MCI, PLEASE OBLIGE

When we were students, we had to learn medicine, surgery, obstetrics and gynecology, ophthalmology, ear-nose-throat diseases, orthopediacs and paediatrics as separate clinical subjects. Psychiatry was dealt with in 1-2 lectures, 15 days in the second year and about 15 days of posting in internship. The medicine paper was supposed to have a question on Psychiatry which was usually a short note on one of five favourite topics (which unfortunately did not include depression).

This was 15 years ago. Now when I meet my classmates, irrespective of speciality or area of practice or even if some of them have switched their professions- all my classmates rue the lack of special training in Psychiatry. Most of my non- psychiatry colleagues have told me how a significant portion of their practice is actually psychological intervention or psychiatric treatment. One family physician joked to me that he will have very minimal practice left if he begins to refer patients with psychological problems to Psychiatrists instead of treating them himself! Considering all these experiences, it is very clear that a special training in Psychology and Psychiatry would have been indispensible.

All things cannot be covered in undergraduate medical education because of the vast and changing nature of medical science. Invariably, some amount of learning happens on the job when the doctor actually settles down to start work. So some authorities have argued that psychology and psychiatry will be ‘automatically’ learned by doctors when they need it. So we see a good attendance at CME programs of medical associations when the topics are related to psychiatry. But what about clinical skills? CME programes are only lectures and I don’t know how doctors will learn the clinical skills of mental health care.

Unless the MCI mandates that clinical skills have to be learned, the students will not be able to do so during MBBS. After MBBS, even if they want to pick up these skills, who will teach them? Technical knowledge in psychiatry can be picked up in the CMEs but clinical skills have to be learnt during undergraduate clinical training only. So our MCI should include testing of clinical skills in psychiatry and psychology during exams. Then there is a higher probability that students will imbibe these skills. Leaving market forces to create motivation for this learning is not the right approach. I hope the MCI will oblige.

" Depression in young adolescents" A review

CITED AS-

KULHALLI, V.. Depression in Young Adolescents. The Indian Practitioner, [S.l.], p. 63-65, aug. 2015. ISSN 2394-3017. Available at: <http://theindianpractitioner.com/index.php/tip/article/view/77499>. Date accessed: 14 Sep. 2015.

http://theindianpractitioner.com/index.php/tip/article/view/77499

CHIKITSA AROGYASEVANCHI

This book is written by my respected colleague Dr Shyam Ashtekar.

It is a well researched, logically thought out book about the problems and possible solutions for improvement of health sector in Maharashtra.

I rate the book very highly in terms of its presentation, scholasticism and timeliness. This is not only due to my personal regard towards Dr Ashtekar. I welcome other persons to read the book and give the review.

The content of the book is very practical and utilitarian- a sort of field guide for politicians, policy makers, observers, researchers and students of health care sector. A superficial reading can also inform the reader about many facts and facets. A deeper reading can give a snapshot of todays reality.

Dr Ashtekar's effort is commendable. Rarely does anybody take so much effort- if taken up early and in the right spirit- the system can really be improved beyond imagination- Yours and mine.

Book details- CHIKITSA AROGYASEVANCHI
Granthali publication.
Available in most book shops in Pune and Mumbai and by order from www.bookganga.com

Writing for a news-paper

Nowadays I am writing a regular column for the newspaper 'Loksatta' and my colleagues want to know more about this writing process.

About 3 years ago, I wrote my first article for a newspaper and it was on 'depression in menopausal women'. I think my first boss, Dr Harish Shetty refered my name to the editor. I was very hesitant to write in Marathi. So the first time I sent the material in English and she translated it for me. The article came out very well. My concepts and her translation- an excellent combination.

Thereafter slowly I began to get requests to write more articles. But now I had to write in Marathi itself- another challenge. I speak Marathi very well but writing and typing was another thing. Generous use of dictionary and Google transliterate solved the problem. And the excellent editing inputs- 'kept the technical points at the same time maintaining the readability of the article' (in the words of one of my colleagues who was kind enough to review and give feedback).

I get a small honorarium for my efforts. I have never had to pay for getting articles published. In the initial years I did approach some newspapers with articles; but I learnt that writing is their job and they really dont need any articles from us. So I stopped sending such requests.

After writing articles, many persons and patients have contacted me for their troubles. This works both ways- I get some work and patients get to know where to find the person who can understand their problem and give them treatment. Somehow it adds to my credibility, so just by writing articles now I am supposed to be a better doctor also. Maybe now, that my thinking and knowledge are public- the judgement about my competence is easier. Or that the public is counting on the newspaper to have chosen 'only a competant doctor' to write.

I take my writing very seriously. I read all material on the subject. I review all patient histories relevant to the topic. I am meticulous about sticking to deadlines and word- limit. And I check what I have written. But of course I am not a writer- and my editor always manages to give a wonderful makeover to the article, putting the most appropriate words and phrases. Journalists are wordsmiths- and I have been lucky to have been guided by the best of them in writing my articles.

I feel it is a very good opportunity to revise the topic, learn new things and a different way of serving patients. I have really learnt a lot and will continue to learn from this experience. And I really agree that the written word has the unique power to communicate, impress, give relief and bring change.

Responding to 'Private healthcare providers.........revenue generators' in BMJ

http://www.bmj.com/content/350/bmj.h826/rr

TREATING 'CELEBRITIES'

Whenever my classmates hear that I practice in the Western suburb of Mumbai, they are keen to know which celebrities I have treated. This is because most of the Bollywood live and work in the Western Suburbs of Mumbai and there is a higher than usual probability of any doctor encountering one as a patient.

Well the first point is: I have to disappoint my classmates as I cannot name any patient due to my very uncompromising stance on patient confidentiality. Secondly, they get disappointed to know that famous people are not very different from 'non famous' patients in any way. Like all other groups 70% are just usual people who need treatment while 30% are unnecessarily troublesome. And that they suffer from much the same illnesses, side effects and concerns.

 I prefer not to treat famous clients generally. The main problem is: my time-management goes for a complete toss. Famous clients have round the clock comitments and they though they try hard to maintain control- sadly it is never possible. So the 6 o clock appointment becomes 7, then 8 then 9 and so on. Then for being able to accomodate their crazy schedules I have to reschedule other appointments- this I hate doing as I value all my patients equally. Well some famous folks feel very bad- and as they feel that everything can be set right by money and that is one thing they have in plenty- they try to pay the therapist an 'hourly charge'. But really its not about the money- the genuine therapist is also like a performer- I set an agenda for consultation and am eager to do it at assigned time. Waiting is like a 'false- start'- it causes me to lose the sharpness and interest in intervention.

Some famous people are pitiably foolish. They want their doctors and therapists to be in awe of them and wait at their beck and call. But this is very counter productive as medicine is a profession which requires human judgment based on objectivity. Maybe the famous person gets easy access to the therapist, can bully the therapist- but this causes subtle and sure harm. So we read about doctors who have been prescribing ever higher doses of sleeping pills because patient demanded, or got into relationships with patients because they were not able to assert their limits. The danger of thinking famous people are different is very real- both for patients and their doctors.

THE NEW FRAMEWORK OF PRACTICE

Historically the medical profession has evolved from- faith healers, barbers and 'gurus'. Thirty years ago there was not much specialisation and the average doctor was required to treat all kinds of disorders and patients of all ages. Now is the era of specialisation. We have to become aware of our changing role in this context.

Doctors are supposed to carry on their work sincerely and quietly- active advertising for patients is forbidden. Though many doctors get upset with this rule- it is better that a patient comes out of his/ her own conscious choice. Patients come to doctors with many agendas- least of which is to recover from illness. This may vary from seeking reassurance, wanting certification, making enquiry, expressing concern and sometimes- even to size up the doctor. Doctor should therefore be alert to these undercurrents and not automatically presume that patient accepts everything that the doctor offers. So it is important to communicate clearly and explain to the patient about procedures in clinic- including the process of history-taking and proceed only after patient agrees.

Healthcare is called 'service-industry'. Only a fraction of patients need 'physical' service like injections, physiotherapy, dressing, surgery, etc. Majority of patients only avail of advice. Thus almost all doctors are 'medical advisors'. The doctor advises you about your condition, its treatment and also care to taken at home. The 'management plan' as it is now called- is different for every patient and is arrived at by collaborating with patient. So one patient of diabetes prefers to exercise in a park while another will go to the gym.

This is the essential change in framework of medical practice. A doctor can no longer pretend to be 'omniscient' provider of all solutions. The medical practice is never akin to laundry- where the patient drops his spoiled health and picks up freshly made one for a fee. Medical practice is more like a school where the patient receives guidance about how to solve the immediate problem and also how to prevent further occurence of problems.

Doctors should be conscious of this change and guide their patients about it.