was done with all my work and I was suppose to go home for rest of the day and show up by 8pm for ICCU night. I ended up sitting there in the ward till 7 or 7:30pm and that was the day I missed my breakfast too. I did my ICCU night and went home in the morning, a couple hour later I got a call from one of my residents and i was supposed to go to the ER. So it’s was like i was working for 3 interns because others won’t show up or they couldn’t reach their cell or whatsoever be the reason.
Considering the present situation, keep that face mask up in place.
Save yourself in order to help others.
If your are posted in the isolation wards, be extra careful.
Here’s something I want you to know,
- Don’t do anyone else’s job, especially, when they didn’t ask you. If your co-interns didn’t show up that’s not your problem that’s their and the department’s.
- Don’t take your health lightly. Don’t skip meal, take a break when needed. Don’t just work like a machine because you are liking it, you will burn out soon.
- If you are asked to stay a little longer because your replacement didn’t arrive, stay for a while if it’s important, but don’t stay there for hours, remember you are still an intern. You are done with your work? it’s your out time, inform your residents or attendant and leave.
- If you think it’s going to be fair, it’s not, nobody cares how you and your co is working, they just care that the job is done. Covering for your friend is great and you should do it, but don’t work for someone else on your expense.
- Don’t just sit there doing one job, like taking notes or history or monitoring BP. Divide among your colleagues and learn everything. I mean you can totally spend all your time sitting there at the Blood pressure measuring desk, a lot of interns do but, that’s totally upto you! what you want to do.
You guys have been so patiently reading this, now the most important part. Juice of this whole story.
Medicine is one of the heavy postings, most important too. Don’t miss out on OPD or ER or ICCU. Apart from the basic patient interaction and care, you should also learn:
- Proper resuscitation protocols.
- Airway management (don’t be just crazy over endotracheal intubation, there’s much more to it)
- Intensive care, Coronary care.
- Emergency management.
- Ventilator management
- Other bedside investigations like Echo cardiography
- Treatment protocols of certain conditions like Diabetic keto acidosis or coma, Hypertension, Hepatic encephalopathy, Various poisoning (Never forget to label the lavage sample properly) and unknown bites.
- Most importantly, Don’t catch any infection yourself, if you are posted to isolation wards, be extra careful, don’t go in there unprepared. As of now, you people in General Medicine and Respiratory Medicine are at a higher risk of contacting SARS Cov2/ covid19. Be extra careful.
Long story long! That’s all with medicine for now. Don’t miss any chance of learning something new.
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How are you doing? Anyone currently posted in Medicine department?
Those who have been through their medicine postings will relate, and those who are yet to go, take notes.
Medicine was 2nd in my rotation.
(Days are mentioned as in, the one I found worth sharing, otherwise medicine is like never ending one;
for more reach out to me.)
9am, all of us gathered in front of the HOD’s office. We were allotted particular units, and then we went to meet our respective unit heads after, the clerical staff gave us good to go signal (really important work in order to get the completion). Everyone have their preferences, like which unit they want to get in. My suggestion- don’t put your head much into it, most of the time you will be surprised. Like everyone else I had preferences too, I was friends with a few residents and they told me to get into their particular units. Anyhow, I got into a unit where I didn’t know anybody, infact my friends teased me over getting into that unit, because the lecture there was considered pretty strict. During our final year exams all of us witnessed him yelling.
I went to the wards looking for my unit head along with 2 other interns, he wasn’t there, so we met one of the sweetest resident there, Dr. Shrutika. Though I didn’t get to work with her for very long, every time I shared ER with her was so much fun, she briefed us and asked one of us to stay, and others to go to female ward. I got the male ward. My 1st day ended by 12:30 am or so. Morning 9, began the OPD, interns in medicine OPD will be tired of measuring blood pressure. Believe me, all over the hospital if anyone need BP monitoring, he will be sent to you. What’s in it for you? other than the obvious learning/practice? Good grip exercise! (don’t expect a digital BP apparatus. In most government setups you have to use the mercury sphygmomanometer. And your stethoscope will hurt your ears like anything, by the end of the day you wouldn’t be hearing anything that well).
You will be sent to accompany patients (go, give your hands a break). I didn’t like either of the two, so I’d only do it, if that’s like the last resort. You should accompany patient at least once and judge for yourself.(Piece of advice for accompanying seizure or not so cooperative patients to radiological investigations; Be careful with the Midazolam, your residents will just ask you to accompany and tell you to push it a few minutes before it’s your patient’s turn, the nurse will give you 4cc max of it in a syringe.) The max. dose of it, speed and everything else I had to discuss with the nurses there, because turns out what my emergency medicine friends told me didn’t apply at this particular hospital.
My co-interns weren’t much interested in facing the lecturer, professors and unit head. My better luck, I’d always sit either on the computer desk (writing notes, investigations and prescriptions- not everyone enjoys it) or by the lecture’s side. He would ask a lot of questions, ask me to examine the patients, read the reports. I still remember this one time he asked me to read an MRI and other reports, and then pass it on to the JR3, and I was kinda shocked by the reports that the women had MDR Tuberculosis in her carpal bones, and there was no primary focus(All I ever read about skeletal T.B was Pott’s spine or TB hip joint, and it’s hematogenous spread, carpals doesn’t have that good bloody supply, do they? ). Being there in the OPD helped me learn a lot of things real quick. My unit lecturer and JR3 had this habit they’d ask questions and if I’ll just say I don’t know the answer, they wouldn’t tell, instead, would ask me to figure it out. That turned out really well for me, because when you figure out it on your own you tend to remember it.
Remember- Always crosscheck with them.
Dr. Aniket Chate, the lecture, we witnessed yelling during our exams. Now as a doctor, he was just amazing, not just his knowledge, his communication skills too. I was so surprised that he can be so polite, Infact none of my co-interns, friends believed me. I can say this now, I didn’t meet a doctor with better communication skills than him during my internship. His ward rounds was the time, where those 50 patients were 500 questions for me.
My unit head, happened to be a really polite person too.(He talked of me very highly to my Dad)
Let’s come to the residents; interns are most in contact with the residents only, particularly JR1. My unit JR1 joined at the same time i did. Sweet but super slow, poor guy always working. He would literally sleep anywhere.
JR2 and JR3 were the doctors who wanted me to learn everything. The constant source of knowledge. I didn’t know reading an EKG properly, my JR3 was so constantly on my head that eventually I learnt it. Thanks to him I learnt coronary care and echocardiography too. So was JR2, his favourite topics were resuscitation, CPR. I used to hate paper work, I still do, he taught me how to write notes, of all different procedures and cases.
What I want you guys to know is, if you want to learn, they will teach you, everyone will. But, then there will be more workload for you. Sometimes, you will have to stay back for long hours. I think it’s worth it.
And Medicine is ‘The subject’. It’s vast, really vast and something you must have to know, no matter which specialty you are planning to pursue.
Suggestions I’ve for you, are:
- Keep medicine at either 2nd or 1st in your rotation.
- Plan to read the subject alongside the posting. That, I suggest for all the subjects. Try to finish reading medicine during the medicine posting, Surgery with surgery and so on.
- Now, if you want to keep your workload a bit light, don’t choose the 1st few units, they generally have more patients. But if, you are someone who really wants to see a lot of different patients and already want to experience whether you can handle that particular speciality, choose first 2-3 units. Not much of your co-interns want to get into the HOD’s unit, so you can easily get that unit. I did quite a times.
- Likewise, Male wards tend to have more patients. You can work with your co-interns and can switch like 1 month in male ward other month in female, that way both of you get to see all the patients.
- Never miss rounds, whether it’s the unit head or the JR, rounds are the time where you will learn the most. Observe how your seniors interact with the patient and patient’s relatives, what investigations they order. How they write down the notes, i must tell you, you will be bombarded with a lot of questions so be prepared. Read.
- Read the patient file. Now is the time when you have the access, read it carefully, you’d learn a lot of new things and as I mentioned earlier don’t be shy of asking questions. Also, if you have already read the file it will help you manage your work better, you would be able to fill the discharge papers better and wouldn’t miss any of the ordered investigations. Moreover, you remember these things better than what you will read from the textbooks.
- Don’t just draw blood and send the investigations you are asked to, know why those investigations in that particular patient. What are those particular bulbs/blood collection tubes for? their content and everything. Which i.v. cannula/intracath is used in which patient. Colour coding for all the equipment. You’d be doing it for a year, you’d anyway learn it, but do pay attention.(these are the questions for all the competitive exams)
- With the changing pattern of NEET PG and NEXT coming up, I believe internship now have even more crucial role to play.
If you ask the right questions to the right person, you’d get much more than you expect.Tweet
This blog is getting pretty long, so I’ve just mentioned a few important points here. There’s lot more to it in Part 2, like things you shouldn’t do, what you should definitely learn in this very posting. As I said medicine is vast.
Stay tuned for part 2
Guys I’ve to rewrite this whole blog because I thought it was too long to be read in one go. Do lemme know if, you liked this idea of dividing it into 2 parts.
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I want to ask this question to all the medicos out there…
Does any of you read Lockdown as any sort of prevention in Community Medicine aka Preventive and social medicine?
I couldn’t recall…
so I did some research and I came across this one article.
The idea that a pandemic could be controlled with social distancing and public lockdowns is a relatively new one, said Tucker. It was first suggested in a 2006 study by New Mexico scientist Robert J. Glass, who got the idea from his 14-year-old daughter’s science project.That was then and this is now.
Inspiration can come from anyone, from anywhere,
but putting that into an idea and
what you make of that idea is totally up to you!
My thoughts were different then than now.
And I sometimes wonder it happened? But how?
“When the country went on total lockdown;
I think I was the only one in my family who didn’t frown;
Infact I happily, Spent whatever time I got, with my family.
I’m so well acquainted, with living solitarily;
And was confident that everyone can do it temporarily;
Instead of going for a walk or drive, dig into an unread book;
Avoid the bars and restaurants and learn to cook.”
It did good to me. To you?
Are you doing well?
Next coming up a detailed story of Medicine department.
With Do’s and Don’t’s.
P.s: It’s much more than just drawing blood.