Day 5-6
Today and yesterday we spent time at JSS hospital in the pulmonology department. Our attending was named Dr. Mahesh. All the residents and other doctors referred to him as “sir” and would say “the sir” has ordered me to this this or that. One thing I noticed that was quite obvious was the relationship between physicians at different levels. It seems almost military like, the residents would only speak when asked to. They would not speak if not spoken to, and say yes sir, no sir to the attending. I come from the assumption that rounds is more like a back and forth dialogue with the attending, that was one thing that is different in the medical culture here. When the attending was around the Indian residents always seemed at attention, and waiting for orders. When he was gone, the residents expected the same from the students- to be at attention and waiting orders from the residents, expecting a military like hierarchy.
During down time, it was refreshing to see that the residents here are a lot like the medical students and residents back home. They all had Facebook, they were showing us their photos, and we even had an in depth discussion about the show “The Wire.”
JSS hospital itself, though better funded than RK hospital, was shocking to me in terms of lack of privacy and the sheer number of cases they see a day. When rounding, the attending, 5 or 6 residents, med students, nurses, PharmDs would all crowd around and discuss the case right over the patient without any problem, without regard to who else was listening. Lack of privacy is very noticeable. HIPPA does not exist in India. Today an interesting point was made about the lack of privacy- one of the physicians said, we do not know if lack of privacy in Indian hospitals is a bad thing or something that is completely unavoidable and has not effect. In the hospitals and doctors offices here, when one patient is being examined and interviewed, there are so many other people in line waiting in easy ear shot, sometimes people in the same room shirt off ready to be examined as the doctor is consulting another patient. Patients just seem to be crowded around everywhere, anxious to get a little face time with the physicians.
Something else I noticed- people usually present to the doctor or the hospital in the late stages of their disease. Most people came to the hospital with late stage cancer or advanced disease. Because the people are so poor, they do not regularly visit the physician for screening and only come to see a doctor when they have symptoms. By that time it is too late. For example, in COPD patients, symptoms don’t usually manifest until the patient has lost about 50% lung function. By this time, it is almost impossible to help the patient. Another example would be, women do not regularly get Pap Smears. As a result, they will only go see a doctor if there is vaginal bleeding. By this time, the cervical cancer is already late stage and has poor prognosis.
We saw MANY interesting cases today- diseases and situations that are rare in the US but commonplace here in India. There is a very high rate of TB in India, and since we were following a pulmonologist, we got to see many TB cases. Back in the states, when dealing with a patient with TB, the patient must wear a respirator mask and so must the health care providers. In India, that does not happen. I am told there are TB sanatoriums where people with TB are treated, however what me an Alex saw these past days were people with active TB with in the general in patient and ER population, no mask on. I wonder what the rates are of hospital acquired TB in patients and health care workers.
One skill that doctors have to be very good at here in India is reading X-ray films. Since patients cant afford more expensive tests like CT, it is extremely important for each physician to be masters at reading X-ray film. Unlike in the US where physicians have the X-ray digitally on a computer screen, can zoom/manipulate it, or send it to a radiologist instantly for a 2nd opinion, the physicians here have an actual physical film to look at. I feel that after a month in India, we would be able to look at any X-ray and be absolute experts on how to read it.
ICU at JSS hosptial. ALOT more equipment and resources than the RK hopsital's ICU.
Today and yesterday we spent time at JSS hospital in the pulmonology department. Our attending was named Dr. Mahesh. All the residents and other doctors referred to him as “sir” and would say “the sir” has ordered me to this this or that. One thing I noticed that was quite obvious was the relationship between physicians at different levels. It seems almost military like, the residents would only speak when asked to. They would not speak if not spoken to, and say yes sir, no sir to the attending. I come from the assumption that rounds is more like a back and forth dialogue with the attending, that was one thing that is different in the medical culture here. When the attending was around the Indian residents always seemed at attention, and waiting for orders. When he was gone, the residents expected the same from the students- to be at attention and waiting orders from the residents, expecting a military like hierarchy.
During down time, it was refreshing to see that the residents here are a lot like the medical students and residents back home. They all had Facebook, they were showing us their photos, and we even had an in depth discussion about the show “The Wire.”
JSS hospital itself, though better funded than RK hospital, was shocking to me in terms of lack of privacy and the sheer number of cases they see a day. When rounding, the attending, 5 or 6 residents, med students, nurses, PharmDs would all crowd around and discuss the case right over the patient without any problem, without regard to who else was listening. Lack of privacy is very noticeable. HIPPA does not exist in India. Today an interesting point was made about the lack of privacy- one of the physicians said, we do not know if lack of privacy in Indian hospitals is a bad thing or something that is completely unavoidable and has not effect. In the hospitals and doctors offices here, when one patient is being examined and interviewed, there are so many other people in line waiting in easy ear shot, sometimes people in the same room shirt off ready to be examined as the doctor is consulting another patient. Patients just seem to be crowded around everywhere, anxious to get a little face time with the physicians.
Something else I noticed- people usually present to the doctor or the hospital in the late stages of their disease. Most people came to the hospital with late stage cancer or advanced disease. Because the people are so poor, they do not regularly visit the physician for screening and only come to see a doctor when they have symptoms. By that time it is too late. For example, in COPD patients, symptoms don’t usually manifest until the patient has lost about 50% lung function. By this time, it is almost impossible to help the patient. Another example would be, women do not regularly get Pap Smears. As a result, they will only go see a doctor if there is vaginal bleeding. By this time, the cervical cancer is already late stage and has poor prognosis.
We saw MANY interesting cases today- diseases and situations that are rare in the US but commonplace here in India. There is a very high rate of TB in India, and since we were following a pulmonologist, we got to see many TB cases. Back in the states, when dealing with a patient with TB, the patient must wear a respirator mask and so must the health care providers. In India, that does not happen. I am told there are TB sanatoriums where people with TB are treated, however what me an Alex saw these past days were people with active TB with in the general in patient and ER population, no mask on. I wonder what the rates are of hospital acquired TB in patients and health care workers.
One skill that doctors have to be very good at here in India is reading X-ray films. Since patients cant afford more expensive tests like CT, it is extremely important for each physician to be masters at reading X-ray film. Unlike in the US where physicians have the X-ray digitally on a computer screen, can zoom/manipulate it, or send it to a radiologist instantly for a 2nd opinion, the physicians here have an actual physical film to look at. I feel that after a month in India, we would be able to look at any X-ray and be absolute experts on how to read it.
ReplyDeleteCOPD is a very common lung disease. Diagnosing this disease is so difficult. Because the symptoms of this disease comes and goes. If you diagnosed with this disease then you should start treatment as soon as possible. Our Stem cells COPD treatment is the best treatment for this disease.