Changing world of ObGyn training

Has the world changed and left me behind, or was it always so, and I never realized because I never looked at it properly? The current generation of residents and students have put me in a confused state over this issue. I was quite upset that in spite of my repeated explanation that the standard practice of putting a uterine sound into the uterine cavity was a safety precaution for preventing uterine or cervical perforation, my resident doctors just would not do so. It reached such a stage that the theater-nurses stopped keeping a uterine sound on the instruments' trolley, The residents ware changing our science! Finally I had had enough and decided to conduct an on the spot test to check their awareness level of this issue. Two of my senior residents (third year) had just performed first trimester pregnancy terminations without using a sound to check the direction of the cervical canal prior to cervical dilatation. I called all residents, gave each of them a piece of paper and asked them to write the need for a uterine sound while performing a first trimester pregnancy termination. Two of them wrote “neo need”. All others, including two fourth year residents (qualified to be consultants) gave wrong answers except one second year resident. Some of them measured utero-cervical length, which was inviting fundal perforation, since the gravid uterus is quite soft. Some of them measured the length of the cervical canal. One first year resident had been present when I had told the correct answer to one of the two erring third year residents. Even he gave a wrong answer. I gave him minus ten marks; minus five for giving a wrong answer, and minus five for inability to comprehend spoken English. I told the resident who had given the correct answer that I was quite happy with her, and she beamed. Then she washed up for the next case with me, and put a uterine manipulator into the uterine cavity without sounding it first. So I had a theory-master who would not practice what she knew was right. I have no clue why they behave in this way. I don't think they think they are more knowledgeable than me, because I keep asking them questions, and tell them the right answers when they cannot answer. I don't think they want to revolt against discipline, because they are otherwise quite decent people. I think it is their training, and someone else has been a more effective trainer than me, though unfortunately a wrong one. Habits don't die hard, habits don't ever die, period. To top this all, my undergraduate students entered the operation theater at that unfortunate moment. I gave them the test too. Out of four of them, one borrowed a pen from my first year resident. I laughed at this, As soon as I had finished my residents about this, another student asked me to lend her my pen. I was aghast. As students we never even thought of asking the Boss to lend us his pen or anything else. And none of the students answered the question correctly. My third third-year, resident said he knew the right answer and practiced it so, but did not take the test because he had heard the answer from me when I corrected the erring resident. He turned out to have taught the students this topic. To confirm that he had taught them the right thing, I asked the students to show me the notes they had taken that time. They just stood there hanging their heads. They had not taken any notes! I think the world has indeed changed, and probably for worse.

Steal a Professor

It began in a way that was quite subtle, and unexpected. We had two vacancies of Professors in our department, We had one eligible person for this post, The other one was at another corporation hospital in the city, Both posts had been vacant for about 2 years. Finally our own candidate pushed them so much that the promoted both of them. Our candidate joined immediately. The other one would not. She wanted to get promoted where she was, without there being a vacancy in her institute. She was said to be quite influential, she had received her previous promotion while she had been on long leave, out of the country. Such things don't happen unless you are well connected, This time she came to see me and requested me to a allow her to remain at her own hospital for one year, so that she could finish her projects, I said 'No', because we were really short-staffed and overworked. She had put up a letter to this effect, on which I had written in detail Why Such a thing was not possible, Then we heard that she was trying to get our post transferred to her hospital. I told the Dean about this in a meeting of all heads of departments, The Dean said, 'That will not happen', which should have reassured me. It didn't, A short while later, the Dean told me in another meeting of all heads of departments that since she (the said candidate) had met a number of people (read high up people), we would allow her to remain where she was until end of June, and she would join duty with us on 1st of July. We had sent letters to the Commissioner against this arrangement, which had probably made the Dean stall the issue till end of June. I knew why she set that particular date. The Dean was to retire from 1st july. And would not be there to answer any questions if this person did not come as stated. She was said to be related to the VC and the Dean both. Which explained a lot of things that happened. First July came, but the Professor did not come, The Dean was not there to give any explanation, about this, very conveniently. We wrote a number of letters to higher authorities including the commissioner. There was no response, Then this person met an AMC, who just sent an order allowing her to become a professor of our institute, take salary from us, and work in her hospital, not ours. We protested strongly, but they all ignored us. She was given this post, because the order came from a higher officer, an AMC, higher than our new Dean. The interest of a healthcare giant and its poor patients was put aside for an individual, whose only virtue was being well-connected. It was not just injustice of the highest order, it was corruption of the system and dictatorship of a sort in a country with the greatest democracy in the world. We hear that our erstwhile Dean, now merrily appointed to a higher position owing to her own connections, had actually arranged all this. She as a Dean was expected to safeguard the interest of the institute, She not only failed to perform this duty, but actually caused irreparable damage to the institute. When this happened and we were feeling lost, with no solution in sight, one of our Associate Professors said, "May be she will just die". I was somewhat taken aback, but it seemed it would be the only solution if God also wished it. God did not. She lives; shamelessly. In the corrupt world of the corporation, the medical colleges and hospitals were spared somewhat so far. Not any more. If God is watching all this, I hope He corrects the wrongs, because I know there is no one in corporation who has integrity enough to set wrongs right.

Medical Dementors

Careless dementors: It takes a great deal of effort to mentor someone, Unfortunately in the current residency system, the mentee does not remain with the mentor until the process is complete. The residents are rotated from one unit to another, with the objective of exposing them to different consultants. They are expected to pick up the best from each of consultants. Unfortunately, bad habits are picked up far more readily than the good ones. When I spend six months (the duration of one post) training a batch of residents, I expect them to remember what I teach them, and practice that at least until they find something better. Unfortunately, if they go to some other consultants in the next couple of posts, and then return to me, I sometimes find them adopting some clinical practices that are not found anywhere in the medical books and journals, that do not stand to logical scrutiny that should be a part of every clinician’s practice. There is no explanation of this phenomenon other than that they unlearnt whatever I taught them, and learnt something different while they were away from me. It is unlikely, but not impossible, that the consultants they worked with forced them into doing this. I feel it is unlikely because someone so senior would not openly advise something against standard teachings. I feel it is not impossible, because there are some people who believe that what they feel about any clinical situation at a given moment is the final truth, and then things like evidence-based practice become superfluous, But I feel that a more likely explanation is that such consultants often indulge in practices that deviate from standard practices without realizing the implications. When the residents see such things happen, or are themselves a part of those happenings, they come to believe after some time that those are the norms or standard practices. The seniors who indulge in deviations from standard management guidelines sometimes cause harm to their patients, but many patients get well and never realize that not-so-correct treatment was given to them. But a greater damage is done by these senior clinicians to the residents, who pick up wrong practices, and even teach those to their juniors. Some of the residents are intelligent, and understand the errors of their ways when they read books and journals. But many others do not apply their minds to this and continue with such practices. These seniors who undo the work of good teachers and mentors are, in my opinion, dementors. The dementors are either the victims of senior dementors, or have become so all by themselves. The sad thing is that it is beyond anyone's control to correct either the victims or the dementors. The good thing is that God watches over the patients and generally nothing much goes wrong. But when things go wrong, there is grief for those affected, and even if they go to court and get justice, the damage done cannot be reversed.

Surgeons Out of This World

I have come across a large number of surgeons. Many of them follow a standard technique of surgery. Maybe one person will hold an instrument with a ten degrees more or less tilt than others. But other than minor variations, there is overall uniformity. But I have come across some rather peculiar ones too, and today I am going to write about two of them. One was an honorary professor when I was an undergraduate student and then a resident. He had a very busy private practice, and used to be quite pressed for time. If he had a patient in his private practice could not afford his charges, he would send her to our hospital, and operate on her for free. But that could took valuable time, which he did not afford. So he adopted a technique which was unique. Hysterectomy or surgical removal of the uterus usually involved application of a clamp to six pedicles, one at a time. The clamped structures are cut and a ligature is placed in place of the clamp. The ligature prevents bleeding from the structures cut. The process is then repeated for the next pedicle. Our erstwhile professor would use six clamps. He would clamp and cut each of the six pedicles one after another, without replacing any clamp with a ligature, Then he would leave the patient with six clamps poking out of her open abdomen, instructing his assistant to put a ligature in place of each damp, and then close the abdomen. It worked for him. But had any of the ligatures become loose and the patient bled, he would have got into serious trouble. Luckily for him and the patients, nothing of this sort happened. It is definitely wrong to do so. But in those days, doctors were like Gods, allowed to do whatever they pleased. The other one I want to write about is a modern professor working in my department at present. She is a full-time worker with plenty of time on her hands between9.00 a.m, and 4.00 p.m. to do things. She does not have to rush anywhere. She does not put six clamps at a time like our erstwhile honorary professor. She probably cannot, because it would require skill far beyond her. She places one clamp, cuts the pedicle, and then asks her assistant to place a ligature to replace the clamp while she stands there and observes. Then she places the clamp on the next pedicle and so on. It is not known why she does this. One theory is that if the patient bleeds due to a loose ligature, she can put blame on the assistant who tied the ligature. How it will work in a court is difficult to say. Another theory is that her tummy comes in the way and she cannot bend forward to tie the ligature. The third theory is that she thinks it is below her dignity to suture something she has cut. It is like the old-time bosses doing a case and going away, asking the assistant to close the abdomen, or the autopsy surgeon asking the autopsy room servant to stitch up the open abdomen of a dead body after he finishes the autopsy. Hopefully I will ask her one day why she does this. If I learn the reason, I will definitely let you know.

Life Comes a Full Circle

Life Often comes full circle. You just have to wait for it, and remember the past to realize what has happened, You will remember my post about how a professor and head of another department had sent me a malicious e-mail in the disguise of a mail from a dissatisfied resident doctor. I had electronic proof to show that the mail had never been to the Yahoo server that it was made to look like. I also knew the origin of the e-mail. However I had let go and gone ahead with life. It was meaningless to keep holding onto some hurt, when the person who handed out that hurt was enjoying his own life. But something interesting happened yesterday. The resident in whose name the e-mail had been sent came back to work in my department for three months after being away for 3 months. I knew he had not sent the mail, because I knew who had. Now it confirmed what I knew. No one would come back to work under a person whom he has sent a malicious e-mail in his own name. But I was curious. When he came along with his immediate boss to meet me, I welcomed him back to the department. Then I asked him to stay for a while; for a brief discussion. He agreed he had the e-mail ID as in the mail. He said he had not sent any such mail. He also read the mail in my in-box, and said it was rubbish. The horrible language, the atrocious grammar, and the malicious content were indeed quite rubbish. He was aghast when he read the line about the sender threatening to trouble my son in college, away from home, But he could not understand how it was done. I suggested he checked his sent mail box. He opened it and showed me. He had not sent any mail to anyone for three months that he was away, because he had gone home for his wife's delivery, and had no internet facility there. I convinced him to change his password, because theoretically it was possible that someone had hacked into his mail account. I knew it would not be the case, since resident doctors in my hospital were not so tech-savvy, Even my son cannot, though he is a geek or nerd or whatever they call computer experts. Then he said something brilliant. He said perhaps it was a mistake of the person who did the sorting on our mail server. I agreed, but I knew his choice of verbs was wrong. It was not a a "mistake", it was a "misdeed". He said he was sorry so much trouble he had caused. I told him he had no part to play in it. Someone believed he would never come back and used his name. That was a very cowardly and mean trick, setting him up as the scapegoat. Luckily for him, I had enough technical knowledge to understand the whole issue and absolve him. I hope the evil one reads all this, and makes an effort to improve.

Destructive Politics

As head of an institution, the well-being of the institution should be the top priority of the Dean. Just because one has the power to do what one wants, and make others do what one wants them to do, one must not be vindictive, taking pleasure in giving irrational orders. I initially thought that the Dean was troubling me because I had expressed inability to take her daughter's private tuition. I had two reasons for doing so: the most important one was that it was prohibited by University and our service rules, The other was that it put tremendous pressure on me, and I could not stand the stress. I gave her the second reason, saying my health did not permit me to take tuitions. She had not become Dean at that time. But after she did, she mentioned this, just to remind me of what I had said, and that she remembered it too. I must say the time of reign of the Head of department before me had been good for those who loved to have parties and picnics, and taking coffee-breaks every now and then. It had been good for those who licked ass, since the rules would change to suit their needs and situations. I even have a document stating that the decision in any situation would be that of the Head, not a natural (democratic) privilege of anybody, as based on any existing rules. But the new Dean even topped this. She did this in all departments, but I came to know about it much later. She decided what work should be assigned to whom, in each department. she stripped Heads of decision-making rights. She gave prestigious projects to people she liked. She divided departmental staff so that the Head would not become too powerful. She destroyed interpersonal relationships of staff members, so that the in-fighting between staff members would keep them busy and prevent them challenging her authority in any way. This sort of thing is OK in politics, but not in an academic healthcare-institute. In case of my department, she did something even worse. She called the ex-Head for the meeting in which she decided who did what. She kept all of us waiting, while she conferred with the ex-Head. Then she did the distribution, in the style of a king/queen giving territories to his/her favorite court members. She did this without consulting me, the real Head of my department. I had not read Covey at that time, so it hurt. Now I know one can get hurt by someone only if one gives the power to hurt to that someone. Now I don’t hurt anymore. But the fact remains that the two years that I had to spend undoing the damage those two women jointly did to my department, thinking they were damaging me! The loss was not mine, but of the institute I served, because two years of time and effort of the leader of the team were lost. If the Head of institute did not care, why should I? Anyway I did care, and continued to make efforts, because I am a doer, not one to give up. In my next post, I shall write about the final blow that the Dean dealt my department before retiring from the institute.

Babu at large

There are very few truly saintly people around. The general rule is power corrupts, unless an originally corrupt person manages to become powerful. Either way, the end result is the same. No matter how brilliant one is, and how difficult it is to pass the Administrative Service exam, if the Babu so generated uses his intelligence and expertise to manipulate people and situations for personal gains, the situation is of total loss for the society and the country. There was such a Babu, an AMC, who was in charge of the appointments of lecturers in medical colleges. He had a niece who was desirous of becoming a lecturer in Ob-Gyn in the most central institute (my institute), but was not adequately meritorious to reach the top spot. The top spot was occupied by me, thanks to a life time of studying. So he decided to post the toppers to the most peripheral places, so as to improve those places. As if a new lecturer could improve anything. He should have sent veterans there. But even then, she would not reach the center, since her rank was in-between the top and the bottom, so his next trick was to place the topper (No. 1) to the most peripheral place, No. 2 to less peripheral place, No. 3 at less central place, and No 4 (which was his niece) at the central place. Then he started another cycle of No. 5 to No. 8. The flaw in this policy was obvious. No. 1 and 2 should have been placed in the most peripheral places, if the peripheral places needed them for improvement. Sending No. 5 there instead of No. 2 was defeating that purpose. There was another major flaw in the policy. This policy was not applied to all subjects uniformly, but only after a cut-off, the cut-off happened to be between the morning and afternoon of the same fateful day. Orthopedics interviews were conducted in the morning, and Ob-Gyn in the afternoon, There was no need to apply old rule to half the specialties and the new rule to the other half, since the appointments were made in all the specialties after all the interviews were over. The real explanation was that it was not convenient to apply the rule to Orthopedics, there being influential candidates near the top of that merit list. The Babu got away with it, because non-influential people cannot fight the system and win. People without money do not go to court against the system, because the have to spend their own money (if they have any) on court cases, while the Babus use the resources of the system, which uses public money (paid as taxes by poor people). The same Babu was involved in a scam of selling land of a port. He got away honorably, probably by using standard means, like money or influence. His niece took advantage of the system like taking maternity leave, full vacation for undergoing appendectomy (which she never underwent) and then left. Those doctors like me who truly wanted to work had to struggle to get back into the central institute. But that we will keep for another post.

Questionnaire

I should have read Stephen Covey much before I actually did, Actually, I would have benefited tremendously if I had the book in my formative years, But probably Covey himself was in his formative years at that time. Anyway I read his book much after I went through the hurt I felt I did not deserve, and being people-centered then, it hurt quite a lot. It all began after I became Head of my department. I had been a resident doctor in the same institute20 years ago, but somehow it did not feel such a long time ago. I still felt the pains I had experienced as a resident, and wanted to set things right for those doing residency now, and for those who would do it in future. I held a few meetings with the resident doctors, trying to find out their current problems, and how they expected to get them solved. The meetings yielded nothing. They would just stare somewhere waiting for the meeting to get over, so that they could go away to do whatever they had to. I decided not to waste everybody's time, and asked them to elect one representative for each unit, I would meet the six representatives every fourth Thursday. Now six residents started staring somewhere, waiting for the meetings to get over. Nothing was gained, Then I declared that only those representatives who had any problems or anything to discuss should attend the meetings. I was astonished to find that I was the only person attending the meeting. I knew very well that things were not so well that they did not have any problems. I don't know why they refused to communicate with me, though I had been Adult-Adult in my approach,. Perhaps they were conditioned to expect a Parent-Child relationship with their bosses, and could not accept anything different. I put up the suggestion box, and it failed miserably, I have written about it in another post. Then I had this brainwave, and I got an Associate professor to help me build a questionnaire in which we included a lot of questions about their living and working conditions. I put up questions like whether they got time for breakfast, lunch, and dinner everyday. I tried to find out if they got reasonable duration of sleep every night. I asked if they had time to read. My colleague put questions to find out if they were stressed, depressed, and if they ever had to take recourse to psychoactive medication. We thought we had prepared a comprehensive questionnaire. We distributed copies to the residents. In my democratic method of management, I used to call all staff members, and discuss issues at hand, So I told them about this idea. I know four of the staff members disliked me, not because of my looks or such things, but probably because of my type A personality, perfectionist approach, and being a stickler for rules and discipline. So one of them, a Professor, said they were not consulted, and the content of the questionnaire wasn't approved by them. I said I needed that information for improving the working and living conditions of the residents, and I did not consult them, since there was no policy decision to be made, Then the professor said that Ethics committee's permission was required for this study. I said that it wasn't a study on human subjects, but just a questionnaire for finding out what they needed. Another professor, quite friendly with this first professor, and equally unfriendly with me, supported the first one. Finally I got exasperated and told them that I had done this in my capacity of Head of the department and was not asking their opinion, but just giving them information. They did not like it, It came out later that two resident doctors who went around speaking against the questionnaire were inspired to do so by their heads of units, which were none other than these two professors. They said we had asked unethical information like use of or need for psychoactive drugs, and the question “At what time do you get to go to sleep” was not proper, that it was sexually oriented. If I were not directly involved, I would have laughed. I couldn't. The two professors could be seen standing outside the canteen, counseling the two residents. The second professor got his resident to write to the municipal commissioner on the stationery of the Association of Resident Doctors, of which the said resident was local secretary. My colleague who had helped me develop the questionnaire was quite upset, when she saw a copy of that letter. I finally got my own unit resident to collect signatures of all residents who were supporting me. All except these two residents, and one who was on long leave signed. Some even said that I was the only person who had shown desire to improve their lot. My senior resident, wise for his years, said something I cannot forget. He said “Self-proclaimed leaders believe the world is following them. But when they turn back to see, they find there is no one following them, This leader falls in that category", The storm settled down. What I find difficult to accept even after having read Covey is that the world has a lot of people who cannot accept any activity, however good it might be, only because it is undertaken by someone they cannot stand. They fight it, even if it means a great loss to a number of people in need. That also reminds me of the person who was Head of Department before me. This person had grown to dislike me so much that wherever I made any good suggestion, this person would criticize it even before thinking about it. Well, you have to live with people of all sorts, including such people, and make progress despite them.

Suggestion Box

When I became the Head of my department, I was enthusiastic, and quite keen to bring about changes for better. I was full of ideas. At the same time, I was keen to pick up ideas from others if worthwhile. I soon realized that very few staff members wanted any change, leave alone wanting to contribute any ideas for a change.I strongly urged the resident doctors to make any suggestions on the department’s management they felt like. No resident doctor came forward to ask for any change that would improve things for themselves, leave alone the institute. I thought they were not feeling ready to meet me in person, so I went to the market, purchased a letter box, and got the hospital carpenters to fix it outside my office, Then I printed “Suggestion Box" in New Times Roman" font size 72, and pasted it on the front of the letter box. Initially I opened it everyday. When there was nothing found in it over 2 weeks, I reduced the frequency to twice a week, and later once a week. Finally it dwindled to once a month. Nothing was dropped in for one whole year, then an outgoing resident asked me if I had read his suggestion. I had not, because it was not one month since I had opened the box last. I opened it, discussed the issues with him, and he left the institute. Then another year went by, without any more suggestions. Finally one day I found an empty cover of a sachet of tobacco in it. It could not have been a staff member or a resident doctor, because none of them chewed tobacco. Some patient's male relative must have thought my suggestion box was the dustbin. I appreciated his desire of not throwing his litter on the floor. I removed the box without help from the carpenter, never to put it up again.

Height of meanness

If there is an adult-adult relationship between the Dean and staff members, there is not much possibility of strained situations and unhappiness, But most of the Deans assume a superior approach, and the relationship becomes parent-child. (This refers to transactional analysis) If the Dean will be a good parent, I would not mind it at all. But if the Dean behaves like a step parent, I mind it very much, This Dean was a step parent, and quite a mean one, There are many stories of her meanness. I will tell you a short one. It was the day of floods in the city, 26th July 2005. She had called a meeting of some staff members at 3.00 p.m., but true to her style and efficiency, she started the meeting at 4.00 P.M. The city was already flooded, but most of us did not know the true enormity of the calamity. Many had left for the day. Those in the meeting kept waiting for her to end the meeting, so that they could go home. She just wouldn't. She knew the nature of the situation outside, because as Dean of our hospital, she had constant contact with the control room, being responsible for managing health aspects of disaster in the drainage area of the hospital, The audience knew she knew, because she kept calling her husband on his mobile, urging him to reach home at the earliest, advising him of the situation, and guiding him of safer route home, Those in the audience (members in the meeting) had family members to worry about, and had to go. This mean step parent kept them there till 6.00 P.M. and then said, “Ok, Go!'' There was no way they could have gone home, Roads were closed by floods. Trains had stopped. People were being washed away and dying, she conveniently forgot to mention this. She did not say, “Don’t go out, stay in the hospital”. One of my female colleague, an Associate professor, oblivious of the havoc outside, decided to go home, Her son was hopefully home, probably alone. On her way, she met the Dean, who was going to the canteen with the usual crowd of ass-lickers. The Dean asked her, “What are you doing?” “I am going home”, she said. “Where is your home?" the Dean asked. ''Malad'; she said (which is about half an hour’s drive when the roads are clear). "OK!'' grinned the Dean all over her face. "If you reach home, tell me also the route you find easy'! thy colleague left in her car, which she had to abandon on the highway, submerged 2/3 in water. Then she had to walk a few kilometers in chin-deep water, on dark roads, afraid of many things a lone woman can be afraid of at night on a dark road. She managed to reach a friend's home past midnight. Her son was OK at home, she learnt using someone's phone which wasn't dead, quite miraculously. She told us this story when roads opened and we met at the hospital two days later. The emotions on her face made us feel what she must have felt going through all this. The mean woman in the Dean's chair continued to sit on her throne like a queen, unharmed, unaffected, remorseless. God must have been watching, and if He did not choose to punish that woman, He must have a strong reason to do so, just as He must have had strong reasons to make her Dean of our hospital, instead of someone worthy of the post, someone who would do something good for the institute, instead of mentally torturing people under one's power, and sending some of them out to suffer, perhaps die, without any qualms.

Tremor syndrome

I had a resident working with me a couple of years ago. She was good natured, intelligent, and hard-working, I had never had occasion to scold her for any reason. But she had a funny habit. Her hands would tremble rhythmically while operating if she sensed my presence nearby, and the tremors would go away as soon as I went away. No degree of sweet talk or reassurance would cure her, I don't know where she practices now, I would like to visit her once and see if I still have the same effect on her. Recently I found the same phenomenon in two of my residents, both girls-One of them is already qualified, and the other will qualify in six months. I called the qualified one after the operation was over and asked her if she had essential tremors. She said she did not. Then I asked her if she had tremors only if I was observing. She smiled and said it was so, Then I asked the other one, and she said the same thing. This was not a good sign. I seemed to be a monster, which I knew I wasn't. A week later, I found the second one was having similar tremors again. She knew I was in the OT, but not hear her. she was being assisted by my Associate professor, who was much more critical and outspoken than me, perhaps I was not the factor causative. To confirm this, [declared loudly that I was going away, Then I quietly instructed a houseman to inform me if her tremors disappeared after I went away-Ten minutes later he came out and told me the tremors had persisted. So either she had essential tremors, or any boss gave her tremors, not me alone. Now I need to observe her in action when both me and my Associate Professor are away, If she has tremors, those are essential tremors. If she doesn’t, she needs behavioral therapy, not us.

Me and my strictness

Many people have told me that I have a reputation of being very strict. Well, I admit I am as strict with myself as I am with anyone else who works as my junior. I have not been unreasonable at any time, nor have I insisted I am right when I have been proved wrong. Strictness is for maintaining discipline where it is necessary, as in patient care, If the rules are laid down and clear to everyone, there is no confusion about what is to be done at any time in any situation. That gives stability to the environment. If there is need to do otherwise, and the need is genuine, I would not insist it be done as I say. If need be, I would do it myself, rather than permit some people I like to do as they please, and make some others I do not like to do the dirty work. That generates corruption of sorts. That divides people into favored and un-favored, into happy and dissatisfied. I am strict, but that is no reason for anyone to be afraid of me, because it is not my nature to be whimsical and trouble anyone only because I want to. If one does one's own job, I would be the first person to praise him, and the last person to think ill of him, I am writing this because it never occurred to me that my principle-centered life would be the subject of intense dislike by someone. Someone sent hate-mail to the institute's contact address, referring to me as the ''so-called honorable Dr. Parulekar, and wrote a few things that had happened in the department as a result of policy developed by all staff members, and not by me as the Head. I am upset because that someone cannot understand that we are different from many other places where persons in position of power do what they please, whether it is in the rule book or not. I am more upset because I traced the origin of the mail electronically and found that it was actually sent by a Professor and Head of another department. I had thought that Person was ok, but now I know different. I replied to the hate mail as follows. "I am aware of your real identity, and the exact location of the server from where you this mail. I want you to note that in my department all activity is as per policy laid down by all staff members, and not as I please. I don't hold any grudge against you for writing what you have written about me, I can see you need help, and suggest you read the following book, which I recommend to people like you who need help. ‘Seven Habits of Highly Effective People, by Stephen Covey’. You will be a better person if you read this book and understand it.”

Electronic snooping

I do not have anything to hide from the world, at least nothing that is worth hiding. But I do not like when people open my letters to read them. Nor do I like email service providers reading my mail. I prefer to keep my non secrets secret. So when one day I sent myself a text page with encryption, MSN Hotmail guys launched my mail login page again instead of sending the mail. I had to login again before I could send the mail. This was repeated on two more days. Since they give free email service, I could not complain. But I decided to fool them. I wrote the following subjects on 4 of my successive mails to my different email account. MSN wonderful MSN hotwheels Bright MSN guys MSN bright All of these 4 mails were sent first shot by Hotmail guys. Then I sent one with the subject "MSN Virus". Immediately they launched a page asking me to enter assorted letters and numbers they had printed there into a text box for confirmation that it was not a spammer trying to send mail in my name (or so they claimed). I entered those, and then they sent my mail.The email server at my son's college returns emails as policy violation if the subject contains one of the words that they have put in the list of objectionable words, e.g. download, virus, love, update, news etc.Henceforth I will send my emails with a wonderful but benign subject, and attache the message as a coded text file.

Reservations

I was on a bus, on my way home after a 12 hour day at work. It had been exceptionally heavy, with a lot of operations. I had found a seat which was meant for senior citizens, meaning those 65 years or older. There was no eligible commuter of that age, and I occupied the seat. I myself am above 50, and look my age. With the amount of work I had done, I must have looked half dead. I was half dozing, when an elderly gentleman tapped my shoulder, pointed to the board of reservation and asked for the seat. I relinquished without a word, because he looked old, though a picture of health. He checked thrice how I was doing standing up, but I said nothing. I stood rest of the way, wishing there would be a seat. There was none. There were 6 seats reserved for women, all occupied by young, healthy women. All looked perfectly fit, and enjoying the ride too. I had sold off my car and wouldn't take a cab because I believed in public transport and did not want to contribute to waste of fuel by using a car for one person, myself. So I deserved what I got. I cannot blame those who enjoy what is reserved for them by the law of the country, because wise men must have made those laws. I do not blame them for being unable to think of needs of others, because they probably have not been taught how to. I hope I don't reach that age myself so that I might benefit from the reservation myself. I would hate to ask a younger man to get up, and would not be able to stand myself.

Unintentional Mentors

Unintentional Mentors Medicine has a long tradition of mentorship. Mentor-mentee relationships have been known to enrich the lives of both mentors and mentees, further maturing the mentors at one end and developing the mentees at the other. However this is not so common today as one would have wished. It takes a strong desire on the part of the mentor because it the hard work and not an obligatory part of one's duties. It needs a matching of the wavelengths of the mentor and mentee, which does not happen with every batch of students. It also needs a strong wish on the part of the mentee to be molded into perfection by the mentor. Not all persons can accept such a control from anyone. The mentor has to be willing to let go when his job is done. Perhaps it is a good thing that there are teachers and students rather than mentors and mentees. That at least ensures that the training of the students is more or less standard. One can just imagine the lot of a mentee if the mentor passes on a lot of his undesirable traits to the mentee, however unintentionally. Mentor-mentee relationship is a conscious relationship. Both are aware of the interactions. Both are willing to be involved. Both enjoy it. Who benefits more is a debatable question. The mentee becomes a fully qualified professional at the end of it, and owes a lot of it to the mentor. The mentor gets the satisfaction of not only having done something good but also of having created something worthwhile. The feeling is somewhat akin to having a baby . But a majority of the students learn partly from their teachers and partly by themselves. learning by oneself involves a lot of reading and some observation of others at work. This is where the unintentional mentors come in. The concept of unintentional mentors is opposite of conventional mentors. These persons are in the position of teachers. They often hold responsible positions. They usually a lack the devotion and energy required to be good mentors. They almost never try to be mentors. They possess some, sometimes quite a lot of behavioral traits which a would be mentee would do well not to pick up. These persons occupy important positions so that their actions affect a lot of people often adversely. A large majority of the affected people express dissatisfaction, frustration, and sometimes anger in response to the actions of such persons in power. There is a small group of affected people that actually derives benefit from such actions. It is true that the too suffer like the others. But they notice the wrongful actions, remember these actions in a positive way, and meticulously avoid repeating them when they themselves occupy positions of power. They are the mentees of those unintentional mentors. A conventional mentor teaches the mentee to do the right thing and avoid doing the wrong thing. An unintentional mentor does the wrong thing which an observant mentee notices and trains himself not to do it. It takes no effort on the part of the unintentional mentor in this relationship. In fact, he is unaware of the relationship. The mentee needs to be sensitive and a wise enough to find of what was done that should not have been done. He needs to be able to get above the emotions that arise from the unintentional mentor's action so that he can mold himself not to behave in a similar manner when in a position to do so. He needs to be conscientious enough to stop himself from erring when the time comes. Perhaps it would be to much to ask there be no people who are unintentional mentors, but it is quite reasonable to pray one can rise if the label of an able mentor. It is perhaps wishful thinking that one will find a mentor of one's dreams, but it is possible to develop oneself by watching unintentional mentors, and about all it is quite possible to see that one does not become an unintentional mentor oneself.

Making of a Medical Teacher

Making Of A Medical Teacher Why does one become a teacher? I know some who became teachers because they loved it. I also know some who did so because it was a job, just like any other job, a means to making a living. After all, there is no rule that one has to find a vocation of one’s liking. How does one become a teacher? No matter what the driving force behind, certain qualifications must be obtained and a certain procedure must be followed for becoming a teacher. To become a school teacher, one has to get a bachelor’s degree in a Science or Arts subject, followed by at least a B.Ed. or D.Ed. To become a college teacher, one has to get a master’s degree in a Science, Arts or Commerce subject, followed by M.Phil. and Ph.D. If the education department is so particular about the training and qualifications of teachers who teach in schools and Science, Arts or Commerce colleges, one would expect much more stringent criteria for becoming a medical teacher. However, in contrast to school and college teachers, doctors become medical teachers as a beneficial side effect of getting a clinician’s job in a medical college hospital. Perhaps that is so because with an educational methodology degree as a prerequisite, very few doctors would have opted for becoming teachers, and the medical colleges would have a hard time finding faculty. I remember how I was initiated to teaching. I had just finished two house-posts in Obstetrics and Gynecology and become a Registrar. One fine morning my Boss said, “Shashank, I have to go for an urgent cesarean section in my private nursing home. Take my lecture for the undergraduates at 12.00 non. The topic is normal labor. You should not have any problem teaching that. I had no option. There was no time to plan and prepare the content, no time to prepare teaching aids like overhead transparencies or slides, and no time even to think much about it. This was somewhat akin to pushing someone into deep water as the first lesson in swimming. Luckily for me I turned out be a natural (perhaps not a terrific one, but definitely a natural). The students apparently liked my teaching, and the news reached my Boss. I was entrusted with the responsibility of taking all the remaining lectures of my Boss. I did that and loved it too. I must thank my Boss for making me a teacher. But is this scientific? We know that a person who has passed the M.B.B.S. examination has at least 50% marks in each subject. Then he becomes a resident doctor, and in his third year of residency, without a postgraduate qualification and without any training in teaching methodology, he becomes a medical teacher. If you don’t believe this, check out the post-holding certificate of any resident. It states that the third year posts are teaching posts. After obtaining a postgraduate degree, if one is lucky and desirous, one lands a Lecturer’s job. The prerequisites for the job are a postgraduate degree and certain teaching experience as a resident, but no degree or diploma in teaching methodology. This should appear to be highly irregular to anyone, especially to the education department, the medical council and the university. The job entails training future doctors who are going to give health care to people. If any deficiencies are left in their education, the consequences could be catastrophic. Apparently no one seems to mind, or if they do, they are turning a blind eye to it. After all, things have been done this way for ever, and if the system seems to be working, why change it? Perhaps it was noticed by the medical council. As an afterthought, it was suggested that the medical teachers attend a workshop conducted by ’medical education technology cell’ of the institute, if it has one. If not, they may attend it wherever possible. This is not obligatory. The courses are rather brief, lasting for a week or less. There is a hefty course fee to be paid, a few sessions to be attended, pre- and post-tests (which are not for evaluation of the candidates’ performance anyway), and a valedictory function at which participation certificates are handed out. In less than one week’s part-time training, one becomes a trained medical teacher. Some of the participants keep running away to see a patient or do a case. Still they get the certificate. A colleague of mine once attended a two-day workshop in which I was faculty. She attended on the first day, did not attend on the second day (saying it was all very s****d), but did get the certificate. She could become faculty for future courses of this nature. The point is that the methods used for training doctors to be teachers for undergraduate and postgraduate medical students leave much to be desired. The teachers are responsible not only for training the students, but also for their evaluation. Senior members of the teaching staff participate in development of curricula. One wonders how effective they will be in carrying out these duties without adequate scientific training.