Attention Deficit Disorder: 6th Post Syndrome

Residency is of three years for those seeking a postgraduate degree in medicine. It comprises of six posts of six months each. A lot of them take a long time to get adjusted, and hence their abilities as clinicians get restricted in the first six months. But that is because of the pressure of something that they have not experienced before and an inability to cope. It has nothing to do with any deficit in attention. When they start their last post, they develop a syndrome which we call the '6th Post Syndrome'. In this syndrome they are physically present in the hospital, though their minds are elsewhere. There was a time when they used to go on French leave in some units. When we became senior enough to control this, we held a joint meeting and decided that no unit head would permit this. Then they made their juniors function as Registrars just remained present for the rounds, not doing any work actually. That was detrimental to their training. So we stopped that too. Now they work until they can go on leave to prepare for their exams. But their attention is on their dissertations, reading for exams, and perhaps some other things which are not academic. The following example of morning round of the wards should illustrate this point. “Sir, this patient has preeclampsia. Now her blood pressure is under control.” “What are the results of her anticardiolipin antibody and lupus anticoagulant tests?” I asked. “She has given negative consent for undergoing those tests. She cannot afford those tests.” “Why do you not undergo those tests?” I asked the patient. “I don't know which tests” she said. “I have not been told about any tests.” “Sir, her husband was told and she was present there. He said he did not have money at that time” the Registrar said. “But now he may have money. Have you asked again in these many days after her hospitalization?” “Umm... no sir.” she said. I advised the patient to talk to her husband and then tell us if she would get those tests done. “Sir, this patient is seven months pregnant. When she came, she had fever and her Widal test was positive. She received treatment for typhoid, and now her VDRL test is negative.” “VDRL?” I asked. “Umm... sorry sir. Her Widal test is negative.” “OK.” “Sir, this patient has undergone anterior colporrhaphy yesterday morning. Her input was 25000 ml and output was 1650 ml yesterday.” "How did you transfuse her 25000 ml in less than 24 hours?" I was aghast. "Sir?" "25000 ml input is unbelievable" I said. "Umm... no sir. It was 2500 ml." Then I remembered. This same Registrar had once said a patient's input had been two thousand sixteen hundred in 24 hours. “Why is she still on intravenous fluids? Why have you not started oral intake?” I asked. “Her peristalsis are feeble.” “Why did the peristalsis become feeble?” “....” “Sir, this patient underwent a hysterectomy. The one who underwent anterior colporrhaphy is the next one” the Assistant Professor said, to avoid further unnecessary discussion. I examined that patient, gave appropriate instructions, and then moved on to the next patient, who had undergone anterior colporrhaphy. She was also on intravenous fluids. “Why is she still on intravenous fluids? Why have you not started oral intake?” I asked. “Umm... sir, we keep them nil by mouth for 24 hours after major surgery” the Registrar said. I checked her. She had good peristaltic sounds, and that was no surprise because there was no reason for the peristalsis to get affected. I advised to start oral liquids for her. I had taught all of them this point in past, but they seemed not to retain any information given to them.