Virtual Illnesses In Doctors

There are different types of virtual illnesses. A virtual illness is one which does not actually exist, but is made to appear as if it does. It is a sort of make believe illness. People who want sympathy from others develop such illnesses. People who do not want to work also develop such illnesses. It is unfair to this person's co-workers, who have to do his work.

Another type of virtual illness is a psychosomatic illness. It is actually a psychological illness, which causes symptoms of an organic illness. Patients who do not know the symptoms of different illnesses accurately develop bizarre symptoms in this type of psychological illness. These symptoms range from muscular weakness or paralysis, blindness, difficulty in swallowing, pain anywhere ..(the list could be endless). When a doctor, paramedic, or a nurse develops such an illness, it often mimics an organic illness very accurately, unless that person had put a lot of stuff in option while studying for exams and passed somehow or anyhow.

One would not expect a doctor to develop a virtual illness of the first type to shirk work. Well, they are human beings too, and can have manifestations of that type of illness just like any other person, though perhaps less frequently. The Times has run stories of people who developed fractures which required prolonged rest away from work periodically. Since radiographs cannot be subjected to DNA testing, one radiograph with a fracture can be passed as anyone's radiograph. There have been stories of people who would develop a fracture just before or during a vacation, and the head of department would grant this person full vacation while others had to take half vacations as per rule. When it happened once, no one complained. But when this happened thrice in a row, co-workers started grumbling so much, that the whole vacation business was dropped. There have been stories of people who took abortion pills from the institute they worked in, had medical abortions, and claimed six weeks of abortion leave each for alleged spontaneous abortions. Then there was the story of a medical student. We have a famous saying in Marathi - मुलाचे पाय पाळण्यात दिसतात - which translated into English would be 'a person's traits are visible right from when he is in cradle'. This student would never come for classes on time. He would sleep until very late. When asked him what the matter was, he said, 'I suffer from narcolepsy'. Such a fellow would reach even greater heights if he found a job in a government or civic hospital.

Music Sharing: New Method

There are many forms of music sharing. Sharing music on the internet is called piracy, and is punishable by law. People borrow someone's CD or DVD and listen to music. I suppose that is not piracy, because one is not making illegal copies of anything. It is somewhat like borrowing a book from a library, and returning it after one has read it, or finds it awful and does not want to read it further. Public sharing of music is what happens in festivals. The organizers put music on loud speakers so that the entire population of that area is forced to hear it. It may be called forced sharing of music. Today we are going to see yet another form of music sharing.
I was commuting on a city bus on my way to the hospital. Two young girls were sitting on the seat just in front of me. I noticed something unusual about them. They seemed to be connected by thin wires between their heads. After a while I realized they had thin white wires coming out of their adjacent ears. The two wires joined with each other, and a single wire passed downwards somewhere, probably to a hand of one of them. They were speaking to each other periodically, and then going back into forward gazing stance. After a while a realized that they had earphones in their adjacent ears (meaning right ear of the girl on the left, and left ear of the girl on the right). Then it dawned on me that they were listening to the same music emanating from a single phone or iPod. Since their other ears were open, they could hear each other too, when they decided to talk. What a wonderful bond of friendship, and what a wonderful method of sharing music. It was perfectly legal too.

What is shown above is my artwork showing this phenomenon. I have shown them sitting on a bed rather than on a seat of a city bus, because in case of the latter I would have to draw the complex interior of a bus and a lot of people in it. This was easier, and quite adequate for giving the idea to the reader.

Muster Management Integrity

Normally a clerk looks after the maintenance of the muster, in which all people employed in the department sign. I am in charge of everything in the department including the muster, because I am the head of the department. But that does not mean I stand by the muster and keep checking who comes exactly at what time. After all, I am supposed to treat patients on arrival in the hospital, not while away my time doing a clerk's job. No other department head wastes time standing by the muster, unless there is any specific problem employee who has any specific problem with the muster. It is handled by a clerk in every department.
We have a senior employee in the department, who sometimes holds charge of the department when I am on leave. This person takes a great pleasure in harassing employees. She/he stands by the muster, and puts crosses (indicating absence) the moment it is 10 minutes past the expected time of arrival i.e. at 9:10 A.M. Even if there is a line of employees standing there to sign, having arrived five seconds late, she/he does not let them sign, but continues to put crosses. Her/his own work in the department remains not done all this time, but that does not detract her/him.
This behavior reached a new low when she/he started to stand by the muster and watch it even when I was present and very much in charge. She/he would urge the clerk to put crosses, because she/he was powerless to do so herself/himself at that time. This behavior reached a new low, lower than the previous one, when she/he started questioning their practice of writing the time-in as 9:10 A.M. when they had arrived after 9:10 A.M., and telling the 'late by a few seconds' employees to put crosses on their own names for having come late. They ignored her/him, but that is besides the point. That these employees often stayed working well beyond the standard end of the day at 4:00 P.M., but this person was not concerned about it. After all, the motive for this exercise was to trouble others and show her/his importance.
So the next day I sat in that office on one side and kept watching. At 9:10 A.M., this person barged in, looked at the muster and people around it venomously, signed in it, and then took a stance by its side. Then she/he noticed me through the corner of her/his eye, was taken aback duly, thought it over awhile, and went away.
I sat in my office the next day, looking at the door of this office across the corridor, and went there when this person arrived in a hurry at 9:14 A.M. A lot of other people were watching her/him too. She/he signed and went away without a word. When we checked the time below her/his signature, it was 9:10 A.M.!
"Where is her/his integrity? She/he should have signed and put the time as 9:14 A.M." one person said.
"She/he should have put a cross on her/his name for having arrived later than 9:10 A.M." said another person who had been advised to do so the previous day by this person."
"But she/he always does so when she/he arrives late" a third person said. "I have seen that happen a few times."
I knew that was true, because I had seen that happen too. But I knew that harassing people for being late by a couple of minutes just discouraged them from putting their hearts into their wok. So I never harassed anyone for being a couple of minutes late.
"And this person just goes and sits in her/his cabin for 45 minutes or one hour after arrival, instead of going to work" complained another person. "All the work is done by others whom she/he keeps criticizing."
"This person suffers from a personality disorder, and I heard from a famous psychiatrist that there is no treatment for such disorders" another person said.
I knew that was true too, because that very senior psychiatrist had told me this about this very person once. The disorder could be cured only by self improvement, and such people never want to change themselves for better.

Getting Them Hooked

There is this company that markets products like diapers for babies, amongst other things. This company approached the elected head of the town and got a recommendation to be allowed to distribute to all mothers in the postnatal ward a pack of two 'world class' baby diapers, a photo frame, and a pamphlet describing importance of keeping a baby dry during the night so that it slept peacefully (and hence so did the mother). The institute chief advised us to allow the company to do so, and I presume they gave some mothers at least the diapers and a pamphlet. Four years later, they came back with a photocopy of the previous letter and wanted to do the same activity. The sister-in-charge of the ward brought them to me.
"Please show me records of how many times you did this, and when was the last activity" I said. "We will need the Boss' permission again, and the Boss will ask me these questions."
"I will send our boss to meet you" said the company representative and went away. The boss arrived the next day.
"We are just going to give a hamper of two diapers to each baby" he said.
"Your letter says a photo frame too" I said.
"Um... that was the previous scheme" he said. "Now we won't give any photo frames."
"OK. You need a new permission from the civic body" I said.
"Won't the old permission do?" he asked me. It looked like he did not want the hassle of obtaining a permission again."
"I am afraid not" I said. "The last time the activity was forced on us. Now if I get a directive to allow you to distribute your diapers, I will point out the problems to the civic body."
"What problems?" he asked.
"The mothers believe that whatever is given to them in the hospital is by the hospital, and is totally safe. If any baby gets an allergic rash with your product, the parents of the baby will sue us. The other problem is that I look upon this as unethical marketing."
"How?" he asked without much force. He probably knew how.
"You give two diapers free. The mothers like the idea of keeping the baby dry and not having to get up in the night to change wet diapers. Then they have to buy these expensive diapers. It is somewhat like drug peddlers giving free samples to school children to get them hooked. Once they get hooked, they have to buy the drugs."
His face was a study in emotion. I had hit the nail on the head.
"Can't we find a win-win solution to this impasse" he asked. The guy was good. I could not see how it could have been put better and still not appear to be offering a bribe.
"No," I said "the unethical marketing part cannot change even if you do anything for the institute. We don't need anything at the cost of making poor patients buy expensive diapers. I have nothing personal against you. I am just doing my job. I understand marketing your product is your job. Your best bet is to approach the civic body for a permission. I will put my remarks on the paper when it reaches me. My conscience will be clear, even if the civic body chooses to permit you to do what you want to do."
He went away, probably not very happy. I sat there, happy that I had seen the problem in time, and wondering who had allowed this activity the previous time, probably when I was on leave.

Sexual Harassment of Men

It was a condolence meeting. As usual, people were more interested in telling their own encounters rather than grieving the loss of the deceased.
"Do you remember Madam XXX?" someone whispered to his neighbor in the row in front of me. "The one who just spoke?"
"Yes" the neighbor said. I looked at the speaker who had just paid condolences to the deceased. She had been faculty when I was a resident doctor.
"Do you know what she used to do?" the first one asked.
"What?" the neighbor asked in reply.
"She used to stand behind us guys while we were assisting an abdominal operation being performed by Sir. In order to see better, she would lean forward and put her entire front against our backs."
"......" was the neighbor's response.
'All of them together or one at a time?' I wondered.
"One at a time, of course," the first one said. I wondered how he read my thoughts, me sitting behind him and all. "But she treated all of us in turn."
'Treated?' I thought. 'That is touching students inappropriately. It is sexual harassment.'
'Did you work in her unit any time?" the first one asked.
"Yes" said the neighbor in a sort of strangled voice.
"So you know about it firsthand?"

"Yes" came the strangled reply. He actually blushed while the first one was leering. I could understand why both of them did not complain - the first one had enjoyed it, while the second one had been embarrassed and perhaps afraid too.

Effective Behavioral Control

Labor pains are so severe that many women cannot bear them. In modern world, they offer labor analgesia so that labor is a happy process. However such happy places are very few in this world. Considering the paucity of anesthesiologists in civic institutes, labor analgesia is given only when some anesthetist wants to make a career in it and wants to master the technique before stepping out into the world to cater to the wealthy types.
The nurses and doctors in the labor room suffer almost as much as the women in pain because of their screams. The overworked personnel sometimes lose their cool in face of such auditory trauma.
"You know what one resident doctor did?" someone asked me.
"What?" I asked obligingly.
"She slapped a screaming woman in labor twice to make her stop screaming."
"Huh?" Slapping would increase the screaming, not decrease it, I thought.
"Not only that, but she locked the patient in the delivery room?"
"Why?" I asked. This seemed very inhuman behavior for a doctor.
"I asked the doctor. She said she did not slap the patient. She just patted her mouth asking her to close it. As for the locking thing - she said she did it because the patient kept going out to meet her husband.
I could understand what the patient was doing. I have seen worse. I have seen women sit in the toilet for the duration of labor, save for the brief periods they were coaxed back to the labor tables. I have seen women go lie down on the floor under the labor tables when the pain became unbearable. I hope the resident doctor will mature one day and learn to bear with such behavior of her patients.
"I had another resident doctor a few years ago. When his patient screamed and screamed, he got angry and touched her nose with the scissors he was holding. 'Shut up or I will cut off your nose' he thundered. Then she shut up."
I was speechless. This was an unorthodox use of episiotomy scissors, bordering on homicidal.
"What is he doing these days?" I asked.
"He is in UK as a consultant obstetrician."
Well, if he tried this stunt there, they might do to him what he threatened to do to the patient, and deport him to India, I thought.

Generic Medicine Prescription

"Sir, the union health minister has said that Deans of all medical colleges have been informed to inform doctors working in those hospitals to prescribe only generic medicines" one colleague said.
"I read about it in the newspaper" I said. "It seems to be the decision made by the medical council to prevent doctors being unethically influenced by pharmaceuticals to prescribe their products."
"But the chemists do not have generic medicines."
"I know" I said.
"So when we write generic names, they will dispense brands they want. So now the pharmaceuticals will woo chemists rather than doctors."
"That sounds likely" another colleague said. "Anyway, some chemists are known to substitute one brand for another- one that gives them greater profit margin."
"But what do they mean by asking us to prescribe generic medicines before making generic medicines available?" someone asked.
"That is to reassure people that measures are taken to curb unethical practices" a cynic said. "Mind you, it is 'measures' without any mention of the effectiveness. People want to hear something, and when they hear that, they get satisfied and move on to another topic."
I had heard the preceding arguments from different people before, but that last thing about psychology of people was a new one.
"There is nothing to worry about" someone else said. "The Deans have not informed any doctors to do so yet. And even when the doctors are so informed, there is no machinery in place to check if they follow instructions, or to take action on doctors who don't comply."
There were a few knowing smiles at this.

Final Counseling

We get patients who have been to other doctors and have been advised on their conditions. They reach us because ours is a free hospital, and they cannot afford the treatment in private centers. Sometimes they reach us because they have doubts about what they have been told about their treatment. Sometimes other people bring them, promising better treatment than in private centers.
We counsel them the same way as we would patients who have not been to see other doctors. We tell them what they suffer from, and what the treatment will be. Some of them accept what they hear from us and get treated. Some are not satisfied with that.
"But doctor, the previous doctor said I had *** condition and I needed *** treatment."
"After examining you and checking reports of tests you have undergone, we feel that you have ### condition and you need ### treatment" I say.
"But then why did that previous doctor say differently?"
"That is a question you should ask the previous doctor" I say. "I cannot say why someone else says something."
"But now what should I do? Which treatment should I take?"
I can see that the patient is confused, not only about her diagnosis and treatment, but also about whom to ask which question.
"Now you have to think about what you have heard. Then you should follow that doctor whom you believe to be more intelligent" I say. When that does not make sense to her, I sometimes say "you could always consult a third doctor, and then follow the advice of the majority." I cannot say what she should do if the third doctor advises something that is different from the first two doctors' advice.

Unethical Demand by Ethical People

Many people put their signatures where the administration tells them. The clerical people inculcate this habit in doctors, and the doctors make others do the same when it is their turn to get signatures.
"If your teacher is on leave, get your head of department's signature in his place" the clerks tell our postgraduate students, when they have to send their exam forms to the health university. If I refuse, they say "why not? All department heads do so."
They send me technical specifications of equipment asked for by other institutes, if the cost is above one million rupees. "Please sign the specifications and return the paper" the clerks say. I cannot understand how I can sign that document, when I have not developed it, and the contents of which I do not necessarily agree with. When I express this thought, they say "you just have to sign it. There is nothing more to it." As if the signature is just a part of a ritual which must be carried out, though it has no value in real life.
I have to forward every research proposal to the Ethics Committee of the institute. That includes research proposals of faculty, and proposals of dissertations by the postgraduate students. I used to sign all of those, until I realized that times have changed, and I can be dragged to a court by anyone when anything goes wrong with the proposal.
"Please tell me what my liability is when I sign this document" I asked the secretary of the Ethics Committee.
"You just have to sign it. There is nothing to it."
"What if something goes wrong and someone sues me when I am not connected with the research in any way?" I asked. "If my liability is owing to my administrative position, the civic body should be liable, and pay for any compensation ordered by a court."
"......."
"Will your committee answer my question if I write to it?" I asked. When she said 'yes', I wrote the letter, asking the following. I wrote all possible options, so that they would understand what I wanted.
"Please clarify if my liability is financial, medical, legal, ethical, scientific, moral, and/or any other."
I received an answer after a month and half. It read as follows. "The Ethics Committee deliberated the issue and could not reach any conclusion. So we asked the Boss. The Boss advised as follows. 'The head of the department has to sign all proposals for research by everybody in that department.' The letter with Boss' remarks is attached herewith."
It was a classical example of giving no answer as an answer. I wrote back, thanking for their letter, but asked for clarification on the points I had written about in the my letter. They kept the letter for another month and half, and wrote back "your matter is under consideration, and we will answer your question when a decision is reached. A few months have passed. An answer is awaited. No matter. I have 6 years and 3 months up to retirement. I can wait. In the meantime, I forward all proposals with a remark "forwarded without any financial, medical, legal, ethical, scientific, moral, and/or any other liability. They do not like it, but they take the proposals, because they cannot refuse them without reason, and they cannot decide on a reason. I heard they are thanking God that the heads of other departments have not caught on this idea yet.