The Medical Recipe

One of my friends told me that when he was about to move westward to United States for pursuit of further medical training his mentor told him , “So you are going to practice cookbook medicine”. I did not realize the truth in the statement at the time but thinking about it later, it dawned on me that there may be some substance in the statement. With each new day associated with practice of medicine it becomes clearer.

Medicine has become so protocolised that it may very soon begin to have an inhibitory effect on the education of students and residents. The bulk of medical progress has been made with the aid of thinking about the disease process, however faulty, in the context of an incomplete science. What the protocols in the present form are doing, particularly in the teaching institutions, is making robots that are trained to check the boxes on preprinted sheets for the particular “suspected diagnosis” or symptom. All the resident or student (read robot) has to do is print the recipe with instructions and order the nurses to get the ingredients, push them into the patient and wait for the cooking time to see what comes out of the oven.
I believe that the protocols may decrease errors like spelling errors or errors in medical prophylaxis or screening but at what cost ---at the cost of making a proper diagnosis and a tailored management plan , which is why the patient is there in the first place. I think that the saying “Coming too close to the tree and losing sight of the forest” works well here. The poor student or resident is forced to use a order set for chest pain whatever the other hundred complaints are or a heart failure order set for everyone with shortness of breath and edema etc etc etc.
Are we really teaching here? In the process of reducing errors and increasing documentation are we not compromising education of our next generation. I am of the belief that the best education obtained is at the bedside and not in lectures however grand the speaker may be, by holding the patients hand and not penning down notes in a classroom. I bet if someone would do a study of how many hours residents spend talking to patients and thinking the result would surprise many. There needs to be some serious revision of the proper use of the 80 work hours the proper use of protocols and prewritten orders so that we can boast of giving the world some great clinicians and not check marking machines!

Not a profession--a passion!

Can being a doctor ever be only a profession? I wonder. I have often pondered over this question. Can it really be compared to designing computer software or being a librarian or an architect or a farmer for example? I do not mean to demean any profession but my argument is only, that as physicians we hold the power to directly harm human life and occasionally even kill. I know that other occupations also affect humanity indirectly but the sequence of events or chain of steps is rather long and not direct or instant.

But as physicians we are destined to observe the consequence of our every action in the form of a direct effect on human life in the form relief hopefully most of the time and in the form of pain, suffering and even death sometimes and usually within a clearly observable time span.

And it is not only about harming a physical being but also the tender emotions that the dreary patient often puts on that table in front of you. When in a state of half undress the person on the bed decides to lift the covers off his mind. Sometimes it sends a shudder down my spine when I find myself in the privileged position where a patient trusts me with his deepest secrets.

When I think about the ways in which we as doctors can mess up I realize what a great courage it takes to shoulder this responsibility even for the least conscientious person. For however crooked your mind might be, hurting a warm, breathing and moving body does not go down easily.
An amazing profession I have chosen! Many a times during our daily routines we get used to treating patients and forget this. But as soon as I have some time thinking about this great burden I have decided to lend my shoulder to, I realize my folly in hurrying to finish the rounds or a case, just to gain a few minutes and risk losing peace of mind for eternity. I realize how inconsequential getting mad at the patient who misses all appointments is. It makes me want to delve deeper into the realms of the human mind and get to the root of the behavior . I don’t think everybody realizes this, and if they do , like me they lose sight of it more often than not.

A clinicians blog

More often than not ,when I am alone ,in my car or between patients , a fleeting thought comes to my mind . It could be about anything --life , family, country , my profession as a doctor or even things like trees, sky , the road etc., in short anything that exists. And I feel that the thought needs to be penned down and developed further like a painting or a song that rhymes. What happens is that I never get around to thinking them through. But that is the tragedy of the life in the time constrained world. So I decided to write some of the thoughts as blogs. Maybe there are people who feel the same way. Since medicine is one of my passions I call this a clinicians blog.