Attitudes

This is about attitudes. Some of the departments in my institute have a high incidence of stress. In my department the work stress is very high. In addition there are attitude problems of senior residents that I wrote about before, and that causes a lot of psychiatric disturbances in somewhat weak-minded persons. We are working on it with the help of the psychiatry department, and soon should have good results. There is another department, where the problem is said to lie with the staff members. The head of the department has a high regard for himself and his staff members, who are said to have a style statement of their own. They get resident doctors for superspecialization coming from different parts of the country. They are all intelligent doctors who have excelled in their fields of the medicine, got good marks in the common entrance test for this superspecialization, and got these coveted jobs. Some of them come from towns and villages and lack the stylish English pronunciation and the stylish clothes of the city doctors. Instead of appreciating their talent as doctors and ignoring their lack of style, this head of the department is said to look down upon them and to ridicule them at times. Some of them end up with psychological disturbances like anxiety, depression and sometimes suicidal tendencies. There was one such a resident who needed treatment for suicidal tendencies. The psychiatrist treating this resident doctor managed to get him OK. She also advised the head of that department to change his behavior with the residents so that they would not develop psychological disturbances. This head of the department went back to his department and told the staff members not to speak badly to this resident doctor or he would attempt suicide, and the blame would be put on him and his staff members. The unfortunate part of this was that he made the statement quite loudly in front of the concerned resident doctor and a lot of other people. The resident doctor was greatly humiliated instead of feeling reassured. His condition was aggravated and he needed further therapy. The treating psychiatrist was also disturbed by all this. When we discussed this issue, we concluded that the said head of the department had a problem of a wrong attitude and it was beyond repair.

Residents’ Orations

Orations are in general delivered by senior persons who have presumably done a lot of work in a specialized field. Unfortunately a number of orations arranged these days are not following this principle. They are often based ‘you-scratch-my-back-I will-scratch-yours’ principle. Or they are for paying back some obligation or to get something in return. I have disapproved of this for a long time, and always will. Perhaps this dislike was at the back of my mind when I decided to award one oration each to two of my residents. One of them I caught giving a test dose of an intramuscular iron preparation by the intradermal technique. The preparation stains the skin very badly. So a special technique has to be used while giving it deep intramuscularly, so that it does not track out and stain the skin. And here was my resident giving it directly into the skin! The other resident was found trying to make a skin incision with a stab knife using the cutting technique. The stab knife is to be stabbed in, and other knives are to be used to cut in the conventional manner. This resident was trying to make a series of linear cuts at the same site and not making a good job of it for obvious reasons. It was not as if they had not been taught what was required to be done. The injection technique was taught in the second year of their undergraduate training, and she was already into the second half of her first year of residency. The other one was doing ht second half of her second year of residency, and had observed a number of laparoscopies and done a few herself, and it was a laparoscopy in which she was cutting with a stab knife. She had made the incision at a dangerously low level too. So I decided to make them to extensive reading on these two topics, and give a talk on the respective topics for 15 minutes each. The talks would be attended by all residents in my unit and faculty. I decided to call these talks residents’ orations on the spur of the moment, probably to ridicule the current concept of orations, and also to make them feel a bit ashamed that they did not know what they should have known. They did read and did deliver the ‘orations’. SO they at least made an effort to read. They answered a lot of questions incorrectly. But we provided them with the correct answers. One resident came late, though all work had been finished. I awarded her one oration as a disciplinary action. I thing the residents got quite a bit of academic training and some in time management and discipline too. I hope there will be many more orations, and they achieve the purpose behind them.

Mindlessness

I had thought that just one example of the mindless behavior of some of the current resident doctors would be enough. But I am tempted to give another example of the same resident doctor that I described in the previous post. There was a patient who had undergone a sterilization operation after her delivery. She had been given a spinal anesthesia for the same. Some of the patients given spinal anesthesia develop a headache because of leak of cerebrospinal fluid through the puncture made in the covering of the spinal cord. This patient had a similar headache for which she was given medication by this resident doctor. The next day morning our resident proudly told that she had given tablet Lynoral to that woman because she had a spinal headache. I was aghast because Lynoral contains a synthetic estrogen that among other things suppresses lactation, and has nothing to do with their treatment of a post-spinal headache. I checked what medicine the patient had purchased, and found that it was indeed Lynoral, and she had already taken two doses of the same. I asked the resident doctor why she had given Lynoral to that the patient, since it would not cure her headache, and would suppress her lactation. She thought intensely and said that she had actually wanted to give Lanol-ER. Lanol-ER was paracetamol, which could be used for treating a headache. We stopped the medication and prescribed paracetamol. Luckily her lactation had not been suppressed by the two doses of estrogen she had already taken. One of my colleagues was this resident doctor’s examiner, and passed her in her MS examination. I pity that resident's current and future patients. P.S. : I find that this post is read quite a lot. You may like to read about this same resident at the following link HERE. You may click on it or copy and paste the following link into the address bar of your browser and press the 'Enter' key. http://shashankparulekar.blogspot.com/2009/11/selection-charade.html

Selection Charade

It is very sad that the current method of selection of resident doctors for post graduation is far from perfect. There is a common entrance test based on multiple choice questions. It does not assess how good a doctor the concerned person is. Based on the result of this test the doctors are admitted for post graduate courses. Their aptitude for the concerned subjects is not checked at all. I would like to give just one example of this deficiency. I had a resident doctor whose rank on the merit list of the entrance test was 28. This was quite good. Unfortunately this doctor was pretty dumb. There are many examples of her dumbness. I’ll tell you just one to give you an idea how dumb she was. I was assisting her to perform an abdominal hysterectomy, meaning surgical removal of the uterus by the abdominal approach. There were many large blood vessels feeding the large uterus. One of the vessels started bleeding furiously such that my surgical gown and the clothes underneath got soaked. I asked her to keep pressure on the bleeding blood vessel with a surgical mop while I went to change my gown and clothes. The pressure would stop the bleeding temporarily. I came back in less than three minutes. To my great horror I found that she was standing with a foolish grin on her face visible even through the surgical mask, pressing the mop on the top of the uterus (as during a caesarean section if one has to wait for something), far from the leading blood vessel. The vessel was spurting blood as furiously as before. There was another equally foolish resident doctor as the second assistant, also there owing to her high rank on the selection list. She was holding that tip of a suction cannula just above the spurting blood vessel so that all blood would get removed to a bottle kept at a distance keeping the surroundings clean. The bottle was a quarter full with precious blood that would not have been lost if they had compressed the bleeding vessel with a mop as I had asked them to do. I was aghast. I then took over the surgery and stopped the bleeding. Then I asked them the reason for such behavior. They had no explanation. The point is not to show how foolish and sometimes dangerous to the patients they were. The point is that there is a need for a better method for selecting candidates for postgraduate training.

Integrity? What is that?

One of our previous Deans was quite afraid of pressure from higher authorities and also from politicians. Actually the Dean’s post is a quite senior post and the Dean should be able to maintain his stand with integrity irrespective of wrongful pressures from anyone. However this particular Dean was not so. There was a scheme from the Central Government of paying out money to women belonging to scheduled casts, scheduled tribes, and those below the poverty line. It was necessary for the women to provide proof of belonging to one of the categories. We as the treating obstetricians were supposed to receive the documents and certify the women fit for receiving this money. We were quite particular in our work, as a result of which the number of patients receiving the money was quite low. The administrative office from where the money came told us to distribute money to every woman who delivered with us, so that they could show good performance on their part to the Central Government. But they would not give us written instructions to that effect. They were afraid of giving written instructions. They wanted us to be responsible for any trouble arising out of such action. So we would not do what they wanted us to do. They told our Dean that we would not do what they asked us to do. The Dean asked me why. I told him that if we certified women as eligible for the benefits of the scheme without meeting the eligibility criteria, the money paid would be recovered from us after an audit. We would not do something wrong on our own. Sadly the Dean was unable to stand by us. Instead of supporting us and telling us to maintain our right will stand, he told me that if we did not pay the money as asked by that particular office, we would be held responsible for not carrying out the Government’s scheme and be penalized anyway. We still did not succumb to the pressure and continue to perform as before. Finally the administrative office had to send us a document signed by the additional municipal commissioner telling us that there was no need of documentary support and any woman who seemed to be poor should be given the money. The point is not that we won the battle. The point is that the person who was the chief of our institute should have shown integrity and supported us in our legally correct stand, but could not do so. All employees working under him would have shows integrity following his example, but he failed us all quite miserably.

Spontaneous Cure of Hardware Errors

This is a new concept in computer hardware. I am not a computer engineer. I’m actually a doctor. But I have been using computers for ages and know a bit about hardware and software. I have observed a new phenomenon over the last many years. I call this phenomenon spontaneous cure of hardware problems. A few years ago my computer just stopped working. It had Windows XP installed on it as the operating system which would just not boot. I decided to install windows XP again but it would not work. Finally I changed the hard disk and installed Windows XP on that again. It worked. In the next vacation my son came back from college and wanted his data on the old hard disk. He was not interested in my new hard disk and its installation. So he connected the old hard disk in the computer and the computer just worked fine. The Windows was OK and it continued to work OK for the duration of his vacation. I continued to use it afterwards too. I do not know how the hard disk problem got sorted out by itself after sleeping for almost six months or if it was the Windows installation that corrected. The main thing was that this correction happened in the absence of any electrical current into the disk. At another time I had a RAM that stopped working. It wouldn’t work in spite of being cleaned with a cloth, isopropyl alcohol, and an eraser that school children use. These were the standard methods used by a computer engineer in our institute. I replaced the RAM but did not throw it away. A similar thing happened in my office and I replaced that RAM too. One day I needed RAM for another computer, and not having any spare RAM I used the ones that were not working. I was surprised to find that both of them were fully functional. How they cured themselves is beyond my ability to explain. The latest example is that of a digital pad made in China that I had purchased for 9900 INR. It worked for less than two years. One day of the pencil cells inside the pad leaked and it stopped working too. I cleaned it thoroughly myself after opening it. I replaced the batteries. I replaced the cell in the digital pen. In spite of all these measures it would not work. It could be switched on OK. I could add new pages and remove old pages from it but it would not accept any writing. Finally I packed it up and went on vacation for two weeks. After coming back I opened the pad again to give it one more try and was immensely surprised that it had started working again. I had actually written off the 9900 INR as a loss and was quite happy to see that it was not a loss. Clearly the main point of all this is that one should not throw away hardware that seems to have stopped functioning and cannot be repaired, unless there is a space crunch for storage. There is a new phenomenon that has not been described in the computer industry so far, that seems to correct hardware errors that seem resistant but sometimes cure themselves just on being kept in storage. Perhaps it is reorientation of magnetic elements in the hardware. Perhaps it is drying. Perhaps it is accumulation of some dust that joins tiny circuits that were broken. It sounds silly, I suppose, but the phenomenon exists. If my theories are amateurish and wrong, I hope some knowledgeable person explains the phenomenon scientifically. In the meantime I am keeping all the expensive hardware that seems to be irreparable though looks OK physically.

Ridiculous Decisions: Part Two

Here is another one more example of a ridiculous administrative decision. In the Radiology department of my hospital there was a ten year long problem of technicians not taking radiographs on Sunday as there was a dispute between two different unions. The patients were suffering quite a lot. The resident doctors were made to take the radiographs on Sundays. On one particular Sunday there was an argument between a radiology technicians and a resident doctor and the resident doctor was badly bashed up by the technician. There was a lot of disturbance. A police complaint was lodged. The Dean of the hospital was under tremendous pressure to resolve the issue peacefully. This was where she made a mistake. Instead of solving the problem the right way, she asked the deputy dean to ask senior consultants from clinical departments to be present round the clock on Sunday in the emergency room to see that any radiology technicians did not beat up any resident doctors. In reality this was actually the job to be done by security personnel and police. The Dean’s presumption was that the presence of senior consultants would deter the technicians from being offensive. It was a just a presumption, with no substance in it. She probably had no trust in radiology consultants to control the technicians (which they had anyway failed to do for 10 years). No provision was made for protection of the additional consultants, who were physically much less fit than the technicians who could attack them, and resident doctors who had proved to be unable to defend themselves. This was an absolutely ridiculous decision. The funny part of that was that the Dean would not sign that order. She verbally asked the deputy dean to take out that order. The deputy dean took out the order and sent it to us without his signature. I called him and asked what we were supposed to on that Sunday. He advised me to ask the Dean. I called the Dean, who got very angry and asked me to ask the deputy dean. Finally three of our consultants spent the Sunday in the emergency room doing nothing. Highly trained personnel were asked to do something they had no means of doing, for which they were not compensated in any way, and which gave them an immense degree of dissatisfaction. That Dean was known to avoid responsibility for any decision by asking subordinates to sign the concerned documents. The deputy dean did not want to be the scapegoat, and sent out an order without any signature. It was unfortunate that such things happened in an institute like ours, and such a person headed the institute and made these things happen.

Ridiculous Decisions: Part One

It is surprising that a number of quiet senior and intelligent people under pressure can be quite ridiculous in the orders they issue to their subordinates. A few years ago there was a municipal commission who was as usual an IAS officer. That year once there were very heavy rains and the entire city was flooded. The roads were blocked and no one could go anywhere. The doctors also could not move to the hospital for work and only doctors residing in the hospital were able to carry on the emergency work. They declared a two-day holiday to all municipal employees retrospectively, since they had not been able to go to work anyway. However the minister came under flak for this decision as there was a lot of work of cleaning up the city still not done. As a result he asked the commissioner to take appropriate measures, who passed an order making every municipal employee worked on everyday including Sundays. There was no point in making office workers work on Sundays, as there was no work related to flood relief. There are no patience in some parts of the hospital on Sundays, and none ever in departments like Anatomy and preclinical subjects. The actual work involved the cleaning of the mess on the roads, and treating medical disorders arising out of floods. I had no work as a gynecologist, because that part of the work in the hospital was handled by one consultant every Sunday, and was unchanged by the floods. The correct order should have been making related people work instead of calling everyone on duty, whether there was work to be done or not. There was not a single Dean in the three medical colleges who could tell the commissioner that it was a wrong order. After a few Sunday’s like this the order was canceled. The commissioner probably took it out on the people working under him, when he received flak. There was no maturity in the decision, nor any logic.