I have a nagging fear that a number of doctors that are being trained are not ready to practice. Let us study the following example.
"What treatment will you give to this woman?" I asked a student in term ending examination.
"Iron, calcium, tetanus toxoid" he said slowly.
"Will you say, 'nurse, give this patient iron, calcium, tetanus toxoid?'"
"No Sir."
"How will you instruct her? What will be your prescription?"
"Iron 200 mg."
"Which salt? What route? How many times a day?"
"Um...."
This was repeated candidate after candidate. I am afraid this is partly due to the teachers making similar statements when they teach, rather than speaking precisely. It is also partly due to the students not studying what the teachers do not teach them. The same students qualify and either go into residency or private practice. Then there can be trouble for the patients and the doctors both. I remember the following conversation that took place during a ward round once.
"I was told to give this patient Tramadol for pain."
"How much did you give?" I asked.
"Um.... I don't know. The houseman gave it."
"Did you tell the houseman how much to give?" I asked.
"No, I told her to ask the nurse the dose and give that much."
I was stunned. The doctor is vicariously responsible for a nurse's actions, and here was a doctor who was asking the nurse how much of the drug was to be given. Luckily the nurse had given the correct dosage and all was well. That reminded me of another story. It was a live telecast operative gynecology workshop. On closed circuit, the live operation was seen in an auditorium, questions asked by the audience were heard in the operation theater, and the answers given by the surgeon were heard in the auditorium. A senior doctor was asking the questions into a microphone. A recently retired professor and head of the department was demonstrating some operation. The audience consisted of gynecologists and obstetricians.
"What solution are you infiltrating into the tissues?" he asked the surgeon, for the benefit of the audience.
"Um.....whatever the nurse has given me" the surgeon said.
The entire audience was stunned.
"What treatment will you give to this woman?" I asked a student in term ending examination.
"Iron, calcium, tetanus toxoid" he said slowly.
"Will you say, 'nurse, give this patient iron, calcium, tetanus toxoid?'"
"No Sir."
"How will you instruct her? What will be your prescription?"
"Iron 200 mg."
"Which salt? What route? How many times a day?"
"Um...."
This was repeated candidate after candidate. I am afraid this is partly due to the teachers making similar statements when they teach, rather than speaking precisely. It is also partly due to the students not studying what the teachers do not teach them. The same students qualify and either go into residency or private practice. Then there can be trouble for the patients and the doctors both. I remember the following conversation that took place during a ward round once.
"I was told to give this patient Tramadol for pain."
"How much did you give?" I asked.
"Um.... I don't know. The houseman gave it."
"Did you tell the houseman how much to give?" I asked.
"No, I told her to ask the nurse the dose and give that much."
I was stunned. The doctor is vicariously responsible for a nurse's actions, and here was a doctor who was asking the nurse how much of the drug was to be given. Luckily the nurse had given the correct dosage and all was well. That reminded me of another story. It was a live telecast operative gynecology workshop. On closed circuit, the live operation was seen in an auditorium, questions asked by the audience were heard in the operation theater, and the answers given by the surgeon were heard in the auditorium. A senior doctor was asking the questions into a microphone. A recently retired professor and head of the department was demonstrating some operation. The audience consisted of gynecologists and obstetricians.
"What solution are you infiltrating into the tissues?" he asked the surgeon, for the benefit of the audience.
"Um.....whatever the nurse has given me" the surgeon said.
The entire audience was stunned.
