Matters India |Wednesday, June 28, 2017
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Anything to add to the health of patient-doctor relationship is welcome 

Dr. George Jacob
In a first, scientists are using life like virtual humans to train doctors on how to break bad news and empathize with patients and their families.

Researchers created two virtual humans-Robin and Delmy- that are intelligent and conversational.

‘Communication is the most important part of doctor-patient relationship’, says Frederick Kron from University of Michigan.

Anything that augur the delicate craft of doctor-patient, and doctor-patients’ family communication is welcome
This crucial aspect is neglected in today’s skewed medical curriculum, where students are put through clinical, preclinical and paraclinical courses and quite tumultuous and horrific examinations at the end of the courses, which closely resemble those Alfred Hitchcock horror peddlers.

Students are often left to wonder why these subjects are being taught in the first place, like I did a few years ago. Among those preclinical subjects, anatomy and physiology really did make sense, despite the terror-inducing cadaver, on which we dissected the intricate human anatomy, and those frogs which we pithed to elicit tracings on the chymograph. Biochemistry left me absolutely dumbfounded, often leaving me to wonder if I indeed entered the wrong classroom in a wrong college! After our courtship with those preclinical subjects is through, grueling exams pull the curtains down on them. It is now time for us to ride through the vast terrains of pathology and microbiology, with parasitology riding piggyback. Those done with, the customary exams wind them up too. We are then left to ‘window shop’ through subjects like community medicine, ophthalmology, ENT, Forensic medicine, and dentistry.

Then comes the most crucial part of medical education, when we are taken to the bedside, where we are imparted clinical subjects-Internal Medicine, Surgery, Obstetrics and Gynecology, among which anesthesiology, dermatology and psychiatry are thrown in for good measure.

Through which we are supposed to diagnose diseases and, (if possible) to treat them by ‘examining’ ailing human beings, now called ‘good cases’- which implies cases that could be kept during the qualifying examination at the fag end of a long-winding graduate medical schooling. It is here where medical students forget that these ‘good cases’ are human beings very much like themselves and their imposing teachers. Students being taught surgery are supposed to diagnose a puny lump hiding in some remote corner of a ‘good case’.

Something which the examiners themselves will surely fall short to do in a busy outpatient department where such ‘cases’ report, but unfairly expect exam going frightened medical students to do in less than fifteen minutes! Internal medicine students are taught to diagnose fancy syndromes. Attempts to pronounce them would have one suffer a bleeding tongue bite! In the Obstetrics and Gynecology wards, students are supposed to diagnose how the baby has decided to enter the world- with its head, as is naturally supposed to be, the bum-a tedious process, or sometimes even the face- to frown at the gloved and gowned obstetrician! Once the course is through, students who manage to sneak through the barbed wires of an ordeal called ‘examination’, are put through internship, also called housesurgeoncy, where the young doctors are required to unerringly diagnose and treat patients, who are no more ‘good cases’, now that the examination is behind them. After internship, the young doctor collects his/her (to be fair to the fairer sex) certificate of having successfully completed the MBBS course, and step out of the medical college, either to head straight to work as a junior medical officer in some healthcare facility, or, as is norm these days, to enroll in coaching centers to take on the next juggernaut awaiting to roll over them- the post graduation course, which if successfully survived, would achieve the following

• Will spare the doctor of one of the most irritating questions that could possibly be thrown at him/her by eager countrymen ‘are you only a MBBS graduate?’ As if MBBS is something that is available a-plenty, and can be
bought easily like a box of building blocks in the toyshop!

• Will add to the doctor’s value in the matrimonial market

• Will fetch the lucky doctor quite a fortune as dowry from a wealthy father-in-law(provided the wedding is not a ‘love marriage’)

Once the post graduation is through, the doctor, now at the receiving end of a receding hairline, an expanding midriff(the reason for which are distinctly different in both sexes) and silver streaks in the hair, that once was ‘jet-black’, will now be arm twisted by the father-in-law who just purchased him, ‘ why not a super specialty, beta?’

I am reluctant to admit by default that a similar largess would apply to a beti (daughter {by this time daughter-in-law})

And, at the end of it all, at the very end of protracted medical studies, which have been receding away from him, seemingly, the super specialist steps out from the safe confines of medical colleges, which he/she has hitherto been used to,

• Into the real world of the sick and sickness. A world where there are no more a ‘case’, good or bad, but only suffering humanity, and their families, who run from pillar to post to manage hard-earned money(existing or nonexistent) to pay hospital bills that closely resembles a gargantuan ransom, paid to purchase cure, that seems to elude the patient(who carries in his bag of sickness not only the disease, but also an assortment of numerous co morbidities like hypertension, diabetes, renal failure, and chronic lung dysfunction to name a few).

• Into the world where families paying through their nose demand and expect instant cure and a restored patient back home.

• Into a world, if these are not met, the families of the patients, their friends, neighbors and townsfolk are only eager and ready to tear him/her apart, emotionally first, psychologically next and physically later.
That world catches the super specialist by surprise- a world complicated by fancy instruments and gadgets that have hospital wards resemble a rocket, a world complicated by competitive and ‘pushy’ colleagues only too glad to elbow him/her out of the equation, demanding and seemingly unreasonable bosses, and money avaricious hospital managements, which the aghast and naïve young (read fresh) doctor, familiar only with textbooks and skewed examinations, struggle to come to terms with. Lack of the delicate craft of communicating with the patients, their families and well-wishers leave him/her at their mercy, with none of those voluminous textbooks that was dug into at the medical college, burning liters of midnight oil, coming to his/her aid. The medical course in the country must include a subject which deals with the art of communicating with the patients and their well-wishers, and colleagues too, a subject that should wind up through an examination. The medical course must start not from the dissection table, but from the bedside in a hospital ward.

Medical education as is being resorted to presently leaves the graduate absolutely clueless about the art of dealing with patients, but adept at handling examinations with aplomb. The fresh graduate learns medicine, in its supposed form only when he starts practicing under the proctorship of senior doctors.

The examination system wherein inconsequential umps on the ‘cases’ and murmurs within the heart are diagnosed should be done away with, as that has failed to stand by a young doctor on commencement of the noble art practicing medicine , which has unfortunately come to suffer badly in the hands of over-corporatization, and money-avaricious private players, who have made business out of a noble profession of ‘healing the sick’, where these naïve fresh doctors are left clueless how to deal with violent and unruly well-wishers of patients who fail to respond favorably to well-meant( and inevitably costly) treatment. Where breaking bad news is an assured recipe for violent ‘reaction’ from an unruly mob, ready to shower blows on the hapless doctor.

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