Virtual Students In Virtual Classroom

Virtual classroom is a concept in modern education. It seems the education minister has ordered people to set up virtual classrooms in medical colleges. Some government employee will work out the details of creating virtual classrooms, including the cost, working, and keeping records etc. In the meantime, we can look at a reaction of many people.

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Powerpoint Slides in HTML Pages

Powerpoint slides cannot be put in web pages. Microsoft has put that facility in that software, but it does not work, or if at all, it works only in Internet Explorer, which is not used by a lot of people. Showing slides in a web browser can be useful when one has a wide readership on the internet. It is also useful when one does not carry one's laptop when going on a lecture tour, and is not sure if the venue will have Powerpoint. All computers have a web browser, and any web browser is OK for HTML slides, unlike Powerpoint, which will not show slides made in another software program. Makng HTML slides requires just a text editor, like Notepad, and some knowledge of HTML, CSS and Javascript. I have made such a presentation, which cannot be put on a blog post, because Blogger does not allow putting additional files like CSS and Javascript files along with the HTML file, and one has to upload them to another server and give its reference. You have to use the right and left arrow keys to move forward and backward in the presentation. You can put whatever that can be put on a web page in this presentation. I have put only text because this post is only to present the concept.

I have put that presentation on my website, and here is a link to it.

Click here to see HTML slides presentation.

Instruments Slideshow Beta

H I always wanted to have a slideshow on this blog. Google's Blogger does have a gadget called slideshow. I could not use it, because it required the images to be located in selected places, and I did not have an account there. The slides shown by Blogger in that gadget area were quite small too. Finally I worked out how to show them in the blog post itself. I call this one 'beta' because I have put only three images of one instrument there as a trial. It seems to have worked, but I have to see if it works on (other) computers, tablets, smart phones etc. I will ask colleagues, friends, students, and my readers if it works on their devices. If it works well on all devices, I will write all code required (a big bore, that one) and post about 90 images of instruments used in Gynecology and Obstetrics there. My book has all line diagrams of instruments. With 90 images, revision of instruments should be a breeze for the students, I hope.

Win-Win Situation in Education

An old classmate came visiting the other day. His daughter was studying in final year, which was probably the cause of the visit. After an initial patter, he came to the point.
"Students are not taught these days the way we were taught, huh?" he said.
"What do you mean?" I asked.
"Lectures are not taken at all" he said.
"Did your daughter tell you so?" I asked.
"Yes."
"But we are very particular about teaching students" I said. "If a lecture is missed due to any reason, we reschedule it."
"I did not mean your department. Teaching in your department is meticulous. In XXXXXXX department, not a single lecture has been taken in last one year."
I thought about it for a while.
"Is it same in the other departments?"
"Most of them."
"Why do you not tell the Boss? I am sure he will want to improve things."
"What? Then the concerned departments will victimize my daughter."
"But the head of XXXXXXX department gives adequate attendance certificate to all students. I know, because eligibility for appearing for exams is jointly checked by all departments."
"Zero out of zero is 100%" he said. That might be inaccurate mathematically, but was logical.
"And all teachers keep complaining that students do not attend their lectures" I said.
"That is true for many students, especially when they have exams of other subjects" he said.
Then it dawned on me. It was a win-win situation. The teachers got to not teach, and the students got to stay away from lecture halls and still got required attendance certificate.
"Do you expect me to tell the Boss about this?" I asked.
"Umm..." he said, "that would be nice."
And make enemies of all those teachers? I suddenly recalled a few faculty who came to me time and again and indirectly urged me to fight their battles for them. 'Fight your own battle' I wanted to say, but decided not to.
"I will have to tell him your name" I said.
He thought about it a bit.
"I think my daughter will self study" he said. "Let us not bother your Boss with such trivial things."

CIN: Decision Making Tool

Students get bored with the same pattern of learning. Students are tech savvy these days, and prefer methods that involve electronic gadgets. Some of them like decision making tools. With these points in mind, I used Microsoft Powerpoint to make an interactive presentation on cervical intraepithelial neoplasia (CIN). When one plays it in a Powerpoint Viewer, it keeps offering different options. One has to select that option on each screen that applies to his/her own patient. Then the tool offers another screen with more options. Finally one reaches a recommendation for that patient. I used to do it in Visual Basic. But Powerpoint is easier to work in, does not involve compilation, and creating a setup file, and does not require the user to setup the file on his/her computer. Most people have Powerpoint or equivalent program installed on their computers. So additional software is not required. The starting screen of the tool looks like this.

I showed it to my students today when I taught them CIN. I promised to make it available to them, so that they could use it. It will help them learn the topic. It might inspire some of them to do better than that piece of software. You can click on the image above to download it.

Finishing School For Resident Doctors

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We at Seth Gordhandas Sundardas Medical College teach soft skills to residents in addition to university curriculum.

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Visit this link to find details

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One response by email, amongst many such:
I appreciate the efforts you took into training your residents, to help them tackle the stress and remain humane. I wish I had a teacher like you. I really want to thank you for all the efforts you take to send better doctors into the society.

For Those Who Cannot Read From Computer Screens

This experiment is to see if the blog can be made friendly to those who are
visually challenged. If it does, I can put important stuff in that speech. The
guy speaking has an American accent, though he looks Indian. The guy's
appearance is due to the software I have used, and his accent is due to the text
to speech service I have used. If he runs out of things to say and becomes
silent, it is time to move on. If you missed what he said, you could refresh
your web page. I can program it to say something else after he is done and the
reader asks for more. But if people do not like this one, the effort will be
wasted.

A Kind Soul

I had made an appeal for anyone to suggest a place on the web where I could post my free ebooks on Obstetrics and Gynecology. Finally a kind soul replied. He/she did not disclose his/her identity, so we have to refer to the kind soul as he/she. He/she suggested Google Drive, DropBox, Box, and One Cloud. These sites permit online storage and file sharing. One Cloud seems to be a paid service. I uploaded my books on the Google Drive for many reasons. The first was that I liked Google. It has given me solutions to many difficulties, and I thought these books should help people through Google. The second reason was that Google would show these ebooks on priority when searched. It was indeed the case. When I searched for 'Shashank Parulekar free ebooks', the first link was the page where I put these links. Actually I have given links on the images of my books shown in one of my blog posts HERE. When a blog reader clicks on that image, the ebook opens. It can be saved from there. I do not have to share the links with people. They just do Google search, reach that page, and click on the book images. That is really quite smooth and satisfying.
I had submitted one book to project Gutenberg too, and it can be downloaded from there. Actually I am feeling quite proud that my ebook is available on such a prestigious site. Google search shows that link too. It is HERE. The process of submitting an ebook there is a bit lengthy. When I find time, I will post the other ebook there too.

I am grateful to that anonymous kind soul for his/her suggestion. I hope this post will help others who want to post their free ebooks on the net. After all, our kind soul may not read their appeals and email them as he/she emailed me.

How To Give Away Free eBooks?

This is something that I need advice on.
I have written two eBooks recently, mainly for resident doctors in training. They might help medical students too. They are in PDF format. Their front covers look like this.

I want to give these free to anyone who wants them. The problem is I don't know how to do that. Perhaps there is some place on the internet where I can upload them, and give a link so that people can download them. I would welcome people to give them to anyone who wants them, just so long as one does not print and sell them. The idea is just to let people learn what I learned the hard way. I cannot email them, because that would take away a lot of time, in which I could do something else that also might help people.
If anyone can suggest how I can do this, I will be obliged. Please email me.

05-01-2015
A kind soul advised me to put them on Google drive. Thanks to him/her (did not reveal identity), now you just have to click on the image of the book and the ebook will download. Open it in any PDF reader.

To What End

I was on my way home from the hospital. A very senior consultant boarded the bus just as it was about to leave, and sat down next to me. We chatted a little, about the same things two medical persons chat when they meet occasionally.
"Dr XXXXXX had come visiting recently" the consultant said.
"The preventive medicine person?" I asked.
"No, no. Anesthetist. She was in the same batch as you, she said."
"Oh, yes" I said. I remembered. The name had not made sense at first because I remembered her by her maiden name, while this consultant had referred to her name after marriage.
"How is she?" I asked conversationally.
"Oh, she is fine" the consultant said.
"Is she not in New Zealand?" I asked, straining my memory.
"Australia" the consultant said.
"What does she do?" I asked. There should have been no reason to ask. She should have been practicing anesthesiology. But some of the doctors I had known who had migrated to US had changed their specialties. One had gone from cardiac surgery to radiology. Another had gone from cardiac surgery to gynecology. Another had gone from gynecology to family medicine. Perhaps this one had changed her specialty too.
"She teaches in a school" the consultant said.
"Um..." I was confused. "A medical school, you mean?"
"She teaches children in a school" came the answer.
"But why?" I asked.
"She thought her child would do better in Australia than in India. She did not want to go through residency again in Australia, because she would not be able to give time to her child if she went through the residency".
I kept quiet. I thought of the 8.5 years spent on medical education, finally wasted. I thought of the national resources spent by the government so that she could get subsidized education, now wasted. I thought of loss of one more doctor for my country which needed doctors badly. I thought of the rumors of parental influence used to get her a couple of gold medals over other students who were considered more worthy then.  To what end was all that? I thought and then could not think any more.

Why Myomectomy? For Fibroids, Silly.

History repeats itself.
A year ago, there was a patient in the ward. She had undergone a myomectomy. For those who don't know, myomectomy is an operation which is done for removal of a benign tumor called leiomyoma(s) (formerly known as fibroid) from the uterus and then restoring the uterus. Leiomyomas can cause different  symptoms in different parts of the uterus, and sometimes they cause no symptoms and no complications at all. Which means all leiomyomas need not be removed by myomectomy (or hysterectomy). In a young, married, aymptomatic woman with small leiomyomas, the best advise would be to have the babies she wants before doing anything to the leiomyomas. In case of a near or post menopausal woman with asymptomatic leiomyomas, just observation may suffice, as the leiomyomas shrink after menopause.
"Sir, this patient underwent myomectomy in another hospital" my Registrar told me during our ward round.
"Why did they do myomectomy?" I asked, which meant 'what were her symptoms for which myomectomy was done?'
"For fibroids" she answered brightly. Though she did not say so, I heard what she meant 'for fibroids, silly'. The 'silly' was silent because she probably understood one did not call the Boss silly in his presence.
I kept quiet, but my face must have spoken volumes. The Associate Professor hurriedly explained what I meant. Then the Registrar proceeded to check the patient's old papers and find out the indication for myomectomy. I was not surprised that she believed her Professor perhaps would not know that myomectomy was done for leiomyomas. It is quite fashionable with residents to believe their professors do not know their stuff.
A year later, the Second year Resident of the previous year was Registrar now. We were taking round in the antenatal ward. This one should have witnessed the educational proceedings of the previous year and remembered. One of the two (witnessing or remembering) must have failed. When we came to a pregnant woman who had undergone hystereoscopic and laparoscopic myomectomy in another hospital prior to this pregnancy, I asked the old question "why did they do myomectomy?"
"For fibroid" the Registrar answered after wondering for a second why I asked that silly question. I heard the answer and kept as straight a face as I could when I asked, "is Dr XXXXXX, our previous Registrar your cousin? She had also given me the same answer to this question, about another patient who had undergone a myomectomy.
"She is not my cousin" she answered. She could have said, 'cousins don't think similarly and speak the same thing, silly' and would have been more right than when she had answered my first question. But I did not sense that answer in her voice. ThisReistrar probably believed I was testing her knowledge. It turned out she did not know the indication for that myomectomy.
"When you say myomectomy was done for a fibroid, it implies that in your opinion every fibroid needs to be removed. If your examiner senses that in your answer, you may not pass your MS examination. Be careful" I said.

Leiomyomas With Pregnancy: Can Hysterectomy Be Done?

A woman with a large uterus containing multiple leiomyomas can pose a diagnostic problem if she gets pregnant. If she misses a period, one can suspect that she could be pregnant. If she has symptoms suggestive of a pregnancy, it would help. One may not be able to appreciate signs of early pregnancy in her case, because the uterus with leiomyomas would not soften appreciably so early in pregnancy, and an enlargement in size would not be appreciated. One can do a pregnancy test on urine and make a diagnosis. But what if she does not miss a period? She might have had irregular and heavy periods due to the leiomyomas prior to the pregnancy. If she gets threatened abortion, she will have vaginal bleeding which may be misinterpreted as menstrual bleeding or abnormal uterine bleeding. Then one does not suspect a pregnancy and does not perform a pregnancy test.
There are some patients who are elderly, and are scheduled to undergo hysterectomy for multiple leiomyomas. If they happen to get pregnant, and if the pregnancy is diagnosed, there is a therapeutic dilemma. Would one perform an MTP first, and a hysterectomy after the postabortal period is over? Or would one perform a hysterectomy and get rid of both the conditions at the same time?
I checked all resources - medical databases, books, journals, search engines like Pubmed and Google - and found nothing on this topic. I asked all faculty in my institute. They promised to answer this question, and only five of thirty three answered. The others may be considered to be neutral or unwilling to commit on this issue. Those favoring MTP first stated that the blood loss would be excessive if a hysterectomy was done primarily, the vascularity of the uterus being increased due to the pregnancy. Those in favor of performing only hysterectomy had a number of arguments to support their choice.

1. It would involve a single procedure instead of two, so that the risk of complications (including those of anesthesia) would be reduced.
2. If the fetus were implanted near the fundus, reaching it through the distorted uterine cavity could be difficult and the MTP could fail totally or partially (incomplete abortion).
3. There would be some risk of postabortal sepsis which could make recovery and subsequent hysterectomy more difficult.
4. The blood loss would not be significantly increased with hysterectomy as the only procedure, as there would not be any blood loss after ligation of the uterine vessels.

Since I have mentioned only one point in favor of MTP first, and four points in favor of hysterectomy primarily, perceptive readers must have guessed that I am in favor of the latter. Please let me know what your choice will be, should you get one patient like this.

Compile-Comply-Whatever

Doctors are perhaps too busy to pay attention to new words - new meaning what they had not learned in their student lives, not 'new' words. Then they hear something, register something else, and then use the words incorrectly. It was a coincidence that two different doctors committed the same error and I saw it in the span of one week.
I received an article for publication in our journal JPGO. The following sentence was found in the text of the article, which was a case report. "After compiling the preoperative requirements, corrective surgery was performed on the patient."
A couple of days later, I was scrutinizing a report made by a medical officer of the civic body. This officer was in charge of the healthcare of an entire civic ward, the entire city being divided into areas called wards from A to P, and each one into North and South or East and West. It was about an inspection performed by him after a doctor answered a show-cause notice served to him by the civic body. There was the following sentence in the report, and I was expected to offer my remarks on it as the chairman of the PCPNDT committee of the civic body. "It was found during the inspection that the doctor had compiled the deficiencies pointed out..."
In both the instances, they meant to use the verb 'comply' and not the verb 'compile'. In case one or both of these words are new to any reader (I sincerely hope not), the dictionary meanings of these two words are as shown below, acknowledging the copyright of the respective dictionaries and thanking them for educational use of their meanings in this article.

Word	Meaning
	Oxford dictionary	Macmillan dictionary
Comply	meet specified standards	to obey a rule or law, or to do what someone asks you to do.
Compile	Produce (something, especially a list, report, or book) by assembling information collected from other sources.	to make something such as a list or book by bringing together information from many different places.

I corrected the word in the scientific article and informed the author about it, because it was a good article and I wanted it for our journal. I could not do so in the report I read in the PCPNDT committee meetng because it was a legal document and I had to respond to it. So I wrote,
"Since the respondent has just only 'compiled' the deficiencies, we are unable to offer any remarks on the further course of action to be taken."

Something hilarious happened the next day, which was in the same vein, though the word was different. There was a meeting of big bosses of the major civic hospitals in the office of the Boss' Boss. Heads of various departments in the hospitals, lawyers and NGOs were present too (by invitation). A new form was being discussed, which was a modification of the forms issued by the central government and state government. The additions had made this new form quite exhaustive and hence quite big too. There was a consultant wearing a necktie and all. He offered his opinion as follows.
"The form needs to be shortlisted."
Everyone just kept quiet. Perhaps it was a slip of tongue. After five minutes, he said again, "the form needs to be shortlisted." People's response to this was the same as the first time.
Perhaps he had heard the word 'shortlist' from someone, and liked it, and thought it was a more distinguished way of saying 'shorten'.
For those who think this is a new word, the meaning of the word in the Oxford dictionary is as follows, (acknowledging its copyright and thanking the editors for the use of the meaning for educational purposes):
'Put (someone or something) on a short list. An example is offered, as follows: the novel was short-listed for the Booker Prize'.

Uni-English

One usually has heard of American English, Queen's English, and Hindi English (also known as Hinglish). Uni-English is a new type of English. It is actually quite old, but this is the first time it is being described.
The University conducts a workshop every year, always on the same topic, and invites heads of certain departments from medical colleges in the city as delegates to learn the stuff they teach every time. The topics are the same, and the contents are the same. The speakers are also the same, and usually their English is also same as at the previous times. After all they do not see any reason to improve something that they believe is superb, and what is applauded every time. I jotted down the following sentences from the speeches in one of the workshops, and then forgot all about it. I was sorting out my drawer today, and got hold of it. I thought I must share this stuff with you, because I believe in sharing fun. I could compile different sentences uttered in successive workshops, but I think the samples should suffice.

1. To conduct whole workshop may not be able to possible.
2. Another important thing we are there is ...
3. There is a chapter full on anemia.
4. I feel very proud to see you people talking to you people.
5. Whatever we have done in the last ten twenty years.
6. It is also very very important.
7. The module is very very clear.

We shall call this Uni-English. It is spoken by enthusiasts in University Workshops. Uni is short for University, and has nothing to do with the 'uni' one uses to imply one. The last three examples border on Hinglish (check out the bold letters to know why).

The Stories of Mitral Stenosis - 4 (The Last Straw)

The patients who undergo operative treatment are seen by many doctors before the operation. They are examined by the House Officer and Registrar. This examination is comprehensive, including general, systemic and gynecologic examination. They are seen by a gynecologic consultant, who checks gynecologic aspects. They are seen by anesthesiologists thrice - once in anesthesiology outpatient clinic, then preoperatively in the ward on the day prior to the operation, and finally prior to induction of anesthesia for the operation. If there is any doubt about clinical findings of any particular system, they are seen by senior consultants and specialists of the respective illnesses.
All operated patients are examined by the House Officer and Registrar in the gynecology ward postoperatively. They are seen by a consultant the morning after the operation. I was examining such operated patients once. I had not seen them preoperatively, and someone else had operated on them. They were all OK, I had been told by the resident doctors. When I put my stethoscope on the chest of one of them, I had a sudden sinking feeling in my heart. She had the classical murmur of mitral stenosis. She had been given a spinal anesthesia and a vaginal hysterectomy had been performed. No one had known that she had a mitral stenosis - neither the gynecologists nor the anesthesiologists. Luckily she seemed to have a well compensated heart and the breath sounds were OK too. I advised the residents to get a cardiologist to see her. The very next patient gave me the sinking feeling again. She had the classical murmur of a ventricular septal defect. She had undergone a vaginal hysterectomy under spinal anesthesia, and no one had known about her cardiac condition until I saw her. Luckily her cardiac function was well compensated too. I asked the residents to get a cardiologist to see her too. I told the senior anesthesiologist to sort out the problem of the juniors missing the diagnosis. I decided to give my resident doctors my software to learn cardiac auscultation. If the diagnosis had been made, the two patients would have been seen by a cardiologist and all sorts of preparations would have been made which were not made for patients with normal hearts. The following day I saw the two patients again. They were OK.
"What did the cardiology resident doctor say about this patient?" I asked, pointing at the patient with mitral stenosis.
"He said she had a pansystolic murmur. He has advised 2D echo for her" the Registrar told me.
I was aghast. That was the last straw. A cardiologist in training had mistaken a middiastolic rough murmur for a pansystolic murmur. Perhaps the time had come for throwing away stethoscopes and embracing 2D echo technology for daily work.

The Stories of Mitral Stenosis - 3

The stories on mitral stenosis get more and more interesting. The Resident Doctors have their own assessment of their seniors. They believe that they can categorize their seniors into different types, and that they are predictable. They think the seniors have their own (irrational?) whims and fancies. They tell each other and their juniors what their bosses like and dislike, and what they will say and do in different situations. It is something like the students tell the future batches what jokes certain teachers will tell in lectures on certain topics. It is no wonder that they categorized me too. I don't blame them. How would they know I was different? In fact, they probably believed nobody was different.
This story took place about a year after the last one. That day I saw a pregnant woman with a left parasternal pansystolic murmur in her heart. It was due to a congenital hole in the septum between her cardiac ventricles, what is known as ventricular septal defect. I wanted my resident doctors to learn and also wanted to see which of them were good. So I took the woman's permission,  called them one by one and asked them to auscultate her heart. Their answers were as follows.

Doctor	Diagnosis
First year resident doctor 1	Normal heart sounds
First year resident doctor 2	Mitral stenosis
First year resident doctor 3	Some murmur
Second year resident doctor 1	Mitral stenosis
Second year resident doctor 2	Mitral stenosis
Second year resident doctor 3	Ejection systolic murmur
Third year resident doctor 1	Mitral stenosis
Third year resident doctor 2	Mitral stenosis
Third year resident doctor 3	Mitral stenosis

Out of nine resident doctors, six diagnosed it as mitral stenosis. The only reason for them to mistake a loud, clear murmur that lasted throughout the systole for a milder, rough murmur that lasted mainly in the middle part of the diastole, could be that they had been primed by their seniors. They had been told that some time I would call them for auscultating a woman's heart, and that it would be mitral stenosis.
It was a double whammy for me. The first one was that they were not good with the murmur business. The second was that they believed they could successfully predict what I would do, implying I was one with stereotype thinking, and they were infinitely more smart than I.

The Stories of Mitral Stenosis - 2

Times have changed. We had to rely on our clinical acumen using conventional instruments like a stethoscope to make a diagnosis of a heart disease. I recall listening to recorded cassettes of heart sounds to learn this skill. With advances in instrumentation, people started relying on tests like 2D Echocardiography to make this diagnosis. Then the students started feeling great if they just detected a murmur in the heart, not if they diagnosed the type of the murmur and the nature of the heart disease. When they became resident doctors in our department, they continued the same trend. I felt this practice was quite dangerous, as one would not have access to such technology at all times in any institute, and at all in many parts of the world. Without a diagnosis, even a tentative one, one could not treat a patient. So I decided to test the acumen of the resident doctors once in a while, just to see which ones were good and also to motivate the rest to study better. One day a pregnant woman came to the antenatal clinic. She was asymptomatic, but had a tight mitral stenosis. For hose of my readers who don't know about it, mitral stenosis produces quite characteristic heart sounds and murmur, nd can be diagnosed quite easily and accurately by cardiac auscultation. I called the resident doctors and lecturers one at a time and asked them to diagnose her heart condition by auscultation. The results of their test are shown in the following table.

Doctor	Diagnosis
First year resident doctor 1	Normal heart
First year resident doctor 2	Normal heart
First year resident doctor 3	Some murmur
Second year resident doctor 1	Normal heart
Second year resident doctor 2	Mitral stenosis
Second year resident doctor 3	Ejection systolic murmur
Third year resident doctor 1	Normal heart
Third year resident doctor 2	Chest is clear
Third year resident doctor 3	Some murmur
Lecturer 1	Normal heart
Lecturer 2	Ejection systolic murmur
Lecturer 3	Some murmur

I did not know whether to be aghast that three junior consultants and eight out of nine resident doctors were wrong, or to be ecstatic that at least one of them got the diagnosis correct. The one who had said the chest was clear went on to become a lecturer in due course (which illustrates the point I made in the beginning. I did the test the next year, and the results were similar.

The Stories of Mitral Stenosis - 1

Mitral stenosis is a form of rheumatic heart disease that seems to plague patients even today. It happens to be the most common form of such illnesses. It is also the subject of a number of stories that I have yet to tell. This post is the first one in the series.
In my early days after qualification, I was posted as a Lecturer at a peripheral hospital briefly. There used to be a great shortage of anesthesiologists then, which has only increased manifold over the years. We had to give local anesthesia and sedation to our patients scheduled to undergo minor procedures. I used to do that regularly. We had a complex of operation theaters, in which there were tables for Obstetrics and Gynecology, General Surgery and ENT. The other specialty Resident Doctors had heard of me giving local anesthesia and sedation to my patients. One day the House Officer from the  General Surgery department came to me in the OT and said,
"Will you please give spinal anesthesia to my patient? He is a young fellow with a hydrocele."
"Let me have a look" I said. He took me to the patient who was lying down on the operation table in the surgical OT. I asked his history and auscultated his heart and lungs.
"Hey, he has got a mitral stenosis" I said. "Did you not know about it?"
"No" he said and gave me a look.
"Auscultate his heart" I said. "He has a classical middiastolic murmur with presystolic accentuation."
"So will you anesthetize him or not?" he asked me. I was aghast.
"Sorry, no" I said. Get him checked up by a cardiologist and anesthesiologist. He requires proper anesthesia by a specialist. You should examine your patients before posting them for surgery, or one day you will lose a patient. That will also get you into deep trouble."
He did not seem to like my advise. He took the patient out of the OT anyway. I was worried that he would not improve. So I warned his Lecturer about this. He also gave me a look, but at least promised to talk to the House Officer. I don't know what happened to either of them, and what they are doing today. I only hope their patients and they are OK. This happened thirty years ago. There are new players, but mitral stenosis continues to be ignored. We shall see different aspects of this in the subsequent posts.

Prescription Ready Doctors

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.

Grab Their Attention

I delivered two lectures to the undergrads back to back the other day. One was my scheduled lecture, and the other was for a colleague who had to be elsewhere unexpectedly and there was no one else to deliver a lecture in that time slot. I did not want to lose the slot, because their education had to be completed as per scheduled plan. I tried my best to keep them awake, and entertained them with anecdotes, while continuing to impart education. But I started losing them during the second lecture. After all, there is only so much that a human mind can take. Two of them yawned independently within ten seconds of each other.
"There are two types of yawns. One is the infectious type, in which a person yawns when he/she sees someone else yawn. The other is noninfectious yawn. Just now that guy there yawned. In less than 10 seconds, that girl yawned. But she could not have seen him yawn. She is sitting in a row ahead of him. So these were the noninfectious type of yawns. The only reason for these yawns, I can see, is my lecture."
They laughed. I could teach them some more before they started losing interest again. I had to grab their attention again. So I started with a story, which had to do with a goal before starting out in life. I thought of it in connection with something that happened in class at that moment.
"I will tell you how I reached where I am now" I said. I won't tell the story here, because it will make this post too long. Perhaps some other time. Halfway through the story, I realized that they were listening with rapt attention, like people do when they watching some soap on the TV. Perhaps they thought they would hear something worth gossiping. I completed the story, advised them to fix their goals and went back to teaching. Within ten seconds they went back to their whisperings, texting and not paying any attention.
So I can say that it easy to grab their attention with anecdotes, but very difficult to keep it if you go back to teaching.