BEING DOCTOR

 
Contents
A guide to wellbeing of medical students. 3
Making adjustments to college life 4
Tips to avoid procrastination 6
Planning your study schedule 6
Other tips for efficient study planning: 6
4R technique for studying 7
Introduction to the subjects 7
Here are some tips to help you study human anatomy: 7
Tips to help you study physiology: 9
Tips to help you study biochemistry: 10
Tips to help study pathology. 11
Tips to help study forensic medicine 12
Tips to help study surgery 12
Tips to help study OBG 13
Tips for other subjects 13
Ophthalmology 13
Medicine. 14
Ortho- 14
Paediatrics 14
ENT: 14
PSM: 14
MBBS SYLLABUS 14
INTERNSHIP 16
Other Study TIPS 16
How to handle examination stress 18
Before the exam: 18
During the exam: 18
Bullying, discrimination and ragging in college. 19
Interpersonal relationships 21
Mental wellbeing 21
Signs of emotional distress 21
Suicidality 23
How to be an ally 23
Self-care 24
Staying motivated 26
Mentoring 27
Dealing with difficult people 28
Things you may not learn in college 29
Untold parameters of student evaluation 29
How to pick a medical speciality that’ll keep you happy your entire life? 31
Advice to residents 33
TRANING OF DOCTORS 35
NOTES ON COMMUNICATION WITH PATIENTS 35
ELECTRONIC MEDICAL RECORDS 36
BULLYING IN MEDICINE 36
Good and honest communication saves lives 38
Defensive medicine 39
FIXING DOCTORS FEES 39
Doctors and books of accounts 40
DETACHMENT AS TOLD IN MUNNA BHAI MBBS 41
COMPASSION 41
EMPATHY 42
POLICY OF MCI INDIA 42
TWO MINUTES CONSULT 43
END OF LIFE DISCUSSION 43
TELEMEDICINE 43
OATH 44
PROVIDER 44
HEALING 44
DOCTORS FEE 44
BREAKING BAD NEWS 46
Fee splitting 47
GOALS OF TREATMENT 47
HOW TO SPEAK IN A CONFERENCE 50
Ten commandments for budding doctors. 50
FREEDOM FOR DOCTORS 51
Getting into Doctor’s Mind 51
Golden Words to every doctor 52
Good doctor 53
What is Good medical practice 56
HEALING the Doctor- Patient Strife 57
BRUTAL TRUTH 58
How to Get the Most Out of a Doctor’s Visit 59
Lifestyle of a doctor 60
How do you approach reading a paper in a journal? 61
TRAGEDY OF INDIAN HEALTHCARE 61
IS THERE A DOCTOR IN THE HOUSE? 63
RUDE DOCTOR 64
Senior Doctors Need to Reinvent Themselves 65
Stepwise duties of a doctor facing a dead patient: 66
KNOW YOUR STHETHOSCOPE 68
Six strategies for violence in health care 69
VIP PATIENT 69
What is unethical…??? 70
Why say no to consumer court? 71
IMPASSE 71

A guide to wellbeing of medical students.

All the doctors realise that the first five to six years of life inside a medical college are crucial in fulfilling the dream of becoming a doctor There’s no denying that it requires a demanding schedule. So, it is of utmost importance that you know how to go about it in a prioritised scientific way. How you study will be of importance, for which your physical, mental and spiritual health will be important, along with how you are able to socialise and get along the medical school
Therefore, during this time, it is important that you take care of your health. Good health is the first and most important requirement for you to perform well and enjoy your years as a student. And this includes taking care of your mental health too. It is not uncommon to feel the stress of a tough curriculum, frequent examinations, demanding study calendar, and the struggle to find time to unwind. Sometimes the strain can adversely impact your regular levels of functioning and lead to a mental health issue.
The purpose of this health and wellbeing guide is to provide medical students — especially the first-year students adjusting to a new environment — information, strategies and resources for self-care as an essential part of their undergraduate life.
The suggestions are not meant to be prescriptive. They are intended as examples that have been drawn from research, training, and student support programs that other medical students have found useful. The topics discussed and the insights presented are not a panacea to all problems faced by a medical student; they only serve as possible solutions to the most common challenges encountered. Everyone will have their own unique approach to processing information from this guidebook. Some might prefer to read it all at once, some at different points through the course of a year, others might prefer to read it with friends and discuss the topics amongst each other, and there may be those who would like to make notes. Feel free to use this book in any way that suits you best.
We hope you find this information useful and relevant. If you feel like you are experiencing difficulties of any sort that are listed here, please ask for help – there are many people who can help you. There is no shame in asking for help – it is one of the most courageous things you can do. This guidebook is just one way of promoting a culture of self-care among medical students and will hopefully inspire institutions, policy makers for undergraduate courses, and teachers to broaden the scope of student wellbeing strategies. We welcome comments and suggestions to improve this guide, your inputs will make this a more relevant document for you.
Your time at medical college can be fun and exciting despite the workload and pressure.
While most content here is relevant for all medical students, in a few chapters we have particularly focused on the stressors that first year students face. As you begin your journey, the new environment can be challenging. Knowledge and a little discipline can enable you to stay ahead of the challenges. Senior doctors have also provided some of the ways to study some of the more academically challenging subjects that you will encounter in your first year to final year
The transition from school to college can bring with it a new set of challenges – being responsible for your own activities, managing your time, preparing for exams, dealing with seniors and forming new relationships. In this section, we cover the struggles you are likely to face on entering medical college and offer you some guidelines that could reduce the stress that they may lead to.
Making adjustments to college life
Independence:
Direct scrutiny from parents and teachers will be reduced, especially if you are living away from home. With this independence comes the responsibility to manage your education and life autonomously.
Waking up on time by yourself
Setting time Allotting time for to study hobbies/ interests/
Cleaning your space and doing laundry
Following hostel rules and regulations
Social life
Relying on hostel food, eating at the right time
Interacting with new people
Adjusting to lack of space or time for yourself
Managing your finances (Planning expenditure to include food, hygiene products, emergency funds, stationery, etc.)
Academics: You are in charge of attending lectures, doing classwork, completing projects and self-study, all without direct supervision from others. Ensure that you balance your time for work and leisure appropriately.
Information Overload: Academics in university is different from school. The amount of work/ reading that may need to be done may seem endless. The subjects may have a broad syllabus. Having a planned reading habit will help cover it. Take suggestions and support from your mentors and teachers to ensure that you are studying the right things from the start. Also remember that you may never ‘know it all’ and that is okay.
Alternative activities: There may be multiple clubs and activities within the university that will interest you. Maintain a good balance of physical exercise and other activities.
Socializing: The time you spend socializing with friends increases dramatically when you are in university. Create a schedule that works for you to manage your responsibilities as well as your socializing. Use applications (apps) to help with routine setting and expenditure planning.
If you’re moving to a new town or city, you may be exposed to a whole new culture and way of life. The changes could vary – with everything from a different climate; new cuisine; a language you don’t speak; and different social customs.
Here are some ways that you can deal with these challenges:
• Read about the town or city that you’re moving to
• Get in touch with people you know or friends you already know in
your hostel or college
• Approach the student welfare division of your college if there is one
• Consider joining an activity club that interests you, such as arts,
sports, debating, quizzing etc
Time Management
Making the transition to college brings with it the responsibility of managing your own time, with no one to tell you when to do what. Managing to get all your tasks done can be accomplished by creating a time management plan.
Ideally, your plan should include all of the activities you perform in a day. These can be divided into commitments, personal time, essentials and housekeeping.
Classes
Extra-curricular college activities
Grooming/hygiene Hobbies
Commitments
Work
Calling family
Personal time
Socializing Browsing internet
Essentials
Housework
Cleaning the house
Exercise Commuting
Leisure Shopping
Eating
Sleeping
Cooking Laundry
Washing dishes Paying bills
You can make a similar table for yourself according to what your activities are. Be sure to allot a realistic amount of time that you will need for each task. To do this, you can try logging the amount of time taken per task in a diary for a few weeks.
You can also divide some of the tasks according to how often you need to do them. For example, hygiene is an everyday activity, but laundry can be done once a week.
Tips to avoid procrastination
Procrastination is avoiding or postponing a task despite there being a deadline. You may be faced with the situation of being overwhelmed with large portions of syllabus in front of you. This could discourage you and lead you to procrastinate. Here are some tips that will help you tackle this:
• Starting off your study routine can pose as a major challenge. To avoid this, start with a smaller task even if it isn’t a priority.
• If there is a particular task that is daunting you, try to break it down into smaller, achievable tasks.
• Reward yourself after a few tasks by watching an episode of a show you like, reading a few pages of a novel, or stepping out for a walk. Be mindful that one episode does not become two, and a few pages do not become too many.
• Make sure you create an environment that will help you concentrate. This includes studying at a time of day that suits you depending on whether you are an early bird or a night owl.
• If you’re feeling more active, seize the opportunity and tackle a harder task.
Absolutely urgent, (high importance), Better do it soon, (medium importance),
Planning your study schedule
Studying for medical college can be very different from studying for school or pre-university. You will need to make optimum use of your time to keep up with the change. One of the ways in which you can accomplish this is to make to-do lists and prioritize your tasks into the following groups:
Can wait
As and when the priority level of the task goes up, it can be moved to a group of higher importance.
Pomodoro technique
The Pomodoro technique helps you break your work into intervals using a timer. There are plenty of free apps available to employ this method:
• Make a list of tasks
• Choose one and set the timer to 25 minutes
• Work on the task until the timer rings
• Put a checkmark against the task
• Take a five-minute break
• After every four sets (where one set is 25 minutes) take a 20-minute break

Other tips for efficient study planning:
• Read the course curriculum: The curriculum will have essential information on what you need to study, why you need to study it, how to study it and how you will be tested at the end of the course.
• Organize your study resources: Identify the right resources. Talk to your teachers, seniors, and friends and choose the right resources. The number of books you study will not matter if they are not the right books.
• Read before class: You can benefit most from a lecture if you have surveyed the topic in your textbook before the class. Spend 15 minutes to scan the key concepts, look up unfamiliar terms, and identify what you need to learn from the class.
• Plan self-assessment: After studying, plan a small test to assess yourself to check what you studied and where and how it can be put to use. This will also allow you to recognize what you are having trouble recalling.
• Recall: Make it a habit to briefly recall whatever you’ve studied previously before you sit down to study the topic you were taught that day. The more you recall, the more you retain.
• Look for connections: All of your subjects are interconnected. Relate what you learn in physiology with what you have learned in anatomy and biochemistry.
4R technique for studying
Remember the four ‘R’s:
Read
Recall
Revise and
Repeat until the objectives are achieved

Introduction to the subjects
Studying biology in school or pre-university is very different from studying medicine in college. There are only three subjects that you will study in the first year and they will all be taught in great detail. Many students find this change in syllabus hard to adjust to and feel overwhelmed. Here’s a brief introduction to the subjects and some tips that will help make it more manageable.
Human anatomy in its broadest sense, is the study of the structure of an object; in this case, the human body. Human anatomy deals with the way different parts of human beings — from molecules to bones — interact to form a functional unit.

Here are some tips to help you study human anatomy:
During first year, the subject that worried me the most was actually anatomy. It’s not that I didn’t love it, but because I wasted a considerable amount of time during the beginning of the session which is why I had a problem grasping the subject. But I survived. Finally. Here was my approach.

Before starting Gross Anatomy at all, I went through general anatomy first. I preferred General Anatomy by AKD. Although diagrams are not so reader friendly, still the theory is understandable. Only after that I started Gross Anatomy

Coming to the books, I was told by my teacher that BDC is an MCI recommended book, which means questions in NEET-PG would be strictly based on this book. Since I was not so overwhelmed about anatomy, I decided to follow BDC for theory and diagrams and Vishram Singh for extended theories of important topics (sometimes AKD also) only.

First, I tried to be thorough with the bones. Only then I could proceed further. First, I roughly read the bone and then I drew a rough diagram of the bone and the bony features and shaded with colour, the areas of attachment. This helped me a lot. Although in the beginning it seemed to be tough, it finally became very helpful in MB. When reading and understanding the attachment, I consulted Netters Atlas, and while drawing, I strictly confined myself to the illustration scheme of BDC.

Then I started with the theory, the clavipectoral fascia I remember if I’m not wrong. It had become one of my favourite habits to draw and study. While reading the theory, I referred to Netters Atlas and while drawing, as said before, strictly BDC.

Embryology happened to be my favourite part. I prefer Langman, however if you want to strictly study exam oriented, IB Singh embryology (and histology also) is enough.

Not only that, I joined a tuition since I was not confident enough at first. Sir gave us notes that were beautifully compiled and the content was more than that was needed to get honours.

While studying course of nerve or artery, it would be very convenient if you can roughly draw the divisions and label it accordingly.

Coming to writing answers, you have to be very systematic with appropriate headings. Let’s say you are given to write a short note on the sternocleidomastoid muscle. Therefore, you should write it under the headings: Introduction, Origin, insertion, nerve supply, blood supply, action, testing, peculiarities and applied. Again, let’s say median nerve is given, therefore the headings should be: Introduction, course, termination, branches, peculiarities and applied. Similarly, for joints: Introduction, type of joint, sub-type of joint, bones forming joint, movements permitted, special features, ligaments and cartilages involved, bursa if present and applied.

While writing answers, I made it a habit to draw diagrams wherever necessary. Also, write clinical and applied anatomy wherever possible. I remember writing even the drug needed to treat Bell’s palsy, Prednisolone 30mg in a short note of extracranial part of facial nerve, which was excessive XD

Before exam, make sure to consult the previous year papers to understand and be familiar with the pattern of questions in your college.
Coming to practical’s, let me come to the fact. It’s never possible for 10 students to properly study the cadaver when the demonstration is being done by the teacher. You should always visit the Anatomy lab during free period and study the cadaver yourself, the better u study, the better results you get in future. I would suggest you to take the McMinn clinical Anatomy Atlas along when you go. Most of the time it works, since the condition of the cadavers are not A class in most cases. After you learn the structures, you can demonstrate them to your enthusiastic batchmates which would again benefit you. Never ignore small and scoring topics like Radiology, surface marking and cross section. They are very scoring. Pay attention in your histology classes to be able to understand and describe histology slides. Still, sometimes identifying a particular slide can be really confusing. But you shouldn’t worry about that. Everyone makes mistakes.
While studying, study intelligently using charts, diagrams, flowcharts etc. Use different apps for anatomy when you are at home like Essential Anatomy, watch videos from Ackland. because sometimes they could be easier to decipher than a real-world cadaver, moreover sometimes it’s the qualitative study that matters 🙂
• Categorize each bone by type, the joints formed by it, identifying the type of joint to describe and demonstrate the movement occurring at that joint.
• Practice surface marking on the cadaver; compare it with living anatomy by repeating this on yourself or your friends (after having taken their consent!).
• Never miss a dissection class, and chance to dissect. See the dissected specimens in all the dissection tables.
• Remember that in the first-year all you are expected to do is identify the normal anatomical structures in the X-ray, and none of the abnormalities present – so try and avoid being a radiologist this early in your MBBS course.
Physiology is the scientific study of the functions and mechanisms that work within a living system. As a subdiscipline of biology, it focuses on how organisms, organ systems, organs, cells, and biomolecules carry out chemical and physical functions in a living system. Several basic skills relevant to becoming a physician are introduced in the course – clinical examination skills, understanding laboratory tests and problem-solving.
• Tips to help you study physiology:

I may be wrong but what I have seen is that, people read this just to pass the exam and only before exams. The title of the chapters looks quite familiar and people started thinking its class 11th physiology that we have read in the past. It can be easily done before exams. Kindly don’t think this way. It’s really huge and worth to learn to have a better understanding of higher subjects.
Follow standard books: Start your study with a good book like Guyton and try to finish it (it’s doable). It’s really worth to spend that much time in physiology. You will bless me when you will read pathology. We are so much pre occupied in anatomy that we sometimes forget physiology is also a subject. Kindly start with Guyton or AK Jain. Consistency Matters: Read it throughout the year (like anatomy) and try to build the concepts, have a learning attitude. If possible, prepare your own notes, if not, mark in book.
• Attend classes: Classes are important to ensure that you are on the right track. Be in touch. Attend regular classes.

• Practice skills and procedures during practical/laboratory classes. The more you do, the more you relate it to what you learn.
• Look for connections. Physiological systems are interconnected. Relate what you learn in one section of physiology with what you have learnt in other contexts.
• Learning how a healthy body functions provides the framework for understanding mechanisms and consequences of disease and the basis for managing them. Think of it largely as a systems-based approach to biology with a smattering of physics.
Biochemistry is the application of chemistry to the study of biological processes at the cellular and molecular level.

Tips to help you study biochemistry:

Harper is one the best textbooks I have ever read. Very clear in concepts. Though you may need additional books too. Vasudevan is a good Indian author. Or use any other book which your seniors recommend since your final professional paper is to be set from it. Keep reading books regularly and make notes for last minute revision. Those notes actually help for the small topics which would otherwise get ignored for the lack of time later. Lippincott if you like the 6th standard textbooks with big text and lots of images and very simple language. Try reading conceptually. Concepts remain for long. Rote or’ Ratta’ remains for like, what? 2 days?
Attack strategy: See the questions of previous years papers and mentally write answers to them. What points should be there to this question? Always remember, teachers need the main points. And write according to marks allotted to that question. And if you make a diagram, the teacher is bound to fall for the answer. Always try drawing one.
Practice of the above: see last year’s question papers and make notes of the important questions repeated over. You can also do MCQ’s relevant to the topics you study.
Attack strategy: My answer should have all these points, along with a diagram and should be self-explanatory. Viva questions should be answered in brief and to the point only. Do not add information you are not 100 percent sure of. Half knowledge is going to get you killed in the viva. Answer smartly and don’t vomit out the book.
Confidence. Key to everything you do. Needs to be kept so that the hard work doesn’t go down the drain.
Real life situation: all the above are like the standard guidelines I would like to follow. But not everything can be done. Even I couldn’t do all of it. Just do the maximum possible. Of course, having fun during MBBS is also very important. Enjoy and work hard.
• Use colours and highlighters. For example, write all the substrates in red, all the products in blue, the energetics in black, enzymes in red and coenzymes in green. Follow the same set of colours for all the pathways that you’ll learn in the first year.
• Always start with writing the site of reaction – which organ or organelle is it happening in? Are there any exceptions? Highlight any anomalies and the key enzymes.
• The reactions in every step are pretty simple, usually involving oxidation, re duction, dehydration and carboxylation. Use the knowledge that you’ve learnt before and mention the type of reaction next to each step.
• One can also make tables for various vitamins, minerals, storage disorders, metabolic pathway defects and draw simple figures for transport mechanism and acid-base balance.
Tips to help study pathology.
Pathology will require one hour of your prime study time every day of the second year. Pathology is the subject of second year.

TIME: I would recommend studying for four hours each day and giving one hour each to Path, pharma and micro additional one hour can be devoted to studying the clinical subject that you are attending postings for. Forensic won’t require more than an hour or two every week, that too when you get sleepy.
TIME AGAIN: what time to read? I would suggest reading soon after the classes for the day are over. Most students go and sleep after classes are over, this is not a good habit. By all means take a break, but try to get to reading table at the earliest.
PLACE: Have a regular place to read, I strongly recommend library or the external reading room. Hostel room or your home will have lots of distractions and you will likely lose focus. Sit at a regular place, preferably within eye line and earshot distance of the librarian’s seat. This ensures that your friends or acquaintances will get barked at by the librarian when they try to disturb you. Having a regular desk or table is important. Treat the place with reverence. This is why I recommend reading in evenings soon after class as you can use the library effectively in evenings, it tends to get crowded as the day progresses.
BOOKS: Robbins pathologic basis of disease is the book to read, do not listen to anyone who will say otherwise. Senior log who are yet to finish MBBS always advice reading basic pathology or Harshmohan or pathoma or some other book, DO NOT LISTEN TO THEM. Importance of reading Robbins becomes evident only after MBBS is completed and one starts entrance preparation earnestly. You can add more books to the mix like Underwood (very British, very English and also surprisingly easy to understand, such an underrated book IMHO), Illustrated pathology by Mcfarlane, Walter and Israel for general Pathology, Bhende for general pathology. Chandrasoma and Taylor is also a good book. Whenever you feel there is a difficulty in understanding what Robbins says, go to these books as per your preference, one cannot buy all these books, that’s why go to library often.
READING AND WRITING: before beginning reading for a chapter, go through previous question papers in pathology or a question bank. This will allow you to know which are the important topics that keep repeating. Sensible examiners do not ask questions on cardiomyopathies to undergraduates, I am interested in knowing your knowledge about Myocardial infarction and rheumatic heart disease. I have limited time and limited number of questions to ask, my aim is to find out if you know your basics well, not if you are AIIMS material, we will do that during entrance. This leads us to asking about MI, RHD and endocarditis frequently than some rare cardiomyopathy or heart transplants. Now survey the chapter and find out where these topics are within the text, brush through them, see the pictures, it must take 10–15 mins. Then start reading, your mind will focus on finding answers to questions you just read. Keep making notes as you go along.
NOTES: Keep a hard bound 200 or a 300-page notebook, preferably ruled one, don’t skimp on it, buy a durable book, which will last for 5 years. YOU’LL NEED THIS BOOK IN FINAL YEAR AND DURING ENTRANCE PREP, hence invest in a good book, remember all the books I told you about earlier, read from them if you’ve difficulty with Robbins, make notes from them, you can’t keep opening half a dozen texts again and again to read same topic. Make neat notes, notes must be heavy on diagrams and flow charts, try to make your own flow charts, make mind maps. Use colours, to highlight important points. Mark stuff that is important for PG entrance.
REREAD: read what you’ve written at the end of session, read it at night before going to sleep, if you feel it needs additions go back next day and do them, add a sticky note if there is no space. Reread it again during weekend and end of the month. This note must be detailed enough to get you through exams.
PRACTICALS: they are important for all purposes, most are repeats of first year physiology, what changes is the introduction of clinical context, you need to remember causes for abnormal values and know why there is increase. practical exercises are the first step in understanding of clinical interpretation of laboratory tests. Gross pathology/morbid anatomy and histopathology can be understood only if you’ve revised the topic beforehand and gone through an atlas or pictures in Robbins pathologic basis of disease. Read after the class as well, preferably at the earliest, the same day.
Tips to help study forensic medicine
Every subject in mbbs, no matter how small or vast it is, no matter how disgusting it may seem, plays a part just as important as the other subjects in the building of a doctor. I admit, a second prof student, already burdened by 3 major subjects, would indeed find it tempting to question the existence of forensic in the mbbs curriculum, but only when one works in the hospital will one be able to appreciate its importance. Knowledge of forensic medicine is not at all optional, it is absolutely ESSENTIAL. It may so happen that you don’t have to recall the concepts in professional life, but if the situation demands it, you have to be absolutely faultless else the entire charge may shift from the convict to you. If you don’t know that you have to record the dimensions of a wound before suturing it, if you cannot differentiate between suicidal and homicidal injuries, if you are not aware of the fact that you have to inform the local police station when a patient who has consumed “BAYGON” has been brought to the emergency room, then you are absolutely doomed. So, think of forensic as a necessity, and since most doctors neglect it during their formative years, you can jolly well be an advisor to your colleagues when they get into trouble, if you build a fair conception in the subject from now on.
I studied three books: Reddy, R.N. KARMAKAR, and GAUTAM BISWAS. The reason for not putting Reddy in bold is that even though it is the oldest book on the subject, the information is very clumsily arranged. Better study R.N. KARMAKAR which has actually data identical to Reddy’s. However, make GAUTAM BISWAS your textbook since it is having a student friendly layout. Whenever you read a chapter, simultaneously consult karmakar, and if there is any data in g biswas that doesn’t match with karmakar, consult the latter.
Regarding offences and their INDIAN PENAL CODES and CRIMINAL PENAL CODES, whenever you encounter one, just note it down in a separate notebook. By the end of the year you will have 10 pages full of IPCs, and just revise that before the examination be it prof or pgmee.
Tips to help study surgery
I hope that you read Bailey & Love, S. Das Clinics before.
You need to read Manipal’s surgery book for exam
plus Dr. M.L. Saha’s book for all purpose.
For Orthopaedics there is nothing to do but read Maheshwari plus minimum Perthes disease from Apley.
If you can read Bailey & Love full book definitely that is great but possibly time is a big factor to think.
Schwartz has good charts for writing long exams in exams. List the long cases & short cases. Practice writing faster mocking real situation.
Surgery Viva –
Most dreaded exam for sure. If Surgery’s long case becomes Orthopaedics, after few questions, Surgery’s long questions will be asked. Nothing to fear. Dr. M.L. Saha’s book helping in questions on clinical cases.
Xray, Instruments for Orthopaedics is not less. Except department’s class not much to do.
Xray, Instruments, viscera for Surgery – Dr. M.L. Saha’s book
Surgery Viva Tips:
Do not say wrong on assumption, add “as far I can” for safety. Hernia, Hydrocele are favourite topics.
Tips to help study OBG
First choose your book and stick to it no matter what….
I studied in both Dutta and Mudaliyar, Shaw…. Never make that mistake…
Get Mudaliyar and Shaw and study that…. Dutta is good but it will not be in a sync…You will get confused with topics and finally will land up in studying everything and knowing nothing….
First note the important practical cases topics study top to bottom and take notes so that it will be easy for you when u revise before final exam….
As far as theory concerned…Read the Obstetrics book i.e. mudaliyar like a newspaper…. just go through…. You will get an idea…. imagine each and every topic while studying…You will never forget. make flow charts for treatment part…. For gynaecology study important topics for e.g. infertility, abnormal uterine bleeding like that first…. make chart for staging of ca cervix, endometrium and ovary and also classification….
OBG is the easiest and you will never hate it….revise nicely…..before exams take index have a look qt topics and revise it….mainly take previous university questions and mcqs and work it out….Mostly book back mcq’s and previous year mcq’s will do….This is more than enough for scoring top marks…

Tips for other subjects
Ophthalmology: The questions in this subject, I personally find hard to answer. You should practise them by writing. Try to prepare flow charts for important topics. This will help you to quickly revise the day before the exam.

Cataract, Conjunctivitis and Glaucoma should be tip of tongue!
Medicine.
I would suggest good readings of Davidson (because that’s the ‘standard’ book). If you’re the kind who’d like to go a bit more in-depth into systems – then Kumar & Clark is also good. Don’t waste efforts on Harrisons.
Ortho- You can select either Maheshwari or Ebnezar- I went for Ebnezar because it was a much more interesting read.
Paediatrics- OP Ghai is a must read. You should set a target of 10-12 days per subject for the first ‘fast’ reading- when you just go through to get a vague idea- and start highlighting important sections of the texts.
second reading- approx. 15-20 days per subject- more than enough to make notes from the highlighted section earlier. this is also when you should try to ‘understand what you read. Do not waste time on portions that you find really difficult, – move on to the next topics, and finish the second reading. Whatever you have read will be in your head, and you will feel lighter during subsequent readings.
Third reading – this is also a ‘recall and learn ‘ phase – with 10-12 days per sub.
remember- not to let too many days gap in between readings, the more readings the better.
Also remember to learn at the wards, and prepare to carry out patient examinations in the time limits.
By middle of your final year- you should aim at finishing 2 readings at least (and going on the third)
by exam time- you will find yourself more at ease with the subjects- and by then since you will have your notes ready- it becomes easier.
ENT: This subject is light to study. ASOM, CSOM should be tip of tongue! Don’t miss to read the surgeries at least twice before the exam. Diagrams in ENT are quite easy to remember and require less efforts.
PSM: About this subject, you should have common sense to handle the question. Important communicable diseases, all non -communicable diseases and govt. schemes should be the first priority. Epidemiology part is equally important.

MBBS SYLLABUS

ANATOMY
Gross anatomy, Microanatomy, Embryology and Genetics, Neuroanatomy
PHYSIOLOGY
General Physiology, Nerve–Muscle, Blood, Respiratory System, Cardiovascular System, Gastrointestinal System, Nutrition, Environmental Physiology, Reproduction, Kidney, Neurophysiology, Yoga
BIOCHEMISTRY
Biological cell, Biomolecules, Enzymes, Metabolic pathways, their regulation and metabolic interrelationships, Food assimilation and nutrition, Hormones, Molecular Biology, Molecular Biology, Immunology, Environmental biochemistry, cancer and cancer makers
FORENSIC MEDICINE AND TOXICOLOGY
Forensic medicine and toxicology
MICROBIOLOGY
Microbiology, Bacteriology, Bacterial Staining and Cultivation, Common Tests for Bacterial identification, parasitology, Virology, Laboratory Diagnosis of Viral Infection, Mycology, Common Laboratory Methods for Diagnosis of Fungal Infections, Collection of Transport of Samples, Host-Parasite relationship, Bacterial and Viral Genetics, Immunity to infection, Immunodiagnostics, Vaccines, Sterilisation and disinfection, Bacteriology of water and air, Microorganisms associated with gastrointestinal infections, Gastrointestinal infections caused by parasites
PATHOLOGY
General Pathology, Systemic Pathology, Practical
PHARMACOLOGY
General Pharmacology, Autonomic nervous system & Peripheral nervous system, Central nervous system, Autacoids, Cardiovascular system, Gastrointestinal and respiratory system, Hormones, Chemotherapy, Miscellaneous
ANAESTHESIOLOGY
Preoperative evaluation & optimization, Skills I/V, Cannulation, Oropharyngeal/Nasopharyngeal Airway insertion, Bag Mask Ventilation, attaching pulse oximeter, BP cuff and ECG electrodes and setting up a monitor
COMMUNITY MEDICINE
Behavioural Sciences, Health Education, Environment, Biostatistics, Epidemiology, Nutrition, Maternal & Child Health, Rehabilitation, Epidemiology of Communicable Diseases and Non-communicable Diseases, Important National Health Programmes, Occupational Health, Health Administration, Health Economics, Geriatrics, Counselling
DERMATOLOGY
Ineffective dermatoses, Infective dermatoses, Infestations, Melanin synthesis, Allergic disorders, Drug eruptions, urticaria, erythema multi-forme, Vesiculo-bullous diseases, Epidermopoisis, Psoriasis, Pathogenesis, Syphilis, Gonococcal and Non-gonococcal infections, HIV infection, Dermatological Emergencies
MEDICINE
Clinical Pharmacology, Nutritional and metabolic disorders, Water, electrolyte and acid-base imbalance, Critical care Medicine, Pain management and palliative care, Medical Psychiatry, Poisonings, Specific environmental and occupational hazards, Immune response and Infections, Cardiovascular system
OBG
Basic Sciences, Obstetrics, Gynaecology, Contraception, Neonatology and Recent Advances
EYE
Microbiology in relation to eye, Pathology in relation to eye, Pharmacology in relation to eye, Disorders of the Lid, Disorders of the Lacrimal Apparatus, Conjunctivitis & Ophthalmia Neonatorum, Trachoma & Other chronic conjunctivitis, Keratitis and corneal ulcers, Corneal ulcer, Scleritis & Episcleritis
ORTHO
Paediatric orthopaedics, Orthopaedic oncology, Management of Trauma, Sports Medicine, Physical Medicine and Rehabilitation, Orthopaedic Neurology, Disorders of Spine, Radiology, Fracture
ENT
Oral cavity and oropharynx, Ear, Instruments, Operative Procedures, X-ray
PEADIATRICS
Vital statistics, Growth and development, Nutrition, Immunization, Infectious diseases, Haematology, Respiratory system, Gastro Intestinal Tract, Central Nervous System, Cardiovascular system, Genito-Urinary system, Neonatology, Paediatrics Emergencies, Fluid-Electrolyte, Genetics, Behavioural Problems, Paediatrics Surgical Problems, Therapeutics
PSYCHIATRY
Behavioural Sciences, Emotion and its application to health, Cognitive process and memory, psychiatric disorders, personality disorders, Schizophrenia, Bipolar disorders, Depression, Anxiety neurosis, phobia and OCD
SURGERY
Skin, Head and Neck region, Arteries, Veins, Breast, Oesophagus, Stomach and duodenum, Small intestine, Colon and rectum, Appendix, Acute abdomen, Urology
INTERNSHIP
There is one-year internship for MBBS course, it is extremely essential that candidates complete their one-year rotatory internship. When candidates are under the internship period, they will be provided with a hands-on experience of how things work in their field. They will also be taught how to maintain inter-personal relations with their patients. During this internship session, emphasis will be laid on hands-on experience. Also, the department that is concerned will be maintaining a daily log book for each candidate.
Other Study TIPS
• Use the internet: Videos, virtual classroom learning, guest lectures, flowcharts and 3D pictures are There is no perfect way to study. Each individual has his own technique, it may work for that person and be disastrous for others.
Ultimately what matters is that your output should be at least 50% of the input, that is you need to pass.

1. Concentrate on topics you find hard. Don’t keep on revising the topics you are good at.
2. I used to use different colour highlighters to highlight important points.
3. Find a partner or a group. Ask each other questions, this is the best way to study. You tend to retain a lot.
4. Always go back and read about the interesting case you saw in the ward. You will grasp faster.
5. Bookish knowledge will evaporate but practical knowledge will stay. Your ward is your library.
6. Read few hours a day, don’t leave things for the last moment.
7. If something is difficult watch videos on YouTube or go to Wikipedia, things are explained more simply there in comparison to text books. However, be careful the information may be false and you will need to verify.
8. Get adequate sleep. We are humans and not owls. Studying through the night and sleeping in the morning is not good for your health.
9. Don’t keep your phone, laptop or TV next to you while studying. You will be tempted to see FB, twitter, other sites after 5 minutes or respond to your WhatsApp chat.
10. Exercise. You will be amazed how much you can grasp if you regularly
11. Read standard books. Use bigger books for reference.
12. Don’t leave any chapter. If you don’t have time, just glance through to see the key words. The chapters which you miss are the ones usually asked in the exam.
13. Read previous year question papers. Most topics are repeated.
14. Don’t go with preconceived notions on a subject just because your friend said so. If you think something is terrible it will be terrible.
15. While answering questions use bullet points, draw tables and diagrams and don’t beat around the bush.
16. Relax the evening before the exam. Just do some light reading. You need to be fresh next day for the exam.
17. Don’t study on an empty stomach.
18. Don’t compare your marks with others, it is not a school anymore.
19. Don’t keep on buying books for the same subject. You will be confused what to read and won’t read anyone completely. Stick to one standard book. You can go to the internet or library to refer for doubts.
20. We all need to memorize but understand the concept and memorize, then only can you retain and reproduce in the exam.
21. Concentrate in the class. I know it is difficult, I never used to. It becomes easier to understand the subject later when you open your books.
22. All medical subjects are interlinked. So, apply what you learnt in one to another.
23. If you are strong in pathology you will automatically become strong in most clinical subjects because all diseases have a pathology.

How to handle examination stress
Feeling stressed out or anxious is normal before and during exams. Normal levels of stress help you work, think faster, study more efficiently and improve your performance. That said, if you find that your anxiety is overwhelming, it could have an adverse effect on your performance. Exam related anxiety is very common and it is essential to be able to recognize its signs and manage it effectively. Becoming aware of what causes this anxiety will help reduce the stress.
Signs of exam anxiety
Patchy sleep and sleepless nights
Physical symptoms like headaches, body aches, feeling uneasy in the stomach
Irritability or short temper
Sudden increase in appetite/overeating, or a loss of appetite
If you recognize these signs of anxiety before exams and tests, it may be advisable to develop a routine before and during your exams.
Before the exam:
Weekly revision timetable: Plan a timetable and divide what needs to be studied over a course of time. This will help you avoid last-minute exam anxiety and will help you achieve better recall. Be realistic and add enough time to socialize and relax.
Prepare your own notes: Writing down your notes or recording them into a recorder allows you to engage directly with the material, and will also help you connect different concepts better.
Organize information: Make use of mind maps, diagrams, flowcharts, flashcards, mnemonics, and tables while studying. Find an online tool that allows you to do this.
Consult past question papers: Going through past question papers will give you an idea of where there are gaps in your understanding and where you can spend more time on revision.
Ask for help: If you are struggling with a certain topic, do not hesitate to contact your teachers, a helpful classmate or seniors for assistance in understanding a concept.
Group study: Group study can be highly beneficial as it facilitates the sharing of ideas and perspectives. Choose a compatible group that gives you a good balance of learning and teaching concepts.
During the exam:
Even if you are prepared, you may to struggle with some anxiety while you’re giving the exam. Spend the first few minutes of your time planning how you are going to answer the question paper.
Read the instructions carefully so you can identify which questions are mandatory, and how many you need to answer. Being anxious can sometimes lead to misreading the simplest instructions.
Deep breathing:
Breathe in
Breathe in through your nose.
Hold your breath for three seconds…
Breathe out slowly
and let it out slowly through your mouth.
Repeat a few times.
Read through all the sections of the question paper and tick all the questions you intend to answer. Calculate the time you need to answer each question as well as the order in which you want to attempt them.
Once you’ve done this, begin writing and ensure that your answers are relevant and precise.
Carry a bottle of water and stay hydrated.

Bullying, discrimination and ragging in college.
First year students are customary subjected to ragging, bullying and discrimination, though illegal. Bullying is any aggressive behaviour that is intended to show power and control over another person. Through physical, verbal and non-verbal abusive behaviour, a bully violates the space of the other person. They may also harass others using technology such as text messages, blogs, and social media.
A person may be more prone to being bullied than others due to a long-standing pattern of societal discrimination against various factors that single them out. This marginalization can be due to factors such as — but not limited to — caste, religion, mental health status, physical ability, socio-economic status, sexual orientation, sex, gender identity, weight, age, and race. Being treated as less than equal, or subjected to exclusionary treatment has a lasting impact on a person’s mental health. Marginalization can have the following effects:
• Vulnerability to stress
• Higher exposure to trauma
• Potential risk of being exploited or excluded
• Social withdrawal
• Paranoia about how they might be perceived or treated by others
• Self-doubt
• Risk of suicide and self-harm
Your college can be a safer environment to those who are marginalized. Every stakeholder in a student’s life must take on the responsibility of educating themselves to recognize and be sensitive to the fact that a person might be dealing with heightened vulnerabilities. Stakeholders here include college administration staff, teachers, parents and students like you. By developing empathy and paying heed to these social inequalities, you can help a person feel less isolated and alone.
Ragging – know your rights
In 2009, the University Grants Commission (UGC) passed a regulation to curb the menace of ragging in higher educational institutes. Let’s break this regulation down for you.
What is ragging?
The law defines ragging as:
Any act of physical or mental abuse targeted at another student is ragging. This includes bullying and practicing exclusionary tactics.
UGC regulates that every institution includes strict pre-emptive measures to control the prevalence of ragging. This includes lodging freshers in a separate hostel and surprise raids (especially at night) by the anti-ragging squad. Senior students and their parents are also required to submit affidavits taking an oath not to indulge in ragging. Every institution must have an anti-ragging committee and an anti-ragging squad.
The anti-ragging squad: Nominated by the head of the institution, the anti-ragging squad consists of members belonging to various sections of the campus community. They are to maintain vigil, oversee, patrol and be mobile, alert and active at all times. They must inspect potential ragging points and conduct surprise raids on hostels and other high-risk locations.
The anti-ragging committee: Headed by the head of the institution, the anti-ragging committee will consist of representatives of civil and police administration, local media, non-governmental organizations (NGOs) involved in youth welfare, faculty members, parents, students (both freshers and seniors) and non-teaching staff. Its purpose is to monitor the anti-ragging activities in the institution and consider the recommendations of the anti-ragging squad to make decisions.
What to do if you are ragged
Anonymously report to
• The anti-ragging committee
The squad must investigate incidents of ragging and make recommendations to
the anti-ragging committee, and work under its overall guidance.
What happens to the perpetrator?
A first information report (FIR) is mandatory following which the perpetrator(s) is penalized with a warning and counselling, suspension, expulsion, suspension from hostel, debarment from examination, rustication or debarment from other institutions depending on the severity of the crime.
A common justification offered by perpetrators is that it was a harmless way of seniors getting to know their juniors. In reality, ragging is a far more serious issue and can result in inducing fear, shame, and humiliation. Some students isolate themselves entirely, may drop out of college and in some instances, suicide is an unfortunate outcome.
How bullying and ragging affect your mental health
A victim of bullying or ragging can experience a number of mental health symptoms that disrupt their daily lives.
The long-term risk of bullying also includes chronic depression, risk of self-harm and suicide, anxiety disorders, post-traumatic stress disorder (PTSD), substance abuse, and difficulty with trust and relationships.
Interpersonal relationships
Importance of community
Community plays a large role in our wellbeing. It helps give us a sense of belonging and lays the foundation for a strong support system. Community can be anyone from your family to friends, classmates, teachers or mentors.
Building a healthy community will go a long way in buffering the emotional burden of medical college. Having a strong support group will help when things get overwhelming. It can help to reconnect with an old friend or confide in a new one at college.
Staying connected to home
• Stay connected to your parents; for example, you can schedule video calls at family mealtimes.
• Make a family group of your parents and siblings; tell them to keep posting pictures of home. If you have a pet, ask them to send pictures and videos of them.
• Stay in touch with friends from your hometown; this may take more effort as you will be busy building social relationships in college. Invest time and effort to stay connected to your old friends. Include phone conversations or text messages, whatever works for you.
Mental wellbeing
Now that you have a fair idea of what to expect in medical college, let’s have a look at mental wellbeing. WHO says, “Mental health is defined as a state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” It is entirely normal to feel like your mental wellbeing is not in the best state. This does not mean you have a mental illness but only that your body and mind are reacting to stress. In this section we discuss the signs of emotional distress, and look at some common psychological issues that will help you be there for your own mental wellbeing and that of your friends.
Signs of emotional distress
We have elaborated on many stressors that you will encounter during your time in medical college. Stress is a part and parcel of life, but sometimes it can get overwhelming and cause emotional distress. Here are some signs of emotional distress that you can keep an eye out for.
Fatigue or dullness
Upset stomach or unexplainable aches and pains
Social withdrawal or isolation
Being emotional, tearing up easily
Drastic change in sleep, appetite or self-care
Being worried, anxious or stressed out
Loss of interest
in otherwise pleasurable activities
Being aggressive and irritated
Absence from college
Inability to perform daily activities
Thoughts of self-blame
Drop in functioning at college
Hopelessness or helplessness
Bouts of uncontrollable anger
Being worried, anxious or stressed out
Severe mood swings
Common psychological issues
When you are faced with overwhelming stress and unable to care for yourself due to hectic schedules, you might start exhibiting signs of emotional distress. This can transform into psychological issues that may disrupt your life. This is a regular consequence of stressful lives and should be treated in the same way that we would treat symptoms of the flu.
Let us now highlight some common psychological issues so you can identify them and seek help for it if necessary.
Anxiety
Depression
Sleep problems
If the above symptoms have persisted for over a few weeks or have been disabling or disrupting in nature for you, seek help from a medical professional.
Here’s a helpful exercise to cope with anxious feelings.
5-4-3-2-1 grounding exercise
Identify and pay attention to the following using your senses:
4things that you can see 3things that you can feel 2things that you can hear 1things that you can smell
thing that you can taste
Using all of your senses, this exercise allows you to observe the present environment around you, which in turn leads to the alleviation of the unpleasant symptoms of anxiety.

Suicidality
Suicidality refers to and includes – suicidal ideation, suicidal thoughts, or attempting suicide.
Symptoms that indicate you or someone you know might be suicidal:
Mood swings or excessive sadness: These are symptoms of depression, which
may result in suicidal ideation.
Sudden calmness following a depressive episode: Feeling calm may be the result of a decision to take one’s own life.
Social withdrawal: Not making social contact or not taking interest in activities that they found pleasurable.
Changes in personality or appearance: There may be a significant change in their attitude and behaviour. They may also start to pay less attention to their appearance.
Indulging in risky behaviour: This could include reckless driving, substance abuse, unsafe sex.
Making preparations for death for no reason: The person may put their affairs in order, make a will, visit friends and family, or even prepare for the actual suicide itself.
Threatening to kill oneself or talking about death: They may talk about death or violence often. They may also talk about wanting to kill themselves. While many threats don’t turn into attempts, they must never be taken lightly.
Feeling worthless, helpless or trapped: They may feel there is no way out, feel like they are a burden to others, and complain about feeling worthless and helpless.
If you are having thoughts of suicide, it is very important that you reach out to someone. Try talking to a friend, a family member or even reach out to a medical professional. If you know someone who might be having thoughts of suicide, reach out to them and get them to seek help.
How to be an ally
If you notice any signs of distress among your friends, there are many things that you can do to be there for them. People with emotional distress can benefit greatly from a support system that understands them and offers them empathy.
To begin with, you can ask your friend how they are feeling and let them know that they can share their thoughts and emotions with you. They may not want to share; in which case you can let them know that you will always be there to listen. This is vital too as it will make your friend aware that support is just around the corner when they need it.
If your friend does decide to share, be careful of the following:
• Listen. Do not judge or blame them for their thoughts.
• Validate their emotions. Tell them it is okay to feel what they’re feeling and encourage them to talk openly.
• Do not offer advice or suggestions unless they specifically ask you for help.
• Find out if they have a support system – other friends, family, mentors, etc.
• Do not pressurize them to open up about something they don’t want to. Respect their boundaries.
If you believe that your friend is having thoughts of suicide, is unable to cope with their emotions, is unable to function because of the emotional distress, or is resorting to substance use, refer them to
Asking for help is not a sign of weakness
Seeking help
Asking for help can take a lot of courage, but it can relieve the emotional distress you may be facing.
When you should seek help
Unable to submit Difficulty in maintaining assignments on time interpersonal relationships
Decline in academic Decline in personal Unable to manage
performance
care
day-to-day activities
Changes in appetite and sleep pattern
Noticeable difference in personal hygiene
Taking the decision to seek help is not easy for many people. You can take the first step by sharing your concerns with family or friends whom you trust and who have been there for you before.
How to seek help
Help can be sought from a mental health professional. This could be a counsellor, psychologist, psychiatric social worker, or a psychiatrist.
Counsellors and psychologists offer therapy and a psychiatrist will provide you with medication, if necessary. Medication and therapy go hand-in-hand. Whoever you consult must inform you of the nature of your issue, illness, prognosis, medication and side effects, as the case may be. Do not hesitate to ask any questions.
Make sure you are comfortable with whichever professional you meet. They must listen to you non-judgmentally and with patience. You may not find the right professional immediately. Do seek a second opinion in this situation.
Self-care
Diet
Nutrition impacts both your mental and physical wellness, and the path to becoming a doctor is a long one. Your schedule will be demanding, rigorous, and you may find it hard to focus on your nutritional intake. Here are some ways in which you can maintain a healthy lifestyle:
• Create a mini-pantry in your room/ hostel/ dormitory — it can be a collective one among six to eight friends — that stores tea, coffee, sugar, salt, pepper, ketchup, jam, mustard, etc.
• Stock up on fresh fruits, eggs, bread, energy bars, nuts, milk, juice, buttermilk tetra packs, whole-grain biscuits, ready-to-eat foods like poha, upma, soup, and noodles.
• Never skip breakfast – if short on time, at least have a fruit!
• Never go to bed hungry; have a cup of warm milk or soup.
• Always have a bottle of water on you, and remember to hydrate through- out the day.
• Avoid too many cups of coffee/ tea especially in the late evening as it might affect your sleep.
• Explore the possibility of getting home-cooked food by subscribing to a tiffin service.
Exercise
Exercise is linked with the release of important brain chemicals such as serotonin, dopamine, and endorphins. An increase in the levels of these chemicals can lift your mood, can reduce hostility, and make you more socially active. In short, it helps you feel happy and healthy.
Improvements in
Appetite Immunity Memory Concentration Energy levels
Sexual function Sleep quality Self-esteem Ability to cope with stress
Making time for exercise in your routine can pose as a challenge. But it is possible to find ways to be physically active.
Join a sports club that you like
Join a gym
Practice yoga
Join a dance class
Walk to college instead of using public transportation
Schedule a walk or jog with a friend
Take the stairs instead of the elevator
Walk around while you’re on the phone
Practice yoga:
Yoga has many benefits including bringing focus and attention to your body and mind which can help reduce anxiety. These are some apps you can use:
Daily Yoga Simply Yoga Studio Yoga Cure Yoga.com
Sleep
Sleep is essential for your physical and mental wellbeing. It is necessary for efficient brain functioning and it has an impact on your mental health, physical health, quality of life and overall safety as you go about your day. Sleep deficiency can have hazardous results – whether it is the impairing of judgment in the moment (like when you are on the road), or over a period of time where it can manifest in the form of health risks. Sleep deficiency can:
Impair judgment
Impact ability to make and store new memories
Create hormonal balance
Affect concentration
Reduce immunity
Increase risk of heart disease
Maintaining a healthy sleep schedule
Wake up and go to bed at the same time every day while aiming to get eight hours of sleep
Do not use any electronic devices with backlights an hour before bedtime
Do not do any activity that requires high levels of focus an hour before bedtime
Avoid heavy meals within two hours of bedtime
Remember, alcohol, nicotine and caffeine can interfere with sleep
Here are some apps that you could use to track your sleep habits and improve them:
Sleep Cycle Insight Timer
Building resilience
Medical college is a long ride and somewhere along the way, you are likely to get overwhelmed and stressed. Resilience is riding through these times without it affecting your mental health, functioning, and interpersonal relationships. It is about how you cope, manage your emotions and seek support during a stressful period.
It is a misconception that resilience is something you are born with; when in fact it can be cultivated. Some of the ways in which you can improve your resilience are:
• Setting realistic goals
• Being aware of your feelings, thoughts, and behaviour
• Expressing yourself and your needs to those around you
• Finding solutions and working towards them
• Having a support system, you can rely on – friends and family
• Having relationships that are based on love, trust, are encouraging and
reassuring in nature
Levels of resilience can change over time – some episodes of stress may affect you more than others. It is important to have a positive view, and to believe in your strengths and abilities.
Staying motivated
There will be times when you feel you lack the motivation to stick it out for the entire journey in becoming a doctor; it is natural for this to happen. These are some ways in which you can stay motivated:
One of the advantages of medical school is the variety of subjects you learn over the course of your journey. While your first year may be very theoretical in nature, your practical experience begins shortly in the year after. With so many branches in medicine, know that there will always be a new subject just around the corner keeping you on your toes.
Picture yourself as a doctor. Be aware that what you are learning is adding to your skill as a doctor. The information might be boring but its value translates to the fact that someday a patient will rely on you to know this.
Remember why you wanted to become a doctor – think of the values, goals, and missions that brought you to this point. You worked hard to find a spot in a medical college and that is strong proof of your ability to put in the required amount of work and achieve results.
Mentoring
It is the process by which one person (mentor) guides the development of another (mentee), in this case, you. In the field of medicine, the mentor is generally a senior doctor who is experienced and knowledgeable. This process can benefit the mentor, you, and the organization itself. For a successful mentorship, you and your mentor need to actively participate in the process. Remember that your relationship will be dynamic and roles will constantly need to be redefined. You can decide the more specific aspects of your mentorship – whether you prefer a structured or flexible program, and the duration of it. The goal of mentorship is to learn, so don’t make it competitive.
The mentoring contract checklist
At the very first meeting, it is helpful to jointly come up with a mentoring contract and make it official.
Preferred means of communication
What areas will you focus on?
How long will the mentorship last?
What are your long-term goals?
How often will you meet?
How often will you review?
What are your short-term goals?
Make sure to ask as many questions as you can about what your expectations are, and what responsibilities you will have to take up. Also maintain a log of your mentoring sessions.
What should you look for in a mentor?
A good mentor should be supportive, knowledgeable, reliable and not judgemental. Exchanges should be kept confidential, and the mentor should be committed to the professional development of the mentee. A mentor should
Motivate
Empower and Encourage Nurture self-confidence Teach by example
Offer wise counsel
Raise the performance bar
: Mentoring young academic surgeons, our most precious asset. Benefits of a mentorship program
Most mentorship program evaluations point to its numerous benefits. It can enhance your future in medicine by giving you a broader educational experience, outside of your textbooks. It can act as an aide for when you need to make decisions about your internships and choice of speciality. A mentor can also be a part of your social support system and enable you to network effectively in the field.
Very few medical colleges have a formal mentorship program. It is up to you — ideally in the first year of college — to take the lead in identifying a mentor and in taking the mentor-mentee relationship forward. One-to-one and face-to-face mentoring is preferable, but where this is not possible group mentoring and e-mentoring can be considered. You can also choose a mentor from outside your medical college, but make sure they are from your medical field.

Dealing with difficult people
As you enter the vast and bewildering world of medical studies you will meet many people along the way; some of them may become memorable for all the wrong reasons. Here are some tips to help cope with difficult interactions with friends, seniors, juniors, teachers and professors.
American psychologist Marsha Linehan outlines suggestions for turning a negative interpersonal interaction into an effective one.
While interacting with someone, try to think of what you would like to salvage:
Depending on what is more important to you, you should be able to let go of the other two.
If you are asking a store owner to refund your money for a faulty stethoscope, the main thing to focus on is getting the refund. If he makes insulting remarks, don’t take them personally. Your self-worth is not of primary importance here, neither is your immediate relationship with him. If you value the relationship more than getting your refund, then you should be willing to compromise on the refund and that’s okay.
In the hostel, you may have to share a room with a difficult senior whom you rely on for borrowing notes. If that senior starts bullying you or harassing you, it may perhaps become important to let go of the focus on the task at hand (getting notes for exams) or your relationship with the senior, and shift the focus on your self-worth. You may choose to stand up for yourself and not let the senior bully you, find a different means of getting notes, and learn to walk away from the toxic relationship.
While interacting with friends you may often find yourself balancing between the three with a healthy dose of compromise to ensure that you build a lasting relationship.
One of the most troubling areas of interaction may be with teachers or professors – especially if there is an unwritten understanding that criticizing students is like a rite of passage, that doing so builds resilience and prepares them better for the future. The same rules apply when interacting with difficult professors – try to turn their criticism to your advantage. Just as every failure provides a learning opportunity, every rude remark or criticism can work as an opportunity to improve yourself.
All of this seems easier said than done and it may be so, especially in your early years when you’re still trying to find your feet. An important asset to develop is an understanding of yourself and your own set of values. Find activities that are meaningful to you and develop your skills in them. You will then gravitate towards like-minded people whom you can turn to when you encounter difficult people.
As you become more aware of yourself and learn to manage your emotions better, you will be more prepared in situations where you have to deal with difficult people.
Things you may not learn in college
The extensive voyage through medical school teaches you the technical requirements for future practice, but lacks in addressing many crucial dos and don’ts for a successful medical career.
Things won’t always go as planned. That’s okay.
Most students start medical college with this grand idea that everything will go perfectly. But there are bumps along the road – being able to adjust to new situations is an incredibly important trait to have as a student. You need to expect the unexpected and accept that you can’t prepare for every potential scenario. The ability to perform under pressure and think on your feet are qualities that will serve you well.
You are never really told how to manage your own health
Medical training is hard on its students, and quite frequently even inconsiderate about students’ physical and mental health. The long running classes and equally long study sessions do take their toll. You need to learn to help yourself before you effectively learn to help others. So, take a step back, take some time off for yourself every once in a while.
Everyone you meet will know something that you don’t
Knowledge can be gained from the most unlikely places. The lab assistant in your physiology or biochemistry labs will often know more about your experiments than you and be willing to teach you most of the time. It’s also not just factual information that gets picked up; the five-minute coffee break discussions with faculty, peers and seniors can be a prospective wellspring of ideas.
Your marks are important but not everything
Exams do not define you; they are simply checking on academic competence. Your self-worth should not be defined by your marks; don’t compare your marks with
those of your peers. Everyone’s journey leads to the same destination – graduating as a doctor. You came to medical school not to become excellent medical students, but to become excellent doctors. Many of you have entered this field with a desire to help people, and your marks can’t stop you from doing that.
You can achieve a lot by moving forward together with your peers
In the stressful milieu of a medical college, ensuring strong relationships with peers takes effort when you are fatigued, honesty when it’s an uncomfortable situation, and integrity when it’s difficult. You need to be able to include your peers and help them refocus when they are looking only at the obstacles – identify when this can’t be achieved and understand when to move past such a situation. Confrontations are frequent; understanding and effective communication are crucial to resolve conflict.
Untold parameters of student evaluation
In medicine, student evaluations are often hinged on long-term observation, on how students can reflect on their errors and correct themselves. This means that you need to be mindful about how you speak and be prepared to communicate effectively to benefit optimally from faculty interactions. Asking questions and participating in discussions will be appreciated as it shows your inquisitiveness and willingness to learn.
Take criticism constructively
Feedback should be received in its entirety, no matter how upsetting it might be. The attitude that criticism is always constructive helps deal effectively with any kind of feedback. It helps to have a discussion with the person giving feedback so that you can identify weaknesses and work on rectifying them. Following up and improving your work in line with the feedback is important as it shows that you’re willing to improve.
Never lose touch with your creative side
Music, art, poetry, literature is all essential to being a well-rounded human. They keep you in touch with the intangible, show you what the material world can’t; and teach you what can’t be taught. Keep in touch with your creative side.
Remember you’re not a doctor yet
Twenty years ago, when I was returning home after being selected for the MBBS course, my hometown was in a festive spirit I felt as if the entire town was celebrating my entry into the medical profession! As I rushed home and bragged about becoming a doctor, my parents gently reminded me “You are not a doctor yet.”
A few months into medical college you will soon realize that the place in which you feel most like a doctor is not in class or in the dissection lab but when you are at home. You will be subjected to a torrent of medical questions and requests for advice from friends and relatives. This is especially common if you are the first medico in the family. There will invariably be an aunt with high blood pressure, an uncle with constant headaches and a friend with abdominal pain. It is important that you offer these individuals some comfort but not necessarily academic medical advice. When you are in the medical profession, your words matter. People have a special propensity for recalling anything that can be interpreted as a prognosis. The same holds true for those just perceived to be in the medical profession. And, like it or not, a first-year medical student does fall into this category. Choose your words wisely, do not surmise on which medication is better, which clinical investigation is sound or what the prognosis is.
It is imperative to remind individuals that you are far from being a physician, and that you are not involved in their care as a professional and as a result don’t know the details of their situation. You need to be conscious of the fact that whatever you say can be taken out of context, and people will read between the lines and make their own assumptions. By indulging in giving such advice, you bring unwarranted pressure on yourself. It may even inadvertently lead to you getting into trouble, in case your advice leads to negative outcomes for their health.
‘Doctor’ literally means ‘to teach’. Hundreds of years’ worth of wisdom has ascertained the fact that to teach, you have to learn continuously. Often medical students assume every change in their body or mind as something they know of. It is true that you know more about clinical conditions like the common cold than the lay man. However, a practicing doctor or an ENT specialist would know far better.
So, when a friend or a family member asks you for advice, be mindful of the consequences of your words, and that it is better to admit that you do not know rather than say something which may lead to complications. It is also prudent to refer them to professionals and experts. Be humble and always keep in mind that you are not a doctor yet.
Neet (PG) exam
Having completed MBBS, the next hurdle will be NEET(PG) exam. This exam is based on MCQ’s and therefore you must do as much MCQ’s as possible.
First 5 months were solely dedicated to thorough understanding of concepts and learning the facts. April, May, June, July, August. Two weeks or more for Long subjects and 1 week or less for short subjects. My study prep. involved more of notes than anything else. In the first 5 months I would read the std. textbooks of the subjects and take notes. Then I would attend the classes of the respective subjects in my coaching centre. I would add the points given there to my notes. After the classes one or two days would be spent doing the MCQ’s.

BOOKS

ANATOMY — Chaurasia; Arvind Arora

PHYSIOLOGY — CRISP

BIOCHEMISTRY – Vasudevan; Rebecca James

PATHOLOGY — Robbins; Vandana Puri

MICROBIOLOGY — Anathanarayanan; Apurba shastry

FM — Sumer sethi

ENT — Dhingra; Sakshi Arora

OPHTHAL — Khurana; Sudha Seetharaman

MEDICINE — Harrisons; Deepak Marwah, Vinod Khanna

SURGERY — SRB; Rajamahendran

OG — Shaw and Mudaliar; Sakshi Arora

PAEDIATRICS — Ghai; Around Arora

ORTHO — Maheshwary; Apuev Mehra

RADIOLOGY and DERM — Arvind arora

The last four months were solely for revisions. You need at least 2 revisions before the main exam. During the first revision it took me 10 days for Long subjects and 5 days for short subjects. For the 2nd revision I needed only 5 days for long subjects and 3 days for short subjects. I would first revise the notes of the topic and subsequently practice the MCQ’s. At the end of completing the subject I would attempt the online CBT’s. Preferably subscribe to 2 different online test series. I recommend ADRplexus, Prep ladder and DAMS. Also attend the mock exams of PRIME and DAMS. Keep yourself up-to-date on the happenings by liking the different faculty Facebook pages. You have to remember 19 subjects, so the only way is to use Mnemonics, flow charts, histograms, etc. Use your own methods for recollection. Associate facts with other things; especially for topics in multiple subjects pool the info into one and learn it at once. Don’t learn it in each subject. For ex. Hemoglobinopathies, which comes in physiology, biochemistry, pathology and medicine. Another important thing, never lose your momentum. Think about the green pasture at the end and do not get into distractions. Some people would have studied throughout the year and would get tired just before the exams. Keep up the pace and try increasing it as you progress. You would also feel that you have studied so much but don’t remember anything. This is normal. It means you are not overconfident of yourself and still have the hunger for knowledge. Keep revising you will remember during the exam.
How to study in medical school?
Students in medical school often feel overwhelmed by the excessive amount of factual knowledge they are obliged to learn. Although a large body of research on effective learning methods is published, scientifically based learning strategies are not a standard part of the curriculum in medical school. Students are largely unaware of how to learn successfully and improve memory. This review outlines three fundamental methods that benefit learning: the testing effect, active recall, and spaced repetition. The review summarizes practical learning strategies to learn effectively and optimize long-term retention of factual knowledge.

Learning in medical school can be divided into two forms of knowledge: factual and procedural knowledge. Factual knowledge is the theoretical background of medical education, e.g., learning the adverse effects of beta-blockers, muscles of the lower extremity, or the definition of the systemic inflammatory response syndrome. Procedural knowledge is the practical part of medicine, e.g., how to perform the insertion of a central line, draw blood, or conduct a clinical exam on a patient with acute respiratory distress. Factual or conceptual knowledge covers “what” information, whereas procedural knowledge covers “how” and “why” information [1].

While the latter can be learned by means of simulation and practice, factual knowledge is more difficult to obtain by means of reading, summarizing, testing, and restudying. The majority of time in medical school is spent on acquiring factual knowledge in the various specialties that is subsequently tested in exams to prove that learning was successful. Usually, students feel overwhelmed and stressed by the sheer amount of facts that medical school obliges them to learn [2]. Students also experience that long-term retention of factual knowledge is mediocre at best and forgetting is the unpleasant side of learning something new [3].

Surprisingly, scientific knowledge of how to learn and acquire factual knowledge is not a standard part of the curriculum in medical school [4]. This article reviews main scientific findings on how to successfully learn and retain factual knowledge.

How Can You Improve Learning in Medical School?
How do students learn factual knowledge? The process of learning can be exemplified by the above-mentioned adverse effects of beta-blockers. In pharmacology, medical students learn about the different substances in the group of beta-blockers, their indications, pharmacodynamics, adverse effects, and conditions when not to prescribe them to patients. Adverse effects of beta-blockers can be summarized to several facts such as bradycardia, bronchoconstriction, claudication, hyperlipidemia, and reduced sensitivity to hypoglycemia. These facts can be learned by means of reading, building mnemonics, or simple repetition. Therefore, learning is successful when these five adverse effects can be named on free recall or by knowing that a patient with diabetes should not be treated with beta-blockers due to the adverse effect of reduced sensitivity to hypoglycemia. In our memory, we build links between the topic beta-blocker and these five adverse effects.

Forgetting is the process of losing this information in memory or not being able to retrieve it even though the information is still stored. The links between beta-blocker and single adverse effects are missing. The German psychologist Hermann Ebbinghaus hypothesized that the process of forgetting follows a curve when experimenting with the memorization of nonsense syllables and subsequent testing of the retention of these syllables [5]. Ebbinghaus found that as time passed, his memory of these syllables faded likewise. Thus, new factual knowledge that we acquire is destined to be forgotten if it is learned just once.

A different experiment revealed the impressive capacity of memory. The Swedish psychologist K. Anders Ericsson and his team published a paper in Science in 1980 that describes an experiment involving an undergraduate with average intelligence and memory abilities [6]. The student engaged in a task that involved recalling the sequence of random digits that were read at the rate of one digit per second. For more than 20 months, the student engaged in this activity about 1 hour a day, 3 to 5 times per week. Starting with a digit span of seven, the undergraduate reached a digit span of almost 80 after 20 months or 230 hours of practice. These results show that the memory skill can be improved by practice even with abstract information.

These two experiments show the effect practice has on memory. Without practice, learned information is quickly lost down the path of Ebbinghaus’ forgetting curve. With practice, the memory can be trained comparable to the training of a muscle. Yet which methods are the most suitable in order to learn and practice what is learned based on scientific findings? This section will cover three topics of effective learning: the testing effect, active recall, and spaced repetition.

The Testing Effect
The testing effect concerns a paradox in the life of every student in medical school. When learning pharmacology and the five main adverse effects of beta-blockers, students read the facts, they summarize them, restudy, or memorize them for a considerable amount of time and are then tested once in a written or oral exam. Testing in the mind of the average student is a means to assess knowledge and not part of learning.

Testing as an active element of learning is more effective than studying the factual knowledge repeatedly [7]. A considerable number of experiments were conducted to study this testing effect. One example cited in the aforementioned paper is a study by Hogan and Kintsch from 1971 [8]. One group of students studied a list of 40 words four times with short breaks between the study time. A second group of students studied the list only once and took three free recall tests afterward. Two days later, both groups underwent a final test. The first group that studied the list four times recalled about 15 percent of the words. The second group, which studied once and then took three free recall tests, recalled about 20 percent of the words. Studying a list of words just once and then testing yourself by free recall led to significantly better results than studying the identical content four times.

A randomized controlled trial confirmed these findings and discovered that repeated testing resulted in significantly higher long-term retention than repeated studying [9]. This study involved a didactic conference for pediatric and emergency medicine residents. There were two counterbalanced groups. One group took tests on the topic of status epilepticus and studied a review sheet on myasthenia gravis. The second group studied a review sheet on status epilepticus and took tests on myasthenia gravis. Testing and studying sessions were held immediately after teaching and on two additional time intervals of about 2 weeks. Each time, feedback was given to the participants. A final test after 6 months completed the study. Six months after the initial teaching session, repeated testing resulted in final test scores that were on average 13 percent higher than in the group of repeated studying [9].

A significant contributor to the testing effect is initial feedback to teach the student whether an answer was correct or incorrect. Interestingly, feedback enhances learning, but even testing without feedback is beneficial [10]. The study by Roediger et al. presents an experiment in which four groups of students read a text passage. One group remained passive after reading, and three groups underwent a multiple-choice test. Of these three groups, one was tested without feedback, another received immediate feedback after each question, and a third received delayed feedback for all questions after the entire test. One week after the initial reading session, all four groups underwent a final test. The group that took no test showed 11 percent correct answers. Those participants who were tested without feedback presented 33 percent correct answers, immediate feedback resulted in 43 percent, and delayed feedback in 54 percent correct answers. Therefore, testing even without feedback tripled the score in a test 1 week after initial studying. Best results were obtained by delayed feedback, which hints at the positive contribution of spaced representation of learning content that will be discussed in one of the following sections.

Despite the various studies that found retesting to be more effective than restudying, students seem to be largely unaware of testing superiority in supporting short-term retention [11]. When students use testing in a learning context, they apply it to assess knowledge and do not see it as a technique to intensify learning. In particular, students do not seem to be aware of the superiority of testing compared to studying.

Active Recall
Whenever new information is repeated, an emphasis should be put on active methods of repetition such as free recall. In the example of the adverse effects of beta-blockers, simple rereading or summarizing of the facts is often applied. However, active recall (e.g., write down or name the five main adverse effect of beta-blockers) is a significantly more effective learning strategy than passive restudying of the facts. Testing as described in the previous section is a form of active recall. However, testing can also be performed by passive presentation of information such as in multiple-choice tests. This section regards active recall methods, meaning the effort to consciously reproduce information that was learned before without using cues.

Active learning methods engage the mind and do not necessarily need to be instantly successful. It has been demonstrated that even unsuccessful attempts to retrieve information from memory that were accompanied by feedback enhanced learning [12], and even quizzing about learning content that was never presented before enhanced learning of that very content. In a study by Kornell et al., two groups studied fictional history questions [12]. One group read the question for 8 seconds and was demanded to immediately type the answer. After 8 seconds, the answer was presented for 5 seconds. The second group simply studied the question and answer together for 13 seconds without the instruction to give an answer. Although the second group had more than double the time to study the fictional fact, both groups showed comparable results without significant difference. The attempt to retrieve fictional information, which was inevitably unsuccessful due to the fictional history facts presented, resulted in comparable learning success compared to a group that had more than double the time to study the learning content. Therefore, quizzing is superior to learning because an equivalent learning success can be reached in less than half of the time. It is understandable that challenging tests are thought of as discouraging for students. Yet the experiment conducted by Kornell et al. showed that difficult tests, which at first result in high error rates, actually stimulate subsequent learning.

Another experiment performed by Morris et al. demonstrated the superiority of active retrieval practice compared to passive representation of the content [13]. The experiment simulated a real-life experience of learning names when meeting new people at a party. One group experienced representation of names, and another group applied retrieval practice. On average, the group experiencing representation of the name of a newly met person recalled 5.8 names at the final test. The retrieval practice group recalled 11.5 names on average. Consequently, trying to remember actively the name of a person you have just met is a more effective learning strategy than merely hearing the person’s name repeatedly.

Spaced Repetitions
The mentioned experiment by Morris et al. also supported the positive effect of spaced repetition. Participants were asked to try to recall the name of the person shortly after they had just met him or her and then again after a longer interval [13]. Instead of trying to recall the name every 30 minutes, it is advisable to space out the repetition and recall the name after 5 minutes, 30 minutes, and then after 2 hours.

In an experiment that tested steady against expanding retrieval practice, 250 students studied 30 immunology and reproductive physiology concepts [14]. The students were divided into five groups. Two groups recalled the concepts actively at a steady interval without (days 1, 10, 20) or with a delay of 7 days (days 8, 15, 22). Another two groups recalled the concepts actively at expanding intervals again without (days 1, 6, 16) or with a delay, in this case of 1 day (days 2, 7, 17). The fifth group served as a control group. All of the groups underwent a test at day 29 to assess the final score; consequently, the end point for all groups was the same. It was found that expanding retrieval practice led to a significantly greater recall of facts at day 29 than recalling at steady intervals [14]. Longer delay between initial learning and recalling facts was associated with poorer retention rate. Therefore, the group that learned with expanding retrieval practice and no delay preceding the first assessment proved to have the best learning strategy.

Generally, the four groups with retrieval practice performed twice as well as the control group did, thus emphasizing the positive effect of active retrieval practice independent of specific retrieval strategy. In comparison, the two groups that applied expanding retrieval performed significantly better than the two groups that recalled the concepts at steady intervals. The combined mean of the first groups (42.57, SD 1.8) was significantly higher than that of the two with steady intervals (34.1, SD 1.36) [14]. In comparison to the control group (21.26, SD 1.4), there was a general beneficial effect of retrieval independent, whether it was at steady or at expanding interval. Thus, two findings stand out: Retrieval practice after initial learning is a main contributor to successful learning, confirming the findings stated above about active recall and the testing effect, and retrieval practice should be performed on expanding intervals to further enhance learning.

Additional insight into the benefit of expanding retrieval practice was presented in another study [15]. The authors found that the positive impact of retrieval practice depends on the degree to which the to-be-learned information is vulnerable to forgetting. It is especially helpful when the learning content consists of several units that may interfere with each other. In one experiment, 30 participants studied an educational text about Antarctica. They were then instructed to free recall information about Antarctica at 4 time intervals of either 0, 3, 7, and 18 or after 7, 7, 7, and 7 minutes. Between these intervals, the participants read text passages about 10 additional regions (e.g., Greenland, Africa) similar to the initial Antarctica text. Consequently, this intervening activity led to interference with the facts that were initially learned.

In a final test 1 week later, the group that learned at expanding time intervals performed significantly better than the group learning with steady intervals, outperforming the latter group by a 2-to-1 margin [15]. The authors conclude that expanding retrieval practice is best used when the learning material is vulnerable to being forgotten. In this case, expanding retrieval practice improves long term retention of correct information and prevents from learning incorrect information.

Conclusions
How do these studies impact learning in medical school? Whenever students learn factual knowledge, they should test themselves while learning, actively recall information, and retest the facts at expanding time intervals to make learning in medical school most effective. These learning strategies help students learn the most in the least amount of time. Studying according to scientific findings on the testing effect, active recall, and expanding repetition intervals assures optimal long-term retention of factual knowledge. It has to be emphasized that despite the obvious positive effects of these learning strategies on students’ performance, learning how to learn is not a standard part of the curriculum in medical school [14,16]. This lack is questionable.

Obviously, medical knowledge is growing. Despite an increase in depth and complexity of medical knowledge in the past decades, the length of medical education remains constant. Time is scarce in the medical curriculum and never sufficient to teach the whole body of medical knowledge. Providing time to teach medical students how to learn is difficult.

It is, however, even more difficult for students to provide time to learn in an ineffective way in medical school, to learn factual knowledge, forget, and relearn it. It takes modest time for medical schools to teach the above-mentioned concepts that enable students to save time and effort. Eventually, students’ final scores and patient care may improve — a result that satisfies medical faculties and students equally.

How should medical schools implement programs to convey these learning strategies? The author proposes that a program based on these concepts should be taught in medical school at an early stage. The program should be based, obviously, on the concepts it conveys. This means that the program should be taught actively by posing questions and quizzing students, provide tests to foster learning, and repeat the learning strategies in spaced intervals. A basis module of this program may consist of several hours to present the concepts and the scientific background. Shorter modules serving as repetition and application of the learning strategies should be taught in expanding time intervals so that students learn the concepts at the start of the term and restudy them, e.g., 7, 15, 30, and 60 days later. Therefore, a basis module combined with several short follow-up modules would suffice to teach the basic scientific findings on effective learning strategies.

Additional scientific concepts apart from the three that were presented in this paper may be added to the program. A module presented in year 1 of medical school may focus on learning factual knowledge, whereas a module in year 3 may shift toward factual and procedural knowledge to prepare for effective learning in clerkships. The modules may be adapted flexibly to the students’ needs. However, the content of the modules may not be the most important issue. The key is to create a constructive atmosphere and to raise awareness about the process of learning in medical school. Before students start to learn, they should be taught how to learn. This idea should become an essential part of the medical curriculum.

The presented learning strategies provide a starting point to enable students to learn more effectively in medical school. Research is conducted concerning the larger picture of how to combine scientific evidence in cognitive neuroscience with medical education [17]. The author proposes this program as a first step to explore con

How to pick a medical speciality that’ll keep you happy your entire life?

One of the hardest decisions in your career begins at the end of MBBS, when you have to start thinking about which specialty to pursue. With over 60 specialties and over 30 subspecialties to consider after MBBS, it can be a tough choice. Most people start narrowing down their preferences in third prof when you get to experience what actually happens in the various medical specialties. You rotate through Surgery. You rotate through Internal Medicine. You rotate through SPM. You rotate through Anaesthesia. You rotate through Psychiatry. During internship, you’re supposed to be narrowing it down to your most likely subject. It’s a tough process, full of uncertainty and soul-searching and fears about locking into it. So here are a few things to keep in mind when you are doing your rotations.
Choose for yourself, not others.
It doesn’t matter if your father wants you to be an orthopaedic surgeon or your mother has been grooming you your entire life to take over her Gynaecology practice. This is your life and you have to be satisfied with your job. So, make your own choice based on the several things mentioned in next points.
An excellent choice of medical speciality should be what you are good at and enjoy simultaneously.
Most people drop out the first condition. But think about it: If you pick something you enjoy but that you are not good at, it will be a disservice to your patients. If you pick something, you’re good at but that you don’t enjoy, it will be a disservice to you. Look for something that will satisfy BOTH the conditions, and you’ll be set. Never opt for the speciality that you don’t like nor you are good at, just because somebody told you it is better. Make the right choice delighting both you and your patients.
When in doubt, keep your options open.
When in doubt Internal Medicine and General Surgery can be good options. They both have tons of sub-specialties that you can sample throughout PG, and either one of them will allow you to fine-tune a career for yourself out of the available options.
Take your daily routine into account.
You must of course take lifestyle into account. If you want nights and weekends to yourself, go into Dermatology. You want a lot of money? Look at some of the surgical sub-specialties like Plastics. Want shift work with solid start and finish times? How about Emergency Medicine? You’re all right with staying at work late to stabilize a patient? Think about something like Internal Medicine. Take your personal preferences into account when picking what to do, because if you pick a lifestyle that won’t work for you, you’ll burn out.
Still if you are unsure of making a decision then ask yourself a few questions stated below. This definitely is going to be productive.
What holds more importance for you?
What do you enjoy the most about medicine? Are you fascinated with research or do you love to treat complex cases? Consider what postings you excelled at and which ones you disliked. Sometimes you have to trust your gut when choosing your path.
How extensively are you willing to train?
After 5.5 years of MBBS and 3 years of PG, you may not want to commit to a super speciality. In this case choose an end branch, which lets you settle down and make a career
Do you need a lot of variety?
If you enjoy the unpredictable, you may want to consider a medical specialty, such as emergency medicine. ER doctors never know what will come through the door next. For those who like more of a structured workday, they may prefer to work in private practice in a specialty, such as paediatrics or family practice.
How do you perform under stress?
It is difficult to predict what specialty will be the most stressful. Lots of factors can contribute to stress, such as operating your own practice, long hours or supervising your staff. But there are certain areas of medicine, which tend to involve treating patients with life-threatening conditions. When the stakes are life and death, the pressure is on. If you do well under pressure, working in critical care or the emergency room may be a good fit. If you prefer a low-key specialty, consider ophthalmology or dermatology.
Are you a people person?
Certain medical specialties involve more patient contact than others. For example, if you enjoy a lot of patient contact, there are many specialties you may do well in. From psychiatry to family practice, you have the opportunity to spend time with your patients. If you are on the opposite end of the spectrum and consider yourself an introvert, you may do better in radiology or pathology.
Do you have a patient population you want to work with?
Not all doctors have a certain population they want to treat. For others, they have an interest in working with children, the elderly or patients with mental health issues. If you have a strong interest in caring for a certain population, it may help lead you to a certain specialty.
How important is doing procedures?
Certain types of doctors are more likely to perform procedures while other medical specialties involve doing more diagnostics.
Conclusion
If you ask yourself the above questions, you will be able to make a right choice in choosing the best suited specialty for you. Other things that can help you out are take aptitude test or talk to the people already in that field. Do not make wrong choice based on any external influences. Make the right decision that keeps you happy, because whatever you choose will stick with you your entire life.
How to choose your medical specialty
One of the hardest decisions in your career begins at foundation level, when you have to start thinking about which specialty to pursue. With over 60 specialties and more than 30 subspecialties to consider after foundation training, it can be a tough choice.

If you know which specialties you prefer, you may be able to opt for particular foundation or core programmes that assist your career decision. Other trainees are more influenced by factors such as geography – they want to stay in a particular region, and will consider a range of specialties in order to fulfil that aim.

If you have decided on a career as a physician, the first step is relatively simple, because there are only two main training routes. You should apply for either core medical training (CMT) or acute care common stem (acute medicine; ACCS) training. Entry is at core training level 1 (CT1), and training lasts for 2–3 years. Both routes open up access to over 30 medical specialties, which commence specialty training at level 3 (ST3). This ST3 training lasts 4–5 years, and can sometimes lead to subspecialty training (eg as a gastroenterologist, you could specialise further in hepatology).

Factors to consider
Personality
When choosing a specialty, it’s important to take into consideration who you are: your personality, likes and dislikes, abilities, interests, ambitions, aptitudes, limitations and task-management skills.

Are you a hands-on practical person, or do you like to think about detail and solve complex problems? Can you deal with uncertainty and complex/busy situations, or do you prefer a more ordered approach with time to think?

Many of the medical specialties require a mixture of attributes because of the varied and variable nature of work as a physician. Many deaneries / local education and training boards (LETBs) and foundation schools provide personality and learning style testing through their careers department, as well as detailed specialty descriptions.
Key preferences to consider while choosing a specialty include:

Patient contact levels – will you have time to develop patient relationships, or would you prefer to see many patients in a day? What kind of patients do you want to treat?
Training schedule and time taken to reach consultant level – how long do you need to train for, how many hours are required and, once you are a consultant, what hours are you required to work?
How competitive is the specialty selection process – do you have the knowledge and skills base to get selected?
Career progression – how far can you go in each specialty, and how far do you want to climb in your career?
Stress management – how do you cope with stress? Could you work in the high-pressure environment of acute medicine?
Do you like research? Data and analysis?
Do you like problem-solving, or straightforward care practices – structured work?
You need to consider the specialty’s requirements, conditions of success, advantages and disadvantages, financial and personal compensations, prospects, and opportunities for further career and educational development. You should be realistic about the relative strength of your application; some specialties are very oversubscribed. You should investigate competition ratios, but bear in mind that these data are historical, and do not necessarily reflect future competition – indeed, the mere act of making this information available can change applicant behaviour.

Opportunity for change
If you find yourself in the position where you doubt that you are in the right specialty, there are still opportunities for change. Quite a few specialties recognise that trainees who move from one training path to another, bringing with them useful skills – for example, undertaking CMT before moving into radiology or general practice, or undertaking general practice before entering physician training. However, the more changes you make, the longer your overall training pathway becomes, and your decision-making capabilities may be questioned by selectors.

You could consider a fixed-term post, either in the UK or abroad, to gain experience in particular specialties; this will help you validate your decision about the specialty that you want to pursue next. This is also relevant if you are having trouble choosing your first specialty.

Quite a few foundation doctors step off the career ladder before entering specialty training, in order to experience different specialties and different healthcare systems, and the experience gained is usually very useful.

Liz Berkin, clinical lead for specialty recruitment, RCP London
Have a look at our life once during residency in government hospital:

This is for ophthalmology, one of the least hectic branches. You can imagine the state of surgery /medicine /obg residents.

Our work starts at 7:30, at times earlier than that, at the earliest we get free at 5-6 pm (luckily, rarely), usually by 9-10 pm and once / twice a week after midnight, no post duty off at RPC.

We shed lot of weight after joining. And hair too. I lost ten kgs in first year. Gained back more than that during final exams. Pretty unhealthy and unregulated, can’t help it.
We skip meals, quite frequently. We are found NPO more frequently than our emergency patients.
Every year one or two of us catch TB, and after intensive phase of treatment, they join back. One resident once got stress fractures. First few days your legs hurt, then you feel nothing.
We don’t feel hungry, neither do we feel full even after a full meal.
We eat whatever we get. We can sleep only 2-3 hours a day and still work with bit swollen eyes and pretty functional brain, I guess. Patients, colleagues, seniors shout on us, sometimes we shout back. No personal life, don’t ask us about the love life. Pretty dysfunctional/ interrupted /troubled ones for majority. unless you are in same department. We have minimal idea of world politics / news/ current events / movies. You would call us really dumb; our vocabulary is limited to medical jargons. Why is it like this? There is so much of work load, so many patients.
Patients, patients everywhere, no end to them. So many come here daily, still so many are left. Our health sector is poorly infrastructure, work force is disproportionately small that we have no time to think about anything but work. In this pace and load of work, we torture and we get tortured. By working schedule, working conditions, patients, seniors, colleagues, juniors etc. It is bound to happen. Everyone can’t manage to stay happy and calm all the time under stress. We learn that eventually. Some never learn that. Some can’t control their anger /frustration /outbursts. So, the one’s around them learn to adjust. Some turn suicidal / depressed. Many leave the course mid-way. Some stay happy /cheerful, develop an equilibrium with existing condition. Though the response is subjective, the stressors are pervasive and objective issues. At the end of residency, we come out as a changed person. Better or worse, depends on how one takes the ‘torture’.
Advice to residents in psychiatry, though applicable to all residents.

I recently came across this compelling tweet: “An open question on mental health as a junior psychiatrist. What do you think I should learn and focus on to be a better doctor and advocate for my patients?”
Could there possibly be a better question for all people starting out in any field to ask themselves, and others, as they embark on their careers?
The 140-character limit imposed by Twitter forced me to offer only a brief reply containing five scant snippets of advice. This troubled me—his serious request deserves a more serious response.
Here it is—the 50 most important things I have learned in my 50 years studying psychiatry:

1. Your patients will be your best teachers.
2. No meeting with any patient is ever routine for them; so, it should never be routine for you.
3. Focus on establishing a strong therapeutic alliance and healing relationship—the most important goal of any first session is the patient’s returning for a second.
4. Helping serious mental illness is very much harder, but also much more gratifying, than treating mild illness or the worried well.
5. Validate that your patients are currently trying to do their best, but also set a tone of future expectations they will find ways to change themselves, and their world, for the better.
6. Always inspire realistic hope and always reverse unrealistic demoralization.
7. Follow your patient, not your preconceived notions, a supervisor, or a manual.
8. There are no bad or boring patients; but there are some bad and boring doctors.
9. Be as empathic, as caring, as involved, and as alert for the tenth patient each day as for the first.
   10.Never lose sight of the practical struggles the patient faces in the real world and try to help them find practical solutions.
10. Don’t be shy about giving advice when advice is needed.
11. Don’t give advice when the patient can find their own way.
12. Include family, friends, other informants, and potential co-therapists whenever possible.
13. Be open ended enough in your questions to let patients tell their life stories; structured enough in your questions to get the specific information you need.
14. Try to create rare magic moments—things you say to patients that they will remember always and use in changing their lives.
15. Take your time and be careful—small mistakes can have major consequences.
16. Know the patient, not just the diagnosis.
17. Diagnosis should almost always be written in pencil—especially in the young and the old. Always err on the side of underdiagnosis—it is easy to later up-diagnose; almost impossible to erase a diagnostic error that can haunt the patient for life.
18. Use DSM, but don’t worship it. I equally distrust clinicians who do not know DSM and those who only know DSM.
19. Educate patients about their symptoms, diagnosis, course, the risks and benefits of plausible treatments.
20. Negotiate, don’t dictate, the treatment plan: allow the patient to pick whichever plausible treatment most suits them—with awareness that no one size fits all.
21. Do not join the bandwagon of diagnostic fads. Whenever everyone seems to suddenly have a diagnosis, it is surely being way overdone (e.g. ADHD, autism, bipolar disorder).
22. Watchful waiting is the best treatment whenever there is doubt or the symptoms are mild.
23. Placebo is best medicine ever invented and responsible for most of what appears to be “drug effect” when milder symptoms improve.
24. Severe illness is usually easy to diagnose reliably and always requires urgent intervention.
25. Always rule out the real possibility that symptoms are caused by medications, alcohol, street drugs, or medical illness.
26. Don’t be a careless “pill-pusher,” but do understand the great value of medications used wisely for proper indications.
27. Know the risks, not just the benefits, of medications
28. Educate your patients on adverse effects, complications, and withdrawal symptoms.
29. Be alert to, and try to avoid, drug-drug interactions and include in your consideration all the many non-psychiatric medications the patient is likely to be taking.
30. Start low and go slow especially with young and old patients.
31. De-prescribing requires much more skill than prescribing—learn it well and apply it often to reduce the harms caused by over-medication.
32. Avoid the current tendency toward irrational poly-polypharmacy
33. Learn and use three treatments that are very effective, but relatively harder to use and thus very underutilized: lithium, clozapine, and ECT.
34. Never meet with drug sales people; ignore all drug company marketing; do not believe any study that was funded by a drug company; and educate patients to be sceptical of direct-to-consumer drug ads that misleadingly promote disease mongering.
35. Read the scientific literature with great scepticism and awareness that most studies do not replicate, positive results are always exaggerated, and negative results are usually buried. Do not be wowed by genetic findings—so far, they have flopped in finding causes and have no place in planning treatments.
36. Uncertainty sure beats false certainty. Accept its inevitability;’ don’t jump to conclusions; and help your patients deal with the anxiety it provokes.
37. Learn statistics, especially as it applies to medical decision making, and think probabilistically, not in rigid yes/no categories.
    “Taking time and energy to train doctors in the physical exam may be less valuable than teaching them how to communicate or to analyse . . . data,” said Wachter, associate chair of medicine at the University of California at San Francisco. “You’ve got to make some choices.”

TRANING OF DOCTORS

There is general agreement that the technological explosion that began in the 1980s led to the decline of bedside skills. Insurance that pays for tests but gives short shrift to a careful and time-consuming history and physical exam accelerated the trend, as has the growing paperwork burden doctors face. The generation of influential mentors who taught physical diagnosis has largely retired. Even bedside rounds — where such knowledge was often imparted to impressionable neophyte physicians — are mostly a thing of the past, migrating from a patient’s hospital bed to a conference room down the hall where test results and the chart — not the actual patient — are examined.
Too often, physical exam skills are dismissed as inferior relics of the past when compared with “the glitter and perceived objectiveness of modern technology,” said Steven McGee, a professor of medicine at the University of Washington and the author of a recent textbook on evidence based physical diagnosis.
McGee said that studies have found that physical exam findings can be as accurate as their technological counterparts. Case in point: A pair of studies involving 185 acutely dizzy patients found that the presence of certain abnormal eye movements was more accurate than an initial MRI scan in distinguishing a serious stroke from a benign inner ear problem.
The enormous amount of technology that doctors now must master has crowded out physical diagnosis, he said. But, he noted, “there is a giant chunk of diagnosis that still depends on what we see and detect” through observation and a physical exam. For a surprising number of diseases, McGee added, diagnosis is based on observation and examination, not a test. Among them are Parkinson’s disease, shingles, drug rashes and constrictive pericarditis.

NOTES ON COMMUNICATION WITH PATIENTS
• Communication is a process of exchange of information
• Active listening involves paying attention, facilitatory cues (Verbal & nonverbal), reflecting, clarifying, deferring judgment, summarizing and giving feedback.
• Proxemics and kinesics need attention
• Nonverbal communication plays important role hence learn to decode clients & manage one’s own facial expressions, gestures, postures and vocal tone modulations.
• Non-judgmental, Acceptance, Nonthreatening, Normalization, Gentle assumption etc are few skills often helpful.
• Learning to be flexible in terms of time, language, understanding levels and context allows one to deal with varied clients with different linguistic competence and psychological sophistication.
• Establishing therapeutic relationship, establishing diagnosis, negotiating management strategies and future plan are most important goals.
• Bringing conscious awareness to above aspects improve one’s skills and competence in clinical interviewing
ELECTRONIC MEDICAL RECORDS
It happens every day, in exam rooms across the country, something that would have been unthinkable 20 years ago: Doctors and nurses turn away from their patients and focus their attention elsewhere — on their computer screens.
By the time the doctor can finally turn back to her patient, she will have spent close to half of the appointment serving not the needs of her patient, but of the electronic medical record.
Electronic medical records, or EMRs, were supposed to improve the quality, safety and efficiency of health care, and provide instant access to vital patient information.
Instead, EMRs have become the bane of doctors and nurses everywhere. They are the medical equivalent of texting while driving, sucking the soul out of the practice of medicine while failing to improve care.
BULLYING IN MEDICINE
“Surgeons are egomaniacs, anaesthesiologists are lazy, orthopaedic surgeons are meatheads, obstetricians are mean and brain surgeons think they are God”
There isn’t a single medical speciality that has not been ripped apart and ridiculed.
As I continue to mature and evolve in clinical practice, I have encountered a variety of doctors. And most of them share a common trait. They live under a grand delusion that their speciality is the only one that matters and worth doing. They have strong negative feelings about doctors who have chosen a different career path and have a deep-seated urge to insult them at every opportunity they get.
This has to stop. Every facet of medicine is equally important.
As a clinical cardiologist I depend on the primary care physicians to detect and refer their patients to me early for cardiac interventions. It would be near impossible for me to screen all the patients with coronary artery disease in the population. I lean heavily on the cardiac surgeons for cases not amenable to minimally invasive interventions. The endocrinologists help us manage the difficult diabetics who need expert fine tuning of their insulin regimes. The emergency physicians are crucial front liners in diagnosing acute cases and stabilizing them prior to sending them to the cardiac care unit. The intensive care specialists help us manage the ventilated patients and are crucial to the running of our cardiology services.
Every single doctor provides an important aspect of patient care which complements the work of the other. We work like a grand complex machine where every part is imperative to the running of sound and safe clinical practice. We are all equally important. And that is the often forgotten ‘stereotype’.
You don’t need to criticize or challenge other doctors to earn respect
I read an article recently where a rival oncologist told the parents of a young patient with incurable cancer that he could have saved her life had she been brought to him earlier. He completely disregarded the considered opinion made by the oncologist who actually managed the patient from the beginning. His actions were borne without actually consulting the managing oncologist and in that one frivolous statement completely shattered the foundation of trust the parents had on the treating team. This unnecessary disagreement between doctors often compromises the best interest of the patient.
Rival doctors often spread malicious lies about their colleagues. I have a friend who works in an established private centre and a rival cardiologist once told one of his patients that “he was a far more brilliant cardiologist” and that my friend was less experienced than he was.
Another surgeon told personal details about another doctor to his patients including mistakes he made as an intern and his unfortunate marital problems.
Just recently I overheard a junior doctor thrashing his ward colleague in front of the nurse’s station. He knew I was within earshot and yet continued to speak ill of his colleague who happens to be a trustworthy, humble and talented doctor.
This leads to lack of trust between doctors and dents one’s reputation. A patient is unlikely to respect a doctor who openly criticizes another and may feel threatened you would do the same to them.
Bullying is not a necessary evil for training doctors
One of my mentors told me prior to my training as a physician that one of the most important attributes I was expected to develop was a thick skin to criticism and condescension.
Each doctor invariably undergoes a different form of bullying throughout a long career. It can be as subtle as denying one the privilege of referring to a patient’s chart while presenting a case just seen barely fifteen minutes ago amid a flurry of admission. Or it can be downright humiliating like being called ‘stupid’ and ‘incompetent’ during morning rounds for an incorrect answer.
I have seen senior surgeons screaming at their residents and interns during surgery for seemingly simple or negligible errors. Every small mistake during surgery is magnified out of proportion and a running commentary will follow suit on how the doctor ‘does not have what it takes to be a good surgeon’.
Physicians are often in a foul mood early in the morning if the lab results are not available on time although the interns would have personally delivered the blood samples to the lab technicians. The interns will face the brunt of their anger knowing full well they did nothing wrong.
Radiologist are often condescending when interns request for an emergency CT scan as they are an easier target compared to the senior consultant whose orders the interns are carrying out.
Family physicians and general practitioners are often the object of irate registrars and consultants who feel they contribute nothing to proper patient care not realizing the crucial role these primary care physicians play in screening patients prior to sending them to tertiary care.
A paediatrician may swear at a doctor for missing an intravenous cannulation on a preterm neonate and then adopt a serene demeanour when facing the parents of the child.
We often excuse doctors who are bullies because they are ‘great with patients’ and are ‘brilliant clinicians’ or ‘gifted surgeons. This hurts the profession more than you can imagine.
Doctors trained in this hostile environment will foster deep resentment towards their peers. It becomes ingrained in their psyche. Once they get better and more confident, they will develop the same impatience that was shown to them towards their junior doctors. And they will in turn become the very bullies they once despised.
This never-ending vicious cycle will continue and the interns will mature into senior doctors thinking that bullying and condescension is a necessary tool for training doctors.
Bullies are cowards. Period. There is no way we can justify the actions of those who continuously seek ways to make the lives of others miserable. Since bullies only respond to strength, the medical hierarchy should start becoming much stronger. Cultures that shun the bullies making them look weak instead of the recipient should be fostered. This is easier said than done as the bullies often sit at the top of the food chain but cultures change because people are committed and steadfast in changing them.
Good and honest communication saves lives
Newly minted doctors need proper training to become competent and safe. They should be encouraged to ask questions and any uncertainty regarding a patient’s management will be cleared during the rounds. The young doctors learn by observing the intricate process of decision making that goes into managing a patient and in time they will become better clinicians.
Suppose a senior registrar or a consultant barks at every question as it is a ‘waste of his precious time’ or that ‘you are supposed to know this’. The junior doctors will hold back their questions or doubts for they are preoccupied with fear of appearing incompetent or lazy. They fall into the trap of placing emphasis on trying to save face and look like they know what they are doing at all times rather than admitting ignorance.
The interns will dread the clinical rounds and will only perform the most basic of duties such as tracing the lab results, writing the discharge summary and updating the progress notes. They will immerse themselves in paperwork and avoid spending time preparing for clinical rounds.
Since the interns and junior doctors are often the ones manning the wards after clinical rounds while the consultants and registrars are engaged in the busy clinics, subtle deterioration in a patient’s clinical condition can go unnoticed. The interns who lack proper clinical training to detect such dangers or even the ones who may suspect something wrong but hold back in apprehension out of creating a false alarm, may not alert the senior doctors until it’s too late.
The patient’s care is severely compromised and the interns will retreat further into their shell as they will be blamed for this unfortunate event. If the interns try to defend themselves and argue back, they will be blackballed throughout their career in medical practice and labelled for insubordination.
And shame does not encourage improvement. The culture of blame and punishment fosters more mistakes and fatalities. Doctors do not report their errors for fear of retribution.
And our mistakes will work its way down to affect the patient’s lives.
The doctor-patient relationship paradigm depends closely on the doctor-doctor relationship. Bad and damaging cultures foster a hostile atmosphere that erodes trust, tarnishes good communication and promotes disrespect within the medical community. The role doctors play in harming each other ubiquitously affects the patient’s care, however unintentionally.
If we work in an environment where we are kind, tolerant and respectful of each other, we will in turn be more humane to our patients. Young doctors will be nurtured in a system that is steeped in kindness and compassion and they in turn will become sound clinicians who resonate the same values.
It is, as Plato once said “Be kind, for everyone you meet is fighting a harder battle”.
The need to train and test physicians in “interpersonal and communication skills” was formally recognized only relatively recently, in 1999, when the American Board of Medical Specialties made them one of physicians’ key competencies. Although medical schools and residency programs then began to train and test students on these skills, once physicians have completed training, they are seldom evaluated on them. And doctors trained before the mid-1990s have rarely, if ever, been evaluated at all.
I realize that many colleagues may see methods like ours as too intrusive on their clinical practice and may say that they don’t have the time. But we need to move away from the perception that social skills and better communication are a kind of optional extra for doctors. A good bedside manner is simply good medicine.
Defensive medicine
Doctors fearing the threat of prosecution are avoiding high-risk procedures and patients who could be denied life-saving treatment as a result.
Defensive medicine is where doctors recommend a test or treatment with the priority being to avoid litigation rather than the patient’s best interests. An example would be declining to carry out a procedure with a relatively low success rate, even if it represents the patient’s only hope of medium to long-term survival.
Almost half of doctors said the possibility of prosecution meant they were more likely to avoid high-risk patients, while 70% said it would lead to more mistakes being hidden.
FIXING DOCTORS FEES
Forcing qualified doctors to perform charity is neither going to work nor is it a democratic solution. Furthermore, we mustn’t forget that healthcare professionals are now in demand all over the world. By making the already difficult job of medical professionals even more difficult in India, we are going to lose even more doctors to richer countries. This will also make it difficult to attract the best and the brightest to medical profession, who are already beginning to show a preference for non-medical fields. Providing healthcare for the impoverished sections of the society is a state responsibility and I am surprised that this bill, instead of using this opportunity to enhance, equip, and enable public healthcare mechanisms and hospitals, puts the blame completely on private medical professionals. Our state-run clinics and hospitals are largely not fit for purpose and suffer from lack of funding, corruption, and inefficient management. It is unfair to ask private practitioners to do as a charity what in reality should be done by state.
Doctors and books of accounts

Every Doctor should maintain regular and proper books of accounts supported by supporting vouchers for expenditure. If the accounts are found to be correct and complete supported by supporting voucher, expenditure actually incurred for the purposes of the profession shall be allowable irrespective of its quantum.
As per Income Tax Act, 1961 you can compute your income chargeable in accordance with either cash or mercantile system of accounting and this system should be regularly employed too.
For doctors and other specified professionals, section 44AA of the Income Tax Act, 1961 require compulsory maintenance of books of accounts. But Doctors and other specified professionals, whose Gross Receipts in the profession do not exceed the prescribed limit of Rs. 1,50,000/- in any one of the said preceding three years (or where the profession has been newly setup in the previous year, his Gross total receipts in the profession for that year are not likely to exceed the said amount) are not compulsorily required to maintain books of accounts as per section 44AA of the Income Tax Act, 1961.
But that doesn’t mean that if you fall under the above category you don’t need to maintain any books of accounts. There are no such prescribed books of accounts for you all falling under the above category but you should maintain such books of accounts and other documents as may enable the Assessing Officer to compute your taxable Income under the Income Tax Act, 1961.
Prescribed books which are to be maintained by doctors and other specified professionals as per Section 44AA of the Income Tax Act,1961 are as follows:
a. A cash book (i.e., a record of all cash receipts and payments kept and maintained from day to day and giving the cash balance in hand of each day or at the yearend of a specified period not exceeding a month);
b. a journal, if the accounts are maintained according to the mercantile system of accounting;
c. a Ledger;
d. carbon copies of bills (whether machine numbered or, otherwise serially maintained) exceeding Rs. 25, issued by you and carbon copies or counterfoils of machine numbered or otherwise serially numbered receipts issued by you;
e. original bills wherever issued to you and receipts in respect of expenditure incurred by you and where the expenditure incurred does not exceed 50 rupees, payment vouchers prepared and signed by you.
In addition to all the aforesaid Books of accounts and documents, Doctors are required to keep the following Books/documents:
a. A daily cash register in Form No. 3C, showing Date, SI. No., Patients name, Nature of Professional, i.e., general consultation, surgery, injection, visit, etc., Fees received, Date of Receipt.
b. An inventory under broad heads as on the first and last days of the previous year, of the stock of drugs, medicines and other consumable accessories used for the purpose of profession
All the aforesaid books of accounts and documents should be kept and maintained for a period of 6 years from the end of the relevant assessment year and at the place where you are carrying on the profession or where the profession is carried on in more places than one at the principal place of profession.
DETACHMENT AS TOLD IN MUNNA BHAI MBBS
As a physician, you are a product of medical culture; in that culture, there are unspoken manners and mores that its members are expected to note and assimilate.
In dealing with patients, for example, the historical model has been for physicians to remain cool, calm, and collected at all times. Your approach is to be strictly scientific: logical, objective, methodical, precise, dispassionate, the very embodiment of the term “clinical.” This, medical tradition has it, is in the best interest of doctors and patients alike.
That’s been the model since Sir William Osler, the father of modern medicine and a paradigmatic figure for generations of doctors, called on his colleagues and students to demonstrate “imperturbability,” which he defined as “coolness and presence of mind under all circumstances.
“A rare and precious gift,” Osler added, “is the art of detachment.”
But today, an attitude of detachment is often a double-edged sword for physicians. In many ways, it can be useful and necessary. It insulates and protects you from the powerful emotions that patients display in your presence: anger, frustration, bewilderment, grief, rage. And it insulates patients from the roiling emotions that you may at times feel toward them.
However, a detached attitude also insulates you from empathizing with patients. A doctor/patient relationship may technically exist, but it’s often too perfunctory to matter. The detached doctor talks in language that is over patients’ heads, assumes that they understand what was said, and keeps her eye on the clock. That, research shows, can have a negative impact on clinical outcomes.
Is Detachment Necessary?
Physicians may justify this aloofness by framing it as necessary for efficient doctor/patient interaction, believing that with people in the doctor’s personal life, there will be a different, more intimate standard of behaviour — one that is more empathic, outgoing, revealing, and vulnerable.
Unfortunately, it doesn’t often work that way. Detachment is not like a light switch that you can turn on and off to suit the situation, experts maintain. It has a tendency to seep into all your relationships. It becomes a personal style of distancing yourself from the world — not just from patients, but also from colleagues, family, friends, and even yourself.
The result can be unhealthy for physicians and patients alike.
COMPASSION
Compassion can be taught; I told a class of medical students — but it also can be lost. A 2008 study of 419 medical students showed that women had twice the empathy scores of men and that scores declined at the end of the third year, when students had begun regular exposure to patients during clinical rotations — exactly at the point where they needed more not less empathy. The 2008 study is not the only one showing this decline, but the trend can be prevented: A study of 209 students at the Robert Wood Johnson Medical School found that empathy was maintained among third-year students who received specialized training.

Looking at bleary-eyed students in front of me, some of whom had their textbooks open trying to prepare for an upcoming exam while I talked, I could see why the grind of medical training could lead to an empathy problem: stress, anxiety, competitiveness and sheer lack of time.
Standing at the podium, I asked the students: “Do you need to show compassion, or do you need to have compassion?”
No one volunteered an answer. I had put forth the same question to my father, who had had bypass surgery and is a cancer survivor. He said, “You can’t be compassionate with every patient. You will get burned out.”
I could see what he meant. In a day’s hospital rounds, I see two or three patients who are terminal. With respect and politeness, I explain the condition in simple language to them and their families, but then I carry on. I hope another specialist or their primary-care doctor will spend more time with each of these patients.
A good technique for showing compassion, I told the students, is simple: 3 T’s. Talk or listen, take time and touch. Merely taking the time to talk and listen to patients is comforting, as is a doctor’s touch.
I shared with them what Branch had told me: “You have to be genuine; otherwise it will show.”
In my practice, I find that each patient is different in his or her need for compassion. The art of medicine is not just choosing the right medicine but gauging the needs and providing reassurance and comfort to the patient. A burly man might appreciate a pat on the shoulder while an elderly woman might like me to hold her hand during a conversation.
EMPATHY
Clinicians who are interested in a patient’s perspective are more likely to have empathy, and researchers are more likely to engage patients of their own volition. It must be realised that the function of empathy2 is not merely to label emotional states, but to recognise what it feels like to experience something. There can be no empathy without shared perspective.
An empathic connection can also make practising medicine more rewarding. Physicians who allow their patients to emotionally move them enrich their own experience of doctoring, and numerous studies have shown that patients who are treated by doctors who score higher
POLICY OF MCI INDIA
Archaic and outmoded rules, regulations and eligibility conditions requiring a capital base of more than Rs.150 crore have made the establishment of medical colleges a business proposition. Combined with no incentives for quality education, there has been a twofold impact: 1. commercialising the medical profession, where “recouping” the investment is the prime concern for the investor and graduating doctor alike; and 2. an aggravated shortage of doctors in three ways: 15 per cent of those in the Non-Resident Indian quota within the 50 per cent management quota do not practice in India; of the remaining 35 per cent, many do not practice, migrate abroad or establish themselves in cities for better incomes; and, poor training makes many “unemployable” as amplified in a provider survey by Jishnu Das in Madhya Pradesh which found a marginal difference in the practices of “qualified” doctors and quacks. Clearly, the commercialisation of medical education is one of independent India’s biggest mistakes.
Therefore, the solution of “flooding the market with doctors by opening more medical colleges” to contain the menace of capitation fees without in the first instance, overhauling the regulatory framework related to quality of instruction, faculty development, better salary structures and banning private practice, etc has little merit.

TWO MINUTES CONSULT
Doctors in India see patients for barely two minutes on average, according to a global study which found that primary care consultations last less than five minutes for half the world’s population, ranging from 48 seconds in Bangladesh to 22.5 minutes in Sweden.
While India’s primary care consultation time was two minutes in 2015, the mean duration was just 1.79 minutes in 2016 in neighbouring Pakistan, the largest international study on consulting time, published in the British medical journal BMJ Open, found.

“Shorter consultation times have been linked to poorer health outcomes for patients and a heightened risk of burnout for doctors,” researchers wrote in the journal.
END OF LIFE DISCUSSION
Physicians all too often skip having an end-of-life discussion, or at least delay it as long as possible, even in the face of a major health crisis. Physicians are rarely prepared to conduct such momentous conversations with patients, least of all about anything as sensitive as advance care directives. We typically think and act short-term rather than looking ahead. But it’s more than that: Such conversations guarantee deep discomfort.
Acknowledging the approach of death means delivering a poor prognosis — and admitting to ourselves that we’re about to fail our patients forever. Doctors are hardly immune to living in denial. We can be unduly optimistic about how long even the sickest of the sick are going to stay alive.
After all, nobody wants to look death in the eye.
And in bypassing this opportunity and doing what we believe to be right, we’re actually committing a wrong, bringing serious consequences. Patients pay the price. Those who need to be alerted to and informed about end-of-life care may wind up ill-advised and even ignorant about the choices available and what they might mean.
Terminal patients should have the opportunity to enter hospice care sooner than most do to take advantage of its clinical, emotional and spiritual benefits. They should also be granted the right to die at home if they so choose rather than in a hospital or a nursing home.
TELEMEDICINE
Telemedicine is another example of what can arise from preserving the doctor’s ability to innovate. There is a growing need for more doctors, and telemedicine is a way to alleviate this shortage. People living in rural areas, where there are very few doctors, can utilize telemedicine to visit with a doctor within the comfort of their own home. It also allows doctors who live in a highly saturated doctor community to still get enough patients to be successful. Most doctor visits do not require both individuals to meet in person. So, telemedicine can also be used as a mechanism to limit the amount of time wasted for patients (taking time off work, commuting to the doctor’s office, waiting in the waiting room), and doctors (waiting for patients to arrive, unnecessary visits). As telemedicine becomes more popular and competitive, it also will lead to cheaper prices for the patient as well as more innovation from the doctor.
OATH
The Hippocratic Oath contains some great principles, like doctor-patient confidentiality and beneficence. One of the Oath’s eminent principles, “primum non nocere,” (“first, do no harm”), wasn’t actually stated in the original Hippocratic Oath but in one of Hippocrates’s other writings, Epidemics. Aside from these great elements, there are some problems with the oath. For example, the oath is sworn to multiple Greek Gods, creating an issue for physicians who aren’t polytheistic.
PROVIDER
The term doctor has authority. The term provider has none. The term provider came along with consumer protection act, in a way to belittle doctors. Let the doctors stay with the term doctor. Also, I remember when the term “provider” slipped into the hospital lexicon. It was perhaps 10 years ago, when our hospital started hiring physician assistants and nurse practitioners to share the clinical load. In contrast to the regular staff nurses, who cared for the patients in conjunction with the doctors, physician assistants and nurse practitioners would see patients independently, the way the rest of the doctors did. So there needed to be a term that would include all three groups – physician assistants, nurse practitioners and doctors — who could have primary responsibility for patients.
“Health care provider” came into vogue as the catchall phrase and was quickly truncated to just “provider.” The term does have its upside, helping to minimize hierarchy. History has shown us that medical hierarchy usually serves more to stomp on underlings than to provide leadership. In fact, physician assistants, nurse practitioners and doctors have more similarities than differences in their day-to-day interactions with patients, even as they come from unique backgrounds and bring different strengths to the table.
Still, the term “provider” has never stopped irritating me. Every time I hear it — and it comes only from administrators, never patients — I cringe. To me it always elicits a vision of the hospital staff as working at Burger King, all of us wearing those paper hats as someone barks: “Two burgers, three Cokes, two statins and a colonoscopy on the side.”

HEALING
Medicine is an equal measure of art and science. Curing and healing are not exactly synonymous. Curing is science intervening to get rid of a disease or infection. But healing involves the whole mind-body complex. That’s the important distinction. There are conditions which you cannot cure, but you may be able to heal a fair amount of anxiety and discomfort. Not uncommonly, the problem is more in the mind, and that is where the art of medicine comes into play. Sometimes you cure and you heal. Sometimes you cannot cure, but you can heal to some extent. Sometimes you can heal when there is no real physical illness to cure.
DOCTORS FEE

Doctor’s consultation fee is always a controversial as some doctors feel that they charges very low and that too once a week or month so provide concession to patients and few doctors feel that in era of inflation it is very hard to suffice so they write Blood & other Fluid Pathology, Radiological, Endoscopic, Cardiac, Neurological, Orthopaedic etc. investigations. They want to get commission or cut provided by diagnostic centres. Many medicines companies provide doctors cut in form of cash or organising lunch/diner with cocktail or free registration fee or air tickets for medical conferences, seminars & meetings/get togethers for writing medicines including vaccines, diagnostic dyes, implants, stents and devices. Some doctors also get cutback by referring patients to other hospitals and doctors and many big & medium hospitals & doctors keep marketing team or agents to get patients from nearby doctors in villages, town, cities, factories and companies and even from foreign countries. Marketing team extensively market the treatment facilities, good records and about doctors in print and electronic media beside door to door visits to doctors and wall hoardings and posters. Even ECHS, CGHS, ESI, Private. Insurance Companies and TPA officials and doctors are bribed to get patients and get passed their inflated or normal bills. False insurance bills, fake medical certificates, Non-reporting of notifiable diseases, and medico legal cases to administrations and keeping unqualified doctors as homeopaths, Ayurveda, umami in modern hospitals, keeping untrained staffs in OTs, labs, ICUs, refusing treatment in emergency and holding treatment of a patients or dead body for non-payment is also practised by few. Many government doctors openly practice in private setups, send investigations in private labs and write costly medicines unavailable in government hospitals and use touts to shift patients from government hospitals to private clinics or hospitals and nursing homes. Most of patients feel that medical profession is a noble profession of service to mankind and as in ancient time doctors would not charge anything from patients, so feel that doctors should charge minimum, should not charge high fee, repeated fee before 1 month. They feel Doctors receive cut back so write unnecessarily investigations and costly, unrequired medicines, admit patients in hospitals and nursing homes without any good reason and keep them for more days and sometime do unrequired surgeries at least add such charges while making bills. Therefore, this noble profession is getting dirty and murkier in the eye of people. So, media, politicians, judges and bureaucrats who can nab and tap doctors are very much active to malign name, fame, reputation of doctors in society. So, In West Bengal Assembly passed, such a derogatory and discriminating bill where doctors can be fined from 3 to10 lacs, may be jailed not for 2 yrs. but also for 10 yrs. with cancellation of registration. Hospitals can be fined from 10 lacs to 50 lacs, its administrators will be jailed and hospital will be closed if medical negligence found leading to suffering or death of a patients or over pricing bills by unnecessarily detaining patients, unwanted or unrequired investigations, medicines by a New Commission of retired Judges & Bureaucrats. Commission will decide every price of any type of service fee, investigations and medicines in hospitals and nursing homes. E Bills, prescriptions, day to day explanation of expense and treatment by a PRO team and fair price medicines shops must be practised. Commission acting as a court will give judgement within 6 months on a simple online application by any patients or relative aggrieved by treatment. It may implicate a criminal proceeding in court against doctors & hospitals. Many more states may follow it soon. So, it is high time that doctors and hospitals should introspect themselves. Medicine is regarded as the most noble of all professions. And, a doctor is accorded a status next to God. Hence, a doctor is duty bound to practice ethical medicine, which also includes ethical earning. We are professionals. We have a professional degree, which gives us a privilege to practice medicine. We are registered with a professional regulatory body. We follow a Code of Ethics as prescribed by the council. Our privileges to practice can be withdrawn in case of breach of the ethical code. Some major ethical and unethical practices are described by our councils are as follows: The consulting fee or billing process begins right at the time when the patient arrives at our clinic or hospital, with registration charges. Patient may also be billed for facilities provided in the clinic or hospital for once or multiple times. Charges for making patient summary, charges for the assistant/nursing staff/paramedical staff, charges for drugs and materials used, issuing a certificate, point of care investigations with no subsidy, dispensing medicines with no subsidy, administrative charges, charges for utility services etc. are other heads under which the patient can be charged are legal and ethical. Such Charges displayed or communicated to patient in advance, then may vary from doctor to doctor and hospitals to hospitals, and they are at liberty to keep their own charge of any service provided, investigations done. Accepting rebates and commission from diagnostic centres/laboratories and hospitals or fee splitting without involving any service for the referring, recommending implants/ stents/ medicines, vaccines or procuring of any patient is unethical. Any income generated out of such practices is unethical earning. Any advertising or marketing medical practice for earning, cuts, concessions, rebates, making false bills, issuing fake certificates, not giving first aid to accident, rape or severely injured or serious patients and unnecessary detention of a patient or a dead body, unreproving of notifiable diseases, medico legal cases and shifting patients from government to private hospitals are gross blunders. Only pharma or medical shops having separate license can sell the medicines or implants etc only. Let us all charge our legitimate fee and pass on the benefits of concessions on diagnostics etc. to the patients. Keep in mind the following: I have a right to charge rationally for my fee. I have a right to charge for every consultation, even the same day. I have a right to charge extra for emergency appointments, same day appointments and routine appointments. I have a right to charge extra for night visits. I have a right to charge extra for long consultations. I have a right to charge for accompanying a patient for diagnostics. I have a right to charge for briefing my senior specialist. I have a right to charge for visiting my patients when they are admitted in a hospital under a specialist. I have a right to charge for legal certificates. I have a right to charge for telephonic consultation. I have a right to charge for reviewing reports. I have a right to charge for only giving opinions on reports.

BREAKING BAD NEWS

Breaking bad news is not an easy task. Too blunt and you might hurt someone. Too soft and you might not be able to make the person understand the gravity of their situation, which is necessary for them to plan their lives.
Also predicting how long someone has to live is very imprecise in most conditions that people die of cancer, heart disease, lung disease (like emphysema), and dementia. What you don’t know, you can’t tell.
We’ve spent 35 years trying to teach doctors how to break bad news and push them into telling people their prognosis, but I don’t think the focus on telling people their prognosis, how long they have to live, is the thing we should be focusing our truth telling on.
The real thing we need to focus on, if we are going to be truthful with patients, is helping them make decisions. We need to explain what we can do for them. We need to say there are some things we can do with your chemotherapy, or your radiation, or whatever else we have to offer, but there will come a time when those things won’t work and may do more harm than good.
People need to know they have an incurable illness, but they also need to know their illness trajectory. They just do not need to know how long they have to live
Fee splitting

Fee splitting is the practice of sharing fees with professional colleagues, such as physicians or lawyers, in return for being sent referrals
This is essentially the payment of a commission to the referrer with the express intention of ensuring that the referring doctor directs referrals of patients to the payee.
In most parts of the world, the practice is considered unethical and unacceptable, hence fee splitting is often covert. The reason it is believed not to be in the interests of patients is because it represents a conflict of interest which may adversely affect patient care and well-being, since patients will not necessarily be referred to the most appropriate doctor to provide their on-going care but will instead be referred to those doctors or hospitals with whom the referring doctor has a “fee splitting” or commission payment type of arrangement. It is also called as ‘CUT’ (also spoken as Cee-You-Tee) practice in many parts of the world including India for its reference to a ‘cut’ from the patient’s bill.
Many countries do not allow promotion of health services via mass media, advertisements and other direct promotions, and in a significant way, information on pricing and quality of care institutions and medicines reaches to patient through their primary care physician, many of whom indulge in a referral fee split unethical practice to refer a patient for business to a higher specialist, brand prescription and admissions.
GOALS OF TREATMENT
I recently came across this compelling tweet: “An open question on mental health as a junior psychiatrist. What do you think I should learn and focus on to be a better doctor and advocate for my patients?”
Could there possibly be a better question for all people starting out in any field to ask themselves, and others, as they embark on their careers?
The 140-character limit imposed by Twitter forced me to offer only a brief reply containing five scant snippets of advice. This troubled me—his serious request deserves a more serious response.
Here it is—the 50 most important things I have learned in my 50 years studying psychiatry:

1. Your patients will be your best teachers.
2. No meeting with any patient is ever routine for them; so, it should never be routine for you.
3. Focus on establishing a strong therapeutic alliance and healing relationship—the most important goal of any first session is the patient’s returning for a second.
4. Helping serious mental illness is very much harder, but also much more gratifying, than treating mild illness or the worried well.
5. Validate that your patients are currently trying to do their best, but also set a tone of future expectations they will find ways to change themselves, and their world, for the better.
6. Always inspire realistic hope and always reverse unrealistic demoralization.
7. Follow your patient, not your preconceived notions, a supervisor, or a manual.
8. There are no bad or boring patients; but there are some bad and boring doctors.
9. Be as empathic, as caring, as involved, and as alert for the tenth patient each day as for the first.
   10.Never lose sight of the practical struggles the patient faces in the real world and try to help them find practical solutions.
10. Don’t be shy about giving advice when advice is needed.
11. Don’t give advice when the patient can find their own way.
12. Include family, friends, other informants, and potential co-therapists whenever possible.
13. Be open ended enough in your questions to let patients tell their life stories; structured enough in your questions to get the specific information you need.
14. Try to create rare magic moments—things you say to patients that they will remember always and use in changing their lives.
15. Take your time and be careful—small mistakes can have major consequences.
16. Know the patient, not just the diagnosis.
17. Diagnosis should almost always be written in pencil—especially in the young and the old. Always err on the side of underdiagnosis—it is easy to later up-diagnose; almost impossible to erase a diagnostic error that can haunt the patient for life.
18. Use DSM, but don’t worship it. I equally distrust clinicians who do not know DSM and those who only know DSM.
19. Educate patients about their symptoms, diagnosis, course, the risks and benefits of plausible treatments.
20. Negotiate, don’t dictate, the treatment plan: allow the patient to pick whichever plausible treatment most suits them—with awareness that no one size fits all.
21. Do not join the bandwagon of diagnostic fads. Whenever everyone seems to suddenly have a diagnosis, it is surely being way overdone (e.g. ADHD, autism, bipolar disorder).
22. Watchful waiting is the best treatment whenever there is doubt or the symptoms are mild.
23. Placebo is best medicine ever invented and responsible for most of what appears to be “drug effect” when milder symptoms improve.
24. Severe illness is usually easy to diagnose reliably and always requires urgent intervention.
25. Always rule out the real possibility that symptoms are caused by medications, alcohol, street drugs, or medical illness.
26. Don’t be a careless “pill-pusher,” but do understand the great value of medications used wisely for proper indications.
27. Know the risks, not just the benefits, of medications
28. Educate your patients on adverse effects, complications, and withdrawal symptoms.
29. Be alert to, and try to avoid, drug-drug interactions and include in your consideration all the many non-psychiatric medications the patient is likely to be taking.
30. Start low and go slow especially with young and old patients.
31. De-prescribing requires much more skill than prescribing—learn it well and apply it often to reduce the harms caused by over-medication.
32. Avoid the current tendency toward irrational poly-polypharmacy
33. Learn and use three treatments that are very effective, but relatively harder to use and thus very underutilized: lithium, clozapine, and ECT.
34. Never meet with drug sales people; ignore all drug company marketing; do not believe any study that was funded by a drug company; and educate patients to be sceptical of direct-to-consumer drug ads that misleadingly promote disease mongering.
35. Read the scientific literature with great scepticism and awareness that most studies do not replicate, positive results are always exaggerated, and negative results are usually buried. Do not be wowed by genetic findings—so far, they have flopped in finding causes and have no place in planning treatments.
36. Uncertainty sure beats false certainty. Accept its inevitability;’ don’t jump to conclusions; and help your patients deal with the anxiety it provokes.
37. Learn statistics, especially as it applies to medical decision making, and think probabilistically, not in rigid yes/no categories.
38. Have a rich, varied, and satisfying personal life.
39. Embark on a personal psychotherapy to help understand yourself better, solve any problems you may have, correct biases based on your personality and experiences, and discover what it is like to be a patient.
40. Learn from your supervisors, but don’t follow them slavishly.
41. Read widely, especially the great classic novels, and see psychologically astute movies and plays.
42. Read history and try to deduce its recurring patterns.
43. Travel the world to understand the wide diversity of human experience.
44. Do not impose your cultural biases, your religious beliefs (or non-beliefs., or your personal values on your patients).
45. For every complex question, there is a simple, reductionistic answer—and it’s wrong. Don’t expect or believe simple answers to complex questions, such as “What causes mental illness and how best to treat it?”
46. Instead, do have a well-rounded, four-dimensional bio/psycho/social/spiritual approach to understanding mental disorders and selecting treatments for them.
47. Be a vocal advocate for our patients. We must do all in our power to reverse the shameless neglect of the severely ill that has relegated 600,000 of them to jail or homelessness.
48. Be yourself—and grow into an even better version of yourself as you enjoy the special privilege of helping others also better themselves.
49. FIRST, DO NO HARM!
    HOW TO SPEAK IN A CONFERENCE
    Whether you’re going to be speaking for an hour or a day, you’ll stand a better chance of remembering what you’re there to share by pre-organizing your presentation to include three core points. Once those main points are established, break things down even further by adding three sub-points to each of the primary ideas. This process allows you to focus on remembering a short list of topics rather than feeling like you have to memorize every word of an entire speech. If you need notes to refer to, write the three main points and three sub-points in large letters on a single piece of paper, and place it in your field of vision.
    Ten commandments for budding doctors.

A – Attitude – You are not doing any favour to the patients. Human body is the nature’s best creation and only we are privileged to deal with it. Patients do a favour to us by having trust in us. Give your best where ever you are. Attitude trumps attributes.
B – Balance – World is full of temptations that constantly distract us. Strike a balance between too much or too little. Don’t worry if you are not the best but avoid being a failure.
C- Compassion – Doctor without compassion is like a flower without fragrance. When in doubt, put yourself in the patients position and you will always get the right answer. Hugs can do what drugs can’t.
D – Dialogue – Communication skill is not only important for being a successful doctor but also for being a good teacher and a good leader. Dialogue impacts patient more than our degrees.
Documentation – In a litigious society, proper recording and storage of important information is imperative.
E – Ethics – Doctors are treated as Gods. One of the elements of Godliness is being honest to yourself, patients and colleagues. Beware, you are a role model for others around you. Work ethically, wealth and respect will follow.
F – Fitness – Fitness of your own mind and body is essential to your ability to heal others. Be the best to bring out the best from you. Medical profession is like a marathon race, don’t sprint. Eat well. Sleep well. Think well.
G – Garment and Get Up – Our appearance and clothes make a lasting impression on patients. Clean look, neat apron, nice clothes, nice body odour, good footwear are considered as essential elements of a good doctor. Quality matters more than qualifications.
H – Hear more and speak less – Patients appreciate doctors who listen to them patiently. Good listening alone helps in diagnosis of common ailments that avoids unnecessary investigation and medication.
I – Inquisitive – In the era where knowledge is freely accessible, it is a challenge to know more than our patients! It is not only beneficial for our patients but also essential for our self-confidence. Having said that, patients are our best teachers.
J – Jovial – Being jovial brightens the otherwise gloomy world of ours. Our friendliness and smile bring hope to the patients and invigorates our team.

FREEDOM FOR DOCTORS

India celebrates its Independence Day every year on 15th August, commemorating its freedom from British rule in 1947. It is the day that all Indians pay homage to our freedom fighters and leaders for their immense contribution that led to freedom of our country. In this democratic country, everyone from a homeless person to the president of India have right to exercise their freedom. Then why are doctors suppressed from their professional freedom? In a country where there is just about 1 doctor for 1700 patients, the Doctors are always over worked and swamped with patients. This leads to a minimal or no family life along with lots of personal sacrifices from missing family member’s birthday to their child’s birth. Nowadays, the biggest stress for doctors are medico-legal issues. And, it is not without any reason. Doctors are being blamed for mistakes that others make. Many untoward events in free camps and community services are instantly blamed on doctors which later are found to be an administrative error. In our country, doctors are arrested merely due to clerical error in PCPNDT act. There are many such cases surfacing every day, which have made working as a doctor even more difficult. This has led to such extreme situations wherein doctors have been severely injured or even some have died due to attacks from violent patients. The Indian Medical Association confirmed that over 75% of doctors in India have faced some form of violence at the patient’s hands. To add fuel to this, the media has also damaged Doctors’ image. To top it all, the government has made it mandatory for every doctor to work in rural area for 2 years. Now, government is making law that might prohibit doctors to travel overseas for work, to stop “brain drain” from India. These regressive policies by the government are further restricting doctors from performing their professional duties. Overall, the unhealthy lifestyle of doctor has resulted in health issues due to irregular working hours, work pressure about patient cases, and stress about medico-legal cases. So, the person that treats and guides everyone into a healthy living himself/herself is suffering from some sort of illness. Because of this strenuous life the younger generation of doctors is losing their drive to work as a doctor and just treating it as a job and nothing more. They have no passion left from this noble profession. Other professionals get holidays, get nice pay hikes and can go home at a fixed time. They have freedom to choose their workplace, and have a happy life with great work-family balance. There is no such freedom for doctors. They are always ON CALL. Hope Doctors in India will soon gain their professional freedom as well.
Getting into Doctor’s Mind

There are some parts of the brain that a doctor uses preferentially over others, memory being the most important to start with. It begins from the time a youngster thinks of taking the entrance exam to medical school – he is required to read, retain and reproduce a large number of factual information and names of body parts and functions.
Unlike the engineering, management, or law students, medical aspirants are hardly required to use mathematical problem solving, creative thinking, logic or thinking out of the box. But ask them names and profiles of thousands of organs, tissues, cells and drugs, and they will have it on their fingertips!
As they progress to the next phase of clinical work, doctors learn to recognise “patterns” of symptoms and signs in patients, and try to fit these into the puzzle board of diagnosis. Chest pain accompanied by sweating would suggest a heart attack, or jaundice with loss of appetite would fit the pattern of “hepatitis”, for instance.
When the doctor starts maturing as a clinician, he starts to pick up a feature called “probabilistic” thinking, wherein the patient’s profile starts becoming a key factor rather than the symptoms alone. To take the example of chest pain again, he starts recognising that the same symptom in a young 20-year-old girl is almost always of neuro-muscular origin and hardly ever from the heart, while in a 50-year-old overweight smoker with high BP, it is very likely to be a heart attack, requiring immediate referral to a cardiac ICU.
With further development in his career, he starts factoring in several aspects of his patient in the process of decision-making. In other words, it is at this stage that he starts incorporating the “art” of decision making to the text-bookish science that he has crammed. Does the vegetable vendor who has come down with cough and fever for 2 days after getting wet in the rain require to be subjected to a CT scan of the chest or would an antibiotic suffice? Does the 16-year-old schoolgirl with recent onset vomiting prior to the board exams require an endoscopic examination right away? What if she had had these symptoms last year too when she was stressed before her final exams?
The mature doctor then is not just a repository of facts, information and knowledge. It is the unconscious assimilation of years of experience, marinated with a sensitive understanding of his patient’s concerns and constraints, and with an iota of intuition thrown in, that make him take decisions that posterity usually seems to approve.
In present times, things get pretty amusing. I often get patients demanding investigations to find out what the reports say and that would explain their symptoms. And then the doctor has to explain why the reports don’t give a clear diagnosis!
Good clinical decision making, like good wine, matures over time. Knowledge alone does not make a good doctor; the flavour matters!

Golden Words to every doctor
A patient is never a customer or consumer, let the law of the land say anything. Every patient is a life with a beating heart and a thinking brain, and you are being trusted by that patient to keep that heart beating and brain thinking. That is your responsibility today and after a thousand years as a doctor. Don’t ever be carried away by pride, anger or suffering, because you are the only link between the patient and life.
Every patient will not be kind to you. Some will shout, some blame, some threaten and some sue. Stay above that plane of interaction and do what you must for the good of that patient. If you feel you are not required, leave without either a harsh word or a bad feeling, because more lives wait to be saved by you, your time is far more precious.
*Clinical skills, patient interaction and communication skills are on a sharp decline. We will all benefit from learning more about these. In the massive information overload that burdens us, clinical skills can form a solid ground to confidently walk upon. *
The fear of committing a mistake is universal among doctors, please learn to develop your own individual strategy to overcome that fear. Please make your own standardised history-taking questions and examination format, and never ever skip a single step in that. Writing your differential diagnosis is the best strategy to learn and eliminate mistakes.
Overconfidence is the biggest risk for a doctor!
Be the best soul that your patient meets. Even the most illiterate or rural patient will notice your words, manners and etiquette. These must always be perfect.
*My dear ones, enjoy every moment of the holiest path that you have chosen to tread upon earth. May God keep you protected and happy, and may each one of you save a million lives.
Good doctor
The difference between a rational, ethical doctor and one who is not can be the crucial difference between good health outcomes and bad health outcomes, and sometimes even between life and death.
As doctors who have practised and interacted with many other doctors, we share clues about how to spot a good physician, not just by looking at technical qualifications, but based on their mode of interacting with patients.
The most important asymmetry between a doctor and patient is the asymmetry of knowledge. The doctor generally knows much more about what is going on in the patient’s body, what needs to be done and what is the likely outcome than what most patients will ever know. Given this context, the doctor has a duty to share a small portion of his or her vast pool of knowledge with the patient- -at the very least by carefully addressing the questions and doubts of the patient and caregivers; and by allowing them the autonomy of choosing appropriate treatment options, wherever possible.
One case from Dr Arun Gadre’s experience is illustrative of the importance of these attributes in a doctor. A 90-year-old man was admitted at midnight to a reputed nursing home with heart failure and severe breathlessness. The relatives were anxious- even though they knew that age was catching up with grandpa, his present suffering was unbearable. The physician came and prescribed something; he was not ready to entertain any questions. His blunt response was: “What can we do for a person at the age of 90 with such severe heart failure?” When the patient’s son tried to inquire about how to alleviate the old man’s suffering, the rude answer came, “Do not argue with me, I have no time to answer silly questions.”
Grandpa was shifted to another hospital. The new physician patiently answered all the questions and elaborated upon the nearly hopeless long-term prognosis for the elderly man, but agreed to perform a small procedure to remove the liquid that had collected around his lungs to relieve him of his acute suffering. The simple process of dialogue between the patient’s caregivers and the doctor made a huge difference.
The message is simple–whenever there is a choice between two doctors with similar years of experience and qualifications, opt for the doctor who is willing to talk and explain things. The practice of medicine is not just about good technical skills, to a great extent it is also about good communication. The very word ‘doctor’ is derived from the Latin word for ‘teacher’. In brief, whenever we are in the role of a patient or caregiver, we should try to choose providers who are willing and able to communicate–every patient
deserves to be spoken to decently and given an explanation about their illness and the treatment that they are undergoing.
A rational, ethical doctor does not create fear or panic, but gives timely and balanced information.
It has been said that if you can make a person sufficiently fearful, you can get him to do almost anything. And there is perhaps nothing that induces as much fear as the apprehension of physical suffering or loss of life. When a patient approaches a doctor, there is a valid expectation that while the severity of the problem should not be underplayed, the patient should not be driven to panic and rushed into taking a major decision like undergoing an operation (except of course in the case of genuine emergencies). Unfortunately, nowadays instances of such ‘panic-inducing medical advice’ are becoming rather common. We have not infrequently come across situations where immediately after an angiography, the cardiologist has told the patient, “Angioplasty must be done immediately, within a few hours,” and the patient has been rushed into undergoing an invasive procedure, even though the option of waiting and taking a balanced decision might have proved to be more appropriate.
A rational, ethical doctor does not pretend to know everything; the doctor can admit that there are aspects of the illness that he or she cannot definitively comment upon.
Not all doctors might like to publicly admit that in a significant number of cases, in the beginning, the doctor may be unsure of the exact diagnosis. In these situations, the doctor is acting on probabilities rather than certainties. The doctor may rule out various possibilities in the course of investigations and treatment. So, when the patient or relative anxiously asks, “Doctor, what is the illness?”, in a certain proportion of cases, the fact may be that even the doctor does not exactly know.
In these days of rapidly expanding medical knowledge, it is very difficult for any doctor to keep up with all the developments even in his or her own speciality, not to mention a myriad other specialities and areas of medicine. Would we not prefer a doctor who is aware and frank about his or her own limitations, who does not hesitate to take another expert’s opinion or refer to an appropriate specialist, when required, in the interest of the patient?
A rational, ethical doctor does not advise additional investigations and procedures due to demands from the patient.
We live in a consumerist society, where we are often conditioned to think that ‘more’ is generally ‘better’. Needless to say, this logic is often inappropriate, but some well-off patients tend to think that if some tests are necessary, then undergoing more investigations is even better, especially if the test is more expensive. However, the job of a physician is not to cater to each and every whim of the patient, but rather to guide the patient towards rational management of illness. Even though many laboratories give hefty commissions to doctors who refer patients to them, a rational physician would not recommend a test or procedure just because the patient asks for it.
Doctors often have to rely on information that is incomplete, while trying to understand what is wrong with the patient. Doctors continuously deal with uncertainty and frequently work their way through the patient’s illness, rather than always having an unambiguous diagnosis from day one.
The human body is an immensely complex entity, which medical science understands only partially, and there are also tremendous variations from patient to patient. The information available to a doctor may be limited, and there may be unusual, unexpected or rare manifestations of an illness that the doctor must grapple with.
Hence, sometimes it may be more logical to talk in terms of possibilities and probabilities rather than pressurizing the doctor to give a completely definitive answer.
Good doctors continuously manage risk–doctors who are only interested in saving themselves may not save many patients.
Many patients have survived and are living today because the doctors treating them were willing to take certain risks. Especially doctors working in remote rural and tribal areas know that recommending a critical patient be taken away to a distant city for treatment may be the equivalent of sending the patient home, and maybe to certain death. If it is within their sphere of competence, they may need to use their professional judgement and take informed and considered risks for the benefit of the patient. Of course, doctors must never take reckless decisions or unjustified risks, or deal with matters that are beyond their competence. But a small risk taken by a doctor may make a huge difference and save a patient’s life.
Doctors need to deal constantly with changing situations, both related to medical knowledge and society. They have to keep abreast of the rapidly changing field of medicine, and also grapple with the changing expectations of patients.
Fortunately, today patients are on the whole better informed about illnesses and treatments than they used to be a generation ago; think of your overall awareness about health issues compared to, say, your parents. This positive change should be harnessed so that the doctor and patient/caregiver can work together as an informed team, in dialogue with each other, and choosing the best line of treatment that is appropriate to the patient. However, there is also a flip side to such increased awareness on medical issues. While Google has literally brought us a world of information, this information may not always be of
high quality or appropriate to the patient’s specific situation. In some situations, patients may access half-baked information off the internet and be convinced that they need to undergo a particular line of treatment.
One of my orthopaedic surgeon friends narrated another case, which exemplifies the changing expectations of patients and the emerging perils of ‘internets’. He was acquainted with an elderly couple. The woman was in her 60s and had mild arthritis. One day she visited him along with her husband and asked him to talk with their engineer daughter, living in the USA, on the phone. The daughter was aggressive with the doctor, and complained that he was not doing his best to relieve her mother’s suffering. She asked for his email ID, as she wanted to send him internet links related to knee replacement surgery. The surgeon calmly and firmly explained that the patient had mild arthritis, that painkillers were working well and if she were to take his advice seriously and start exercising as instructed, the painkillers could be stopped within two months. He refused to operate and asked them to see another doctor if they felt like. But the husband understood his logic, and two months later the old lady visited the him with a bright smile. She had recovered completely.
We need a doctor who would help us to interpret the complex mass of information around us, in the light of our internal values, to take an appropriate decision. We need a doctor who would deliberate with us and would help to bring out the best in ourselves, to choose the healthiest options in life, acting as a friend and guide, not just a detached expert.

What is Good medical practice

The medical profession is considered as the noblest profession and sometimes doctors are even considered as deities. It is said that either you choose a profession or profession chooses you. But, in the hindsight, the key motive of ‘patient care’ is someway slipping down the ladder.
On the flipside, we also need to consider that in the current scenario the cost of healthcare, and medical education, coupled with patients rushing towards commercialization and best facilities along with the appearance are given more importance than the quality of care and competency of doctors.
In this era, have you ever thought what is the key motive behind a ‘Good Medical Practitioner’?
A Good Medical Practitioner (GMP):
Checklist to maintain best practice:
Rendering service to humanity: With full respect towards your profession and dignity of your patient, this aspect marks key in healthcare
Entrusting your care: It is equally important to trust your abilities rendering each and every possible measure for imparting best service
Revising their knowledge: With new technologies and developments happening in the medical world, it is important that doctors continuously update their knowledge to aid their patients with the use of the best possible management plan.
Scientific rationale: It is very important to keep in mind the scientific rationale behind each concept of healing and doctors should follow those rules.
Attending CMEs/Workshops: According to the MCI regulations, physicians should participate in CME programmes, for at least 30 hours every five years. These rules vary from one state to another. Medical practitioners should check the mandates for their states
In this regard, Dr. Amitav Banerjee has highlighted key aspects of a ‘Good Medical Practitioner’

Handling records:
Proper maintenance of medical records goes hand in hand with Good Medical Practice. It serves as the basis on which doctors plan their management and treatment strategies. It is a part and parcel of patient care necessary for legal, ethical and administrative purposes.
Medicolegal focus:
The medical record is the property of a patient and the confidentiality and privacy of his information is very important. It is important to know, if the patient desires to have his medical records, it should be handed over at a reasonable charge. Without taking patient consent, the information should never be passed to anyone.
Instances when information could be shared:
• Referring to another doctor
• Court order, but in that case, the doctor has to submit the original copy and it should photostat
• Consumer protection cases
• To the police or insurance companies but only on a written request

Doctors and their registration number:
It is mandatory for every physician to display their registration number allotted by the State Medical Council/MCI.
Where should it be compulsorily displayed:
• Clinic
• Prescriptions
• Certificates
• Money receipts
According to the MCI Ethics Code of regulations, it is important to display as suffix to their names and should display recognized medical degrees, certificates/diplomas and honours conferring their professional knowledge and skillset.
Following legal restrictions:
In any situation, the physician should not be seen contravening the existing provisions of law. Following law and care of your patient goes hand in hand, and it is the duty of every physician to abide by the existing law and expose the possibilities of violating the ethical code of conduct by any other health care professional.
Good Medical Practice could be farmed as a myth but the will to conduct it honestly separates a good physician from a bad physician.

HEALING the Doctor- Patient Strife

Recently, I was talking to a family and caught myself saying, “Your child is serious and will die without an operation; an operation would mean maybe a 1% chance of survival. If you take the risk, I will operate; otherwise you can go to a higher centre.”
Only this time around, I had cameras recording the conversation and it would stay in my “system” for a month. I also had a consent form in duplicate, listing all the possible complications, with even the mention of death in bold letters, a couple of times. The family would need to sign the consent form. A second copy would go to the family to mainly prevent them later from saying, “Nothing was told to us.” I shook my head in utter disgust at myself.
Why has this happened? No arguing that patients have an extreme scare of many things in the medical profession. But it is also a fact that doctors have an equal fear of the patients. There is mutual distrust and suspicion as the patient stands facing the doctor. “Oh, a lot of tests; surely a commission racket; the medicines are unnecessary; these medicines are powerful; these medicines make a lot of money for the doctor; the surgery is not required; need to check with Google; need to check with another doctor” and so on.
Each party carefully hangs on to each word coming from the other side. The consultation table almost becomes a battle line. The doctor would think, “What village does he belong to? What community does he or she belong to? Would there be trouble if things go wrong? What political backing does this patient hint of? Are there any hints of pressure from politicians, press, lawyers or the police?”
Why is a doctor concerned with the village and community of the patient? Why is the fear of physical violence against the doctors so agonisingly palpable among the doctors? The questions we ask today when the hospital informs us of a death are, “Is there going to be trouble? Is there a mob? How has the family taken it?”
It is strange that not only the populace but the doctor also holds himself guilty of any death at a subconscious level automatically, whatever be the condition of the patient and whatever be the efforts of the doctor.
There was a golden past when the doctor could say, “I am going to cut your head tomorrow and replace it with a cauliflower,” and the patient would say, “When do I get admitted?” Also, there was a time when the doctor would say, “Don’t worry about the payments. Whenever you have the money or whatever you want to pay, that is fine; but let me sort you out first.”
Today, even when the doctor prescribes paracetamol, the sharp patient would receive the prescription with suspicion and scepticism. He would surely check the brand name on the readily available apps. Today, even when a patient and the family agree to a surgery clearly required, as when the bowels hang out from the abdomen, the surgeon would want consent forms in duplicate with lots of signatures and take time for video counselling. The consent forms seem to be getting bigger, better and scarier, similar to those in some western countries.
My sister-in-law was due for delivery in the U.S., and was screaming in pain. The doctors decided for a Caesarean section. It was a consent “book” rather than a “form”, my cousin tells me. As my cousin and his wife were signing each of the pages after careful reading, she gave birth in the room itself!
I get scared by my own consent forms and my own video counselling when I rewind them to see. How can the family even agree for me to be near their child? These are all signs of difficult times and certainly does not augur well for the future of the profession. Things only seem to be spiralling downwards as doctors and patients fly farther away in matters of trust and faith and yet depend on each other for their survival.
BRUTAL TRUTH
‘You should never blurt the truth to them brutally, ‘That is absolutely wrong. Most people, many people, develop hysterical cognitive dissonance. Part of them knows they’re dying, part of them thinks they are going to go on living — so you end up giving people two sets of information. You say this tumour will be fatal but I don’t know how long it will take. There are a few long-term survivors. So, you muddle it a bit, leave it up to them. If you are a decent doctor, which most of us aren’t, you’ll sit down and take your time.

How to Get the Most Out of a Doctor’s Visit
Tips physicians recommend on being a good patient

Having just 15 to 20 minutes with a doctor might seem awfully short, but that’s how long most physicians’ visits last.
Doctors might not get all the information they need to fully understand a patient’s condition. And there are few things more frustrating for a patient than to leave the doctor’s office and suddenly remember something you forgot to ask.
Lani Calder, a 67-year-old retired teacher who splits her time between Ohio and Florida, takes the job of being a good patient pretty seriously. She charts her blood sugar, thyroid and other test results at home. She also brings in a list of questions to her doctors’ visits and takes notes on what they tell her.
To get the most out of the limited time in a doctor’s office, and perhaps have a healthier outcome, here are tips that doctors recommend.
Ask questions
Doctors suggest writing out a list of your questions before a visit to ensure you remember them. “Asking questions and resolving doubts is really important in moving forward as a patient,” says Richard Ryan, a psychology professor at University of Rochester in New York who has studied patient adherence and motivation. Rank the questions in order of importance in case you can’t get to everything in one visit.
Mind the time
Stay focused on why you’re there. “I like a little chitchat, I like to know my patients’ stories and personally interact with them,” says Shannon Dowler, a family physician in Asheville, N.C. “But if you spend 10 minutes showing me pictures of your beautiful grandchildren then that’s half of our office visit.” Call ahead if you’re running a few minutes late for your appointment or need to cancel, she says. And to minimize waiting time, book the first morning appointment or the one right after lunch.
Bring your meds
That includes herbal and over-the-counter medicines and prescriptions you’ve gotten from another doctor. “I have patients seeing a cardiologist, a nephrologist, a lung specialist all at the same time,” “Somebody can make one change which makes a difference.” And bring the actual bottles with the original labels. “We can double check the dosing and make sure we haven’t made an error or the pharmacy didn’t make an error,”
Take notes
Writing down what the doctor says can help jog your memory after the visit is over. “We know patients forget most of what a physician says as soon as they walk out,” says Bryan Murphey, chairman of NCH Physicians Group, an internal medicine practice in Naples, Fla. “We try to write things down for them. But they can read their handwriting better than they can read mine.”
Tell the truth
Uncomfortable topics, such as poor eating habits and medication adherence, or risky sexual practices, can cause patients to avoid or sugar-coat the subject. And don’t leave things out, such as symptoms that may or may not be important. “It’s really hard to surprise us. If you’re not being truthful then we can’t do the best job of taking care of you.”
Bring a friend
Going to an appointment accompanied by a spouse, a grown child or a friend is particularly important if, for example, you’re expecting important test results. Older people, who may have trouble understanding or remembering things, can especially benefit. “If it’s a test result that shows a cancer, a lot of people will just stop hearing what you say after the word ‘cancer’ and that’s all they will remember. Having somebody else there can help with that.
Be realistic
Having a hard time getting more exercise like the doctor told you to? Don’t skip your follow-up appointment. Instead, discuss with your doctor whether the goal is set too high. It’s important to develop a treatment plan that you know you can follow, so let your doctor know what’s realistic. And ask the doctor to repeat instructions if you need to. “Don’t feel embarrassed to ask a question if you don’t understand something
By the way…
When a health concern provokes anxiety, some patients need to work up the nerve to ask about it, sometimes when the doctor is about to walk out the door. “This happens more often than you’d think” “Delaying the most difficult issue can mean that gets the least amount of time in the visit.” Bring up the most important issues first, she suggests. Having a list that you share with the doctor can help with this.

Lifestyle of a doctor
Most of the medical students don’t consider the repercussions of choosing a specialty while making their career choice, and they should. Doctors today are increasingly employed by institutions; work shifts and delegate the hassles of hospital life to hospitalists. To emphasize, there is no right or wrong choice. One should choose a specialty which suits his temperament and interest. While doing so, he should also do his homework well. Talking to seniors/doctors from different speciality helps setting the expectations right and be prepared for it. Irrespective to all the homework one does and advice that he gets, there is still a lot of unpredictability as Forrest Gump said – “life is like a box of chocolates, you never know what you’ll get”. Just like any other human being every doctor has to face his own unique challenges in life. But an informed educated guess is far more reliable than a pure gamble.
Even after you start your clinical practice, it becomes very important to manage your personal and professional life well. Striking the right balance is more of an art than a science. Getting called to the hospital during off hours is part of a doctors’ life. These are some common findings to which any doctor can relate to –
Doctors don’t take much time off, they are overworked
Even when they are on vacation, they are mostly attending calls due to ubiquitous tech revolution (read mobile phones).
A major part of their vacation is lost thinking of the coming tide after the vacation ends
Doctors spend more time in their clinic, hospitals and office as compared to time with family.
Even after spending so much time/effort for patient, most doctors feel that they could have done a little more for their patient. A part and parcel of medicine being a noble profession.
Leisure, relaxation, avocations and personal time for reflection are not evil pursuits. They are the fuel that cultivates and sustains our humanity. Who wouldn’t welcome a little more humanity in the medical profession? In its absence your burnout and lose your edge.
These are my two cents for improving your lifestyle as a doctor –
Set a time aside for your personal life, time with family and leisure and religiously follow it until there is an emergency.
If you are in private practice, keep a budget aside for the support staff at your clinic. Having a good staff at your clinic takes off a lot of burden from you and you can focus on your core competence. In medium and long term, you are better off … both mentally and financially
Have more discussions with your family and life partner so that they are fully aware of the demands of the profession. If they are aware, they will adapt
Take care of your own health. As a doctor, we often forget that sometimes we have to sit on other side of table. Even a regular walk regime is helpful.
Love your profession and have a healthy cordial and yet professional relationship with your patients. You spend more time with them than with your family.

How do you approach reading a paper in a journal?
I start by reading the abstract. Then, I skim the introduction and flip through the article to look at the figures. I try to identify the most prominent one or two figures, and I really make sure I understand what’s going on in them. Then, I read the conclusion/summary. Only when I have done that will I go back into the technical details to clarify any questions I might have.

TRAGEDY OF INDIAN HEALTHCARE
“One doesn’t need to be a doctor to start a hospital, just as one can start a hotel without knowing how to cook”.
Big businessmen and corporates who must invest their money in profitable ventures knew this very well. Up came gigantic buildings under the title ‘advanced / world class healthcare’, where much was invested in the infrastructure and technology, but the quality of doctors was kept to bare minimum necessary: junior most who are willing to accept the atrocious sharing conditions. These new ‘Money Making Machines’ picked up very well, because they gave the rich class an illusion that they can buy health with money, but also attracted the middle and lower classes under the ever-coveted term ‘cashless’. The fear of illness and death was exploited with aggressive marketing. Many things started to change after 1992.
When one invests in many hundred crores, the profits must match. To maintain, there must be continuous patient flow, admissions, tests, procedures and surgeries. Indian society is quite vulnerable to advertising as well as corruption. All the marketing strategies and skills were aggressively employed in that direction. To catch patients for paying procedures and surgeries, to develop a patient base, free camps were arranged in the interiors. ‘Free’ is a universally loved term, most people blindly fall for it.
The idiotic term ‘whole body check-up’ was invented to attract the illiterate, ignorant and hyper anxious crowds. Unnecessary tests were suggested and done happily under the false sense of health security. PROs and marketing teams of various hospitals started visiting private doctors for the obvious: commissions on admission / tests / surgery.
Patients with even simple illnesses that can be treated at primary healthcare center were taken to bigger cities now, and they proudly boasted how much land they sold to get the right treatment.
The perpetual inadequacy or absence of federal / state healthcare infrastructure was never questioned.
Those who had insurance cover started thinking that they now own all the hospitals and doctors. They started behaving as if they are obliging the doctor / hospital by choosing them. ‘Only a good outcome is must because I am paying money’ became a universal expectation, and thanklessness, threats and vandalism started with almost every bad outcome.
Applying the consumer protection act in India, with high illiteracy, poverty and political interference was the final straw. Doctors now could not treat patients based upon only clinical judgement, because the patient and the courts would demand proofs. So, tests became necessary, to the point of finding a proof. Evidence based medicine defeated the need for clinical judgement to treat simple conditions without having to do the tests. Doctors and patients both started to suspect each other, and grew apart.
Still some really patriotic doctors, clinics, smaller nursing homes and hospitals continued what was essential for the society, giving excellent healthcare at the lowest cost, based upon their patient base generated over decades of faith and trust. The ‘Clinical Establishment Act” broke the very spine of such hospitals, because it made western standards blindly mandatory for Indian hospitals. More licensing, over 30 permissions (bribes everywhere), and so much paperwork and infrastructure investment, that it was now impossible to keep healthcare low cost. The only thing that was excluded from such westernization was costing. As the doctor is the only face of healthcare for the patient, the ultimate blame for higher costs was conveniently placed upon his/ her shoulder. All doctors turned villains now.
The hidden plans to eradicate small hospitals and private practitioners are being successful now, given the hardships involved in running one’s own hospital. Thousands of small hospitals / clinics have closed down. Doctors now must join corporate hospitals if they want to continue as specialists. They have no control over billing and hospital policies, and are thrown out if they question anything. Most people do not know that a doctor’s payment is less than 10 percent of most hospital bills, a standard corporate protocol all over India, and if the doctor wants to help the patient, it is his own bill that he/ she will have to sacrifice.
Mediclaim (Medical Insurance) is still at a fraudulent stage in India, with many deserving patients being denied insurance, while many patients being allowed to misuse it. Mediclaim companies now have two fatal policies; to encourage the accreditation business, thereby making it difficult for smaller hospitals to survive, and to dictate lowest healthcare costs for hospitals and doctor’s fees, whereby their own profit margin stays high. In such a scenario, the corporates either must inflate the bills or cut down on the quality of healthcare provided.
The big corporates required specialists who worked at the lowest salaries and accepted all their conditions. Those who had passed out without much merits from less academic medical colleges, those who had lower confidence and / or experience became easily available. Instead of increasing govt medical colleges and seats, private medical education was encouraged, because the highest in the land profited from that policy. The society never objected, because the dream of ‘buying a medical seat and ability of becoming a doctor even without merit’ had become a reality. Only a few exceptional students benefit from private medical education.
To pay for electricity and water and land and building with commercial rates, to get no subsidies, to pay full taxes, and then to be told to “subsidise” patient bills for charity (whereas the govt hospitals keep on increasing it regularly), is atrocious. At every stage a hospital / doctor must bribe for permissions. Very few exceptions. In fact, people expect doctors to pay higher bribes. Doctors belong to the same society as you, and mirror the same good and bad that the society has, there cannot be one-way blame game here. This does not mean there weren’t greedy doctors, in fact the corporate policies helped some such doctors flourish too.
There indeed were days when doctors earned too much money, some with good and some with deceptive means. Gone are those days. Now in each specialty there are a few who do well, and some who don’t. Most doctors struggle to maintain the incomes to continue offering good healthcare. Many have quit the profession.
Even patients are mostly not happy with only honest and good treatment. They want multiple facilities and luxuries, trained staff, accreditations, cashless facility, no marketing/ referral/ cut practice, but still the lowest rates. How will smaller hospitals compete in such a scenario with the giant corporates?
In a few months / years, small hospitals and private medical practice will have been completely eradicated, the only healthcare options will be government or corporate. After defaming the entire medical profession and creating wide rifts between the society and doctors, the marketeers of health and life corporates and insurance companies, will keep on freely filling their coffers while providing compromised healthcare at all stages.

IS THERE A DOCTOR IN THE HOUSE?
Like many other professions, physicians are in the business of providing a service. They are given higher standards to adhere to than perhaps other service providers, because their decisions affect human lives. They rely on a support team of receptionists, nurses, technicians, specialists and therapists. Their training and experience place them in a unique position to predict their patient’s future health needs, based on the patient’s past history, and present health status, somewhat analogous to Charles Dickens’ stories of past, present, and future tense. For example, a physician sees a 48-year-old male with advanced emphysema (chronic lung disorder, resulting in breathing impairment) and a history of smoking two packs of cigarettes a day in treatment room 1, then sees a 21-year-old male with a history of smoking two packs of cigarettes a day in treatment room 2. It’s reasonable for the physician to predict that he’ll see the 21-year-old in 27 years or less in a similar condition as the 48-year-old patient in room 1, if no lifestyle changes are made. As physicians, we have the opportunity in the present to motivate the 21-year-old to avoid the past mistakes of the 48-year-old, and help shape a brighter future in the process. As with all professions, there are the good, the bad and the ugly. No one degree (D.O./ M.D), or specialty, is immune from bad docs. Criteria for a good doc include competency, staying current, having sound ethics, being available to listen, being compassionate, being empathic, and if in doubt, willing to ask for consultation. I’m proud to say that in my four plus decades of practice, I’ve found that the overwhelming majority of physicians are good. They’ve experienced the joy of bringing a new life into this world, and holding the hands of those departing. They’ve shared a family’s hardships, as well as their blessings in life, and been humbled beyond words by patients expressing their gratitude for the care they’ve given, and being called their friend. The bad doc usually lacks several of the above attributes. There are docs who occasionally succumb to the “white-lie scenario” or grey area— “Hey; I’m not doing anything illegally or grossly wrong.” Case in point: one of my patient’s mothers was visiting from Miami, and was seen by me for a minor medical problem. After the exam, I gave her the discharge form and instructed her to check out at the front office. She then handed me a $ 20 dollar bill, which I said no to; the front office will handle it. She then informed me that her doc back home always accepted a tip. Although it’s completely acceptable at your local restaurant, I find it unethical in medicine. We are placed in a position of responsibility for our patients, and should never be tempted to take advantage of their generosity. When I first went into practice in the mid-60s, one of my elderly widowed patients asked if she could add me to her will, because she had no other family to give her assets to. In declining the offer, I suggested she talk it over with her accountant and find a suitable charity to give it to. I thought it a bit strange, and couldn’t believe a physician would ever accept such an offer, until years later when another one of my patients told me her wealthy widowed aunt gave her multimillion-dollar estate to her personal physician. The ugly docs are the ones we usually see exposed in the media falsifying visits and charges, practicing with extreme medical incompetence, operating on a wrong part of the body, or prescribing narcotics for profit, like those signing off on the medical marijuana scams. Some have succumbed to the influence of money from their celebrity patients (Elvis Presley and Michael Jackson), resulting in tragedy. In addition to using common sense when dealing with your medical problems, one needs to apply the same common sense when selecting a good physician. Prior to selecting a doc, call the local medical society, medical board or scan the Internet for recommendations. Beware of physicians using excessive advertising. Those costs are usually made up for with high-cost and high-volume practices. Certainly, personal references are the strongest and most reliable source for finding a good doc. However, third party medicine today may negate all the above. If your insurance only allows you to see a doc you haven’t researched or know, then you may be on shaky ground until you feel comfortable with that particular doc. Generally, your first visit to the office is your first clue to acquiring a level of comfort with the physician. If you get a curt or unfriendly response from the front desk, it may suggest the office staff and doc won’t be any better.

RUDE DOCTOR
None of that is a surprise, and in fact, there is a good deal of literature to suggest that the medical environment includes all kinds of harshness, and that much of the rudeness you encounter as a doctor or nurse is likely to come from colleagues and co-workers. An often-cited British study from 2015 called “Sticks and Stones” reported that rude, dismissive and aggressive communication between doctors (inevitably abbreviated, in a medical journal, as RDA communication) affected 31 percent of doctors several times a week or more. The researchers found that rudeness was more common from certain medical specialties: radiology, general surgery, neurosurgery and cardiology. They also established that higher status was somewhat protective; junior doctors and trainees encountered more rudeness.
Senior Doctors Need to Reinvent Themselves
Most doctors are pretty much set in their way by the time they reach 50. They expect to continue practicing clinical medicine and remaining doctors all their life. In one sense, unfortunately, they’ve become very myopic and end up leading their life pretty much on autopilot. This is partly because they think that clinical medicine is the only thing, they’re good at because this is what they’ve been doing for many years.
Yes, this is something they are extremely good at because they are often at the peak of their professional career. They get referrals from peers; recognition from colleagues and get invited to give lectures at medical conferences. Patients look up to them, and because they have been practising for so many years, they are highly respected in the community. The problem is that they continue thinking of themselves only as being successful doctors and aren’t willing to explore alternative options. Even though many are bored, and some are burnt out, they don’t have the confidence that they can do something new at this stage of their life, so they remain stuck in a rut.
For one thing, they’re in a comfort zone, which acts a bit like a golden handcuff. Society respects them, and they are so comfortable and secure in their avatar as a senior doctor that they cannot think of doing anything beyond medicine. Interestingly, this is so different for MBAs, for example, who are quite happy switching from one company to another, and moving from one domain to another, even though they may have no prior experience in it. You are forced to wonder why doctors don’t display that same degree of flexibility, and why they are happy to remain daily wage earners.
I think doctors forget that they were efficient learning machines when they were 25. They mastered lots of complex skills and could lead a team of clinicians. As they age, perhaps they are worried that they’re no longer able to learn new stuff anymore – they have lost confidence in their ability to reinvent themselves.
This can be tragic because the best years of their life are still ahead of them. They’re still physically fit and mentally sharp. Their kids have grown up and moved out of the house. They’ve met most of their financial obligations, and no longer need to prove themselves to the rest of the world. Hopefully, they are mature enough to realize that they have reached that stage in their life when they can focus on themselves. This is the time to be selfish and put their interests first – to pamper themselves, and explore all the interests they were forced to forego because they were so focused on building their practice, when they always had to put their patients first.
Sadly, many senior doctors don’t have the courage to be able to do this. They often envy other people who can do this, but they enjoy what they do just enough to think they are going to be stuck where they are till, they die. After all, they’ve invested so much of their life in doing medicine and becoming successful doctors that they think it would make no sense at all to chuck that all up and try doing something else.
A friend of mine pointed out, part of the problem is that the doctor, his family, his colleagues and society all seem to expect that the physician will continue to “give back” to his patients for as long as he is able to. After all, we have a shortage of doctors, so isn’t it selfish and unfair for a doctor to hang up his boots, even though he can be professionally productive? And because there are very few role models of doctors who have chosen to follow their own heart, this seems to be the default route for most doctors – to continue doctoring until they aren’t able to do so anymore.
However, one wonders whether both society and the physician are missing out on both receiving and making an even larger contribution by rethinking the role of a senior physician. A lifetime of experience as a doctor can be utilized gainfully in so many other ways – and this way junior doctors (who have a lot more energy) also get a chance to shine and establish themselves.
I think it’s a shame that doctors don’t have the courage to explore new paths. Lots of them became doctors in order to keep their parents happy. Then, they did well in medical college to keep their professors happy. They then spent most their life earning money to be able to give their kids a head starts in life. This is finally the time when they can be a little selfish and do some stuff for themselves. They are still physically fit and mentally sharp, and have enough financial freedom that they don’t need to work for a living anymore. However, because they refuse to explore new horizons, they continue doing the same old thing they’ve been doing day in and day out, and never get to explore how much more life has to offer them!

Stepwise duties of a doctor facing a dead patient:

In view of the rising incidents of the intolerant behaviour of patients and their relatives towards healthcare professionals, it has become extremely important that all medical professionals in general and the resident doctors, in particular, understand their statutory and regulatory responsibilities while handling a dead patient.
Duties of a resident doctor facing a dead patient
Diagnose death
Declare death
Fill “Death report” as per prescribed format and send it to appropriate authority
Certify cause of death
Inform the appropriate authorities because the Maharashtra State Government Act, 1976 (Section 5(2) mentions that death must be informed within 72 hours to the local municipal authorities
Handle the mob
Stepwise procedure in handling patient death
I. Step 1- To establish death
The following helps to routinely recognise and establish death:
No spontaneous movements
No respiratory effort for more than a minute
No heart sounds or palpable pulses for more than a minute
Absence of reflexes e.g., corneal
Fixed and dilated pupils
No response to painful stimuli
Rigor mortis seen 3 hours after death
Approved tests for brain stem deaths (Human Organ Transplant Act)
Pupillary light reflex: Dilated and fixed not reacting to light (cranial nerve II and III; nuclei in midbrain)
VOR reflex absent (Vestibulo-ocular Caloric test): Eye movement with 50 ml of cold water in ear for 1 minute is absent (cranial nerve III, VI and VIII; nuclei in midbrain/pons)
Occulo-cephalic reflex: Dolls eye movement absent (cranial nerve III, VI and VIII; nuclei in midbrain/pons)
Corneal reflex absent (cranial nerve V and VII; nuclei in pons)
Pharyngeal gag reflex absent (cranial nerve IX and X; nuclei in medulla)
Cough (tracheal reflex) absent (cranial nerve X; nuclei in medulla)
Vagal nerve function (atropine challenge negative; cranial nerve X; nuclei in Medulla)
Response to painful stimulus in trigeminal nerve distribution (cranial nerve V and VII; nuclei in pons)
Apnoea test: Raise pCO2 >50 to 60 mmHg by disconnecting ventilator– no spontaneous respiration
Tests for cortical functions: EEG/verbal response/co-ordinated and spontaneous eye movement
Declaration of brain stem death as per THO act
Who should diagnose and declare?
Team of four medical experts including: Medical Administrator In charge of the hospital, Authorised Neurologist/Neuro-Surgeon, Medical Officer treating the patient
Amendments in the THO Act (2011) have allowed selection of a surgeon/physician and an anaesthetist/intensivist, in the event of the non-availability of approved neurosurgeon/neurologist.
What would the team confirm?
Is the patient deeply comatose due to irreversible brain damage of known aetiology?
Is he/she on ventilator despite stopping all neuromuscular blocking agents?
Are all brain-stem reflexes absent?
All the prescribed tests are required to be repeated, after a minimum interval of 6 hours, “to ensure that there has been no observer error” and to document the persistence of the clinical state.
The following investigations are not legally mandatory but may be done if the clinician desires:
Cerebral angiography particularly a four-vessel angiogram: A gold standard to demonstrate absent cerebral circulation remains
CT angiography
CT perfusion and magnetic resonance angiography
EEG
Please note: It is also affected by hypothermia, drugs and metabolic diseases.
Transcranial Doppler
Radionuclide imaging techniques like Technetium-99 m scan
II. Step 2- Give ‘Death report’
After declaration of death to the relatives, a death report is prepared in a format prescribed by various municipal corporations; the format has two components- legal and statistical
It is the doctor’s duty to fill the death report even if we have decided not to give a DC
III. step 3 Give DC if we know the cause of death
Doctors can safely give DC in the following situations:
1 If the cause of death is known and it’s a natural death e.g. death following a disease or malfunction of the body: DC can be given by the physician who has attended the patient within 14 days prior to death (no such ’14 days’ rule/case law exists in India, but it is prudent to follow it as it has become a norm).
2 In case of unnatural death and in a medicolegal case if the cause of death is known: DC should be handed over to the police along with the dead body for final ‘Panchanama”. The investigating officer may choose to accept the DC and hand over a copy to relatives for final cremation. But the investigating officers may also be suspicious and may still want a medicolegal post-mortem.
3 In case death has occurred because of old age the cause is ‘senility’: If the patient was never attended by the physician in past 14 days the local corporate can certify the death due to senility. Several general practitioners have to succumb to social pressures to give DC in such situations.

KNOW YOUR STHETHOSCOPE
Since its invention by a French doctor 200 years ago, this device has become the unique identifier for clinical practitioners. A stethoscope wrapped around the collar of a white-coat medico tethers the patients easily to them. However, the tether is reportedly being frayed. Let us get into the most happening discussion of the time among clinical fraternity about the possible demise of the unmatched clinical tool called stethoscope. The advent of smarter and handy technology has enabled the patient to be diagnosed even from a distance that is out of reach for a stethoscope. This article will try to find out whether the pulse of a stethoscope is really fading with the pressure of newer and smarter devices. Before going into the depth of this discussion, we must understand how a stethoscope works. It is one of the simplest devices ever invented with a huge impact in diagnostic decisions. A stethoscope enhances body sounds (Heart, bowel, lung etc) and transmits those sounds to our ears. A typical model has a flat, round chest piece covered by a thin, tightly stretched skin of plastic called a diaphragm. The diaphragm vibrates when a sound occurs. These sound waves travel up the hollow plastic tubing into hollow metal earpieces and to the doctor’s ears. A stethoscope is even used with a sphygmomanometer to record the blood pressure. Recent advances have enabled physicians to record and analyse the sound heard by stethoscope to make a better diagnostic decision. Futurist has started murmuring the death tune for the modern medicine’s primary diagnostic tool saying it is on the way to being replaced by handheld ultrasound devices and smartphones.

Six strategies for violence in health care
Six solutions should be emphasized in order to ensure the security of medical care environment. First, the law must be reformed to tackle the violence in hospital as that in public area. Currently, the hospital is considered a special place rather than a public area, and therefore, the procedure in control the violence in hospital is rather slower and less effective than in public area. The perpetrator in hospital is punished much less than outside hospital, even outside the door of hospital. The slow response and delayed arrival of police to any urgent request from the medical workers and no reaction of police for the violence in hospital are a well-known phenomenon and should be solved. Second, any biased report, unfair or even false report from media must be stopped and punished seriously and severely. Free speech and free report on medical issue do not mean false or unfair report. Some reporters have little knowledge of medicine, but interested in reporting medical dispute or controversial events incorrectly for gaining public attention and generating the best-selling of the newspapers, they completely ignored the negative impact on the society and medical workers (7). Third, a neutral and fair judicial system to evaluate the medical dispute must be established, which should process independently and promptly, and should not be controlled by medical administrator or government. Fourth, the government should raise the salary of medical workers and encourage them to work with no worries about their living conditions. The aim of the hospital should be focused on the health of patients rather than hospital financial performance. The government should not evaluate the hospital by the index of financial income. Only in this way can the president of hospital, the director of department and medical workers concentrate on the quality of medical care. The medical workers should be guided to strive and compare the medical achievement of health care. Fifth, the suspected violent patients should be listed in the computer system and warned the medical workers to treat them cautiously. Sixth and finally, the medical workers should improve communication ability besides the medicine and know how to communicate with potential violent patients. And more importantly, the medical workers, especially the surgeons have to observe the guidelines of medical practice and evidenced medicine, and should always ask yourself in mind when practice medicine, “could I do it in this way if the patient in front were myself, my mom or my dad?”

VIP PATIENT
This is one medical syndrome, if it can be termed thus, that is not described in any textbook. No medical journal has ever discussed this phenomenon. But ask any practising physician or surgeon and he will talk about its hours on end. Every practising doctor holds it in dread and is mortally scared of it.
Treating ‘important’ persons can be tricky. Most of these patients are immensely demanding. Those who are not, in any case, carry an awesome degree of aura around them. Which is why the treating physician becomes automatically conscious and his antennae pop out. He develops the same kind of jitters that he experienced while treating his first patient. Some doctors, though, are sufficiently strong mentally not to get over-awed by VIPs, but most are affected adversely while treating them.

What is unethical…???
Physicians are unhappy about Surgeons treating DM, HT, thyroid diseases themselves.
Surgeons are unhappy about Physicians developing Medical ICUs and treating surgical diseases.
Gynecologists’ are as such frustrated with PCPNDT and cutthroat competition, surgeons doing hysterectomies.
Ophthalmologists are frustrated with optometrists and Free NGO cataract camps…
Radiologists are in scare due to PCPNDT and unhappy with Orthopaedics buying their own Digital Radiology units. also, they are frustrated with clinicians sending their pts to illegal Nonmedical Digital Xray units. Clinicians asking them to do their patients in less rate for no reason.
Psychiatrists and Physicians are irritated with Neurosurgeons for treating psychiatry cases for months together for no reason.
Neurosurgeons are unhappy about every Medical ICU admitting head injury cases.
Orthopaedics are accusing RGJAY for stealing their bread and butter. also, they accuse Physiotherapists for treating patients on their own.
Plastics Surgeons are not happy about orthros operating burn contractures and surgeons for referring patients only after complicating it for no reason.
Pathologists are unhappy about illegal DMLT labs and their own colleagues signing reports in side labs.
Anaesthetists are accusing surgeons of giving calls from illegal OTs. also, they expect surgeons to be more considerate about basic OT facilities, timings and charges.
Likewise. Every branch has its own issues.
Juniors are grumbling about seniors charging less and seniors accusing juniors about flouting all practice ethics…
Private practitioners are complaining that Govt service people are doing duties and operating in private set ups for extra money sake.
Super specialists are accusing broad specialists for not referring patients… and vice versa Broad specialists are accusing Super specialists about operating hernia and appendix…
Members accuse IMA or their association for being inactive. Association office bearers blame its members for lethargy…
Every Association, has only few members who attend meetings and show interest in the happenings.
Real culprits neither attend any meetings nor bothered about the decisions taken. They continue doing what they think is beneficial to them.
Now what.?
Anything which you cannot stand for in court of law is unethical illegal.
Why you did not refer patient to particular specialist.? Is he the best person in town to treat this patient? You should be able to justify that in Court of Law.
Unethical practice does not only mean cut practice. it has many facets. If you really want to get out of this mess, we all need to think about this.
How was life before you were sick?
I routinely ask my patients how they are feeling, if they have been able to pass urine, gas and poop, if they have had any concerning symptoms like chest pain or shortness of breath. But I almost never ask questions that are equally, if not more, important: How was life before you were sick? How does your sickness affect how you view your life now? What were things that used to bring you joy? These types of questions reveal critical information about goals of care, the story behind the development of an illness, the patient’s current understanding of their prognosis, and allow the physician to emotionally reflect on a patient’s state of wellness.
Why say no to consumer court?
Medicine is Science but Treatment is an art. Medical treatment does not have a rule book- what is recorded as treatment is used as reference to proceed: Treatment differs from doctor to doctor Therapy should be customised -only corporate treatments are protocol-based Institution protocols differs and varies from institution to institution
Various schools and systems exist-European system treats difference from American Evidence based medicine is not blood investigations or CT OR MRI guided the ultrasound investigation of the modern era has led to millions of hysterectomies and gall bladder surgeries Cancer is a disease. Industry driven Research has become an Industry Inspire of MBBS MS/MD DM/MCH when the doctors are still baffled a learned judge cannot solve the medical issue
The team which the court constitutes as expert committee cannot be free from bias. Lastly the apprehension of consumer court has hiked medical treatment cost and ushered in unwanted investigations and disrupted doctor patient trust.
IMPASSE
The dilemma that Indian doctors face today is that their profession is based on principles of morality, ethics and Hippocratic oath, whereas accountability is based on consumer laws, RTI and Laws of tort. He is confused about the realities of his own practice. Out-of-hours duty and worsening work-life balance is the new normal. Unsafe working conditions, increasing incidence of patients attacking doctors and medico-legal debacle are now everyday news.