Rounds were busy on this Monday morning with two patients in the ICU, seven in the men's ward and ten in the women's ward. All were admitted on the previous Saturday most from the outpatient clinic. That seems to be a large difference between this hospital and US hospitals (at least the ones I have worked in). In the US patients get admitted most from the emergency department and occasionally a few from clinic. Perhaps part of the reason is that the outpatient capabilities in the US are much broader with greater access to studies, tests, and healthcare facilities in general. There is a Walgreens on every corner, labs in clinics, and patients can call a provider day or night if something is concerning. Safety nets are in place for patients to be treated in the outpatient arena. There are also incentives for patients to save money by attempting outpatient treatment first. In this area of India it seems unlikely the daily wage workers would be able to call a provider in the middle of the night and ask for a prescription or even if told to go to the ER that would require waiting for the next bus to stop in their village. All that being said please keep in mind I am speaking of the patient population treated in this area which is mainly the underserved with very limited means. There are those with substantial means who obtain their care at private hospitals where access to health care is different if you can pay for it.
Now back to rounds. I was excited to finally have more patients to see but my excitment was shortly replaced with a bit of frustration. I only am able to get about 40% of what is going on with the patients because of the language barrier. Some of the patients I knew because I saw them on Saturday, others I was able to read their charts before rounds to get a general idea. However, those who I was meeting for the first time on rounds were next to impossible to get the entire picture. I had to rely on my physical findings to give me a general clue of the problem, even then I needed the patient history to put the exam findings in context. I truly believe that a majority of the time the key to unlock the diagnosis is found in the history. When listening to a patients lungs and hearing abnormal sounds the context matters in order to narrow the differential and determine the cause, therefore directing your treatment. I was at a loss for the history resulting in broad differentials and lack of treatment course.
This afternoon my Tuscan friends stopped by to take me to go visit her Dad. He had success in the constipation department and now is having diarrhea. She is very concerned about the diarrhea however I'm not sure what she was expecting after feeding him laxatives for the past two days. I considered it a success, uncomfortable in the moment but the constipation was resolved. They wanted to give him a bunch of antidairrheals which made me pause for a second because before you know it he will be constipated again. In medicine at times we are quick to give medications in order to feel like we are doing sometime when time is what is needed. The father seemed genuinely happy to seem me because he saw his daughter had a friend. She has been away from her family and life in America for a month now with no support or friends. They were also comforted and reassurance when I simply examined him. There was nothing magical I did or change in medical care I made. I simply touched the patient with my bare hands and listened with my stethoscope. I heard a regular heartbeat, not too fast, clear lung sounds, and bowel sounds rumbling away. His mouth looked wet and skin was pink, all good signs. The daughter was concerned he was in shock, at least I could say no he is not in shock. With a promise to stop by tomorrow we left her Dad to rest and decided to adventure outside the hospital for some sunshine.
Neither of us had been out so we took advantage of our new friendship to walk over to the medical school and take our own tour. As we walked in the front entrance there was the gorgeous shrine to the goddess of knowledge, Saraswati. The building is four stories of beautiful cream colored marble and deep forest granite floors with flower gardens in the middle of the open air concept courtyard. There were no students around because they were taking their practical in the hospital or have already completed their exams and were on holiday. Another amusing sign we stumbled up is pictured below, Prohibition of Ragging, act 1997. I wonder what events conspired to have to place such a policy then wondered what would happen if that was posted in the US, for both staff and patients.
PS Happy Birthday to Momma Rau!!
Now back to rounds. I was excited to finally have more patients to see but my excitment was shortly replaced with a bit of frustration. I only am able to get about 40% of what is going on with the patients because of the language barrier. Some of the patients I knew because I saw them on Saturday, others I was able to read their charts before rounds to get a general idea. However, those who I was meeting for the first time on rounds were next to impossible to get the entire picture. I had to rely on my physical findings to give me a general clue of the problem, even then I needed the patient history to put the exam findings in context. I truly believe that a majority of the time the key to unlock the diagnosis is found in the history. When listening to a patients lungs and hearing abnormal sounds the context matters in order to narrow the differential and determine the cause, therefore directing your treatment. I was at a loss for the history resulting in broad differentials and lack of treatment course.
This afternoon my Tuscan friends stopped by to take me to go visit her Dad. He had success in the constipation department and now is having diarrhea. She is very concerned about the diarrhea however I'm not sure what she was expecting after feeding him laxatives for the past two days. I considered it a success, uncomfortable in the moment but the constipation was resolved. They wanted to give him a bunch of antidairrheals which made me pause for a second because before you know it he will be constipated again. In medicine at times we are quick to give medications in order to feel like we are doing sometime when time is what is needed. The father seemed genuinely happy to seem me because he saw his daughter had a friend. She has been away from her family and life in America for a month now with no support or friends. They were also comforted and reassurance when I simply examined him. There was nothing magical I did or change in medical care I made. I simply touched the patient with my bare hands and listened with my stethoscope. I heard a regular heartbeat, not too fast, clear lung sounds, and bowel sounds rumbling away. His mouth looked wet and skin was pink, all good signs. The daughter was concerned he was in shock, at least I could say no he is not in shock. With a promise to stop by tomorrow we left her Dad to rest and decided to adventure outside the hospital for some sunshine.
Neither of us had been out so we took advantage of our new friendship to walk over to the medical school and take our own tour. As we walked in the front entrance there was the gorgeous shrine to the goddess of knowledge, Saraswati. The building is four stories of beautiful cream colored marble and deep forest granite floors with flower gardens in the middle of the open air concept courtyard. There were no students around because they were taking their practical in the hospital or have already completed their exams and were on holiday. Another amusing sign we stumbled up is pictured below, Prohibition of Ragging, act 1997. I wonder what events conspired to have to place such a policy then wondered what would happen if that was posted in the US, for both staff and patients.
PS Happy Birthday to Momma Rau!!
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