Future: What happens NEXT?

 

The word ‘future’ has always been a source of great worry to the over burdened and long unemployed medicos. When some of our engineering friends get ‘placed’ and go on to post status updates about the first salary of their lives, we are still in final year fighting tooth and nail to at least pass and finally earn the long coveted MBBS degree.

Many people told us that life will be “set” after you enter MBBS but it was when we finally came to med school that we realized that life out here is actually full of “setbacks”. The long course duration, the huge syllabus, the long practical classes and clinical postings, the lack of holidays all sum up to make life difficult and at times depressing for med students. But these problems have been there for years, these have been dealt with, by our seniors before us and will be faced by us and our juniors too. We have been made to realize by seniors and professors that the syllabus that we read as well as the clinical postings and practical classes we must attend are an important and necessary part of medical education. We know that five and half years is in fact the minimum amount of time that we need to give ourselves to learn properly. This is because at the end of the day the knowledge that we gain must help to save lives at the most precarious conditions.

As per the new NMC guidelines, NEXT exam is set to take place in the month of November this year. It is an MCQ based exam supposed to check the clinical knowledge of the students. The exam will take place over three days on six main clinical subjects and other pre and para clinical subjects “allied” to them. Without clearing these exams, a student will not only be considered ineligible for PG but also, he/she will not be allowed to pursue internship. Post internship the phase 2 of this exam will be held in which the clinical skills of the students will be tested.

With these new guidelines many questions are hovering in our minds depriving us of sleep, “What happens when a student wants to attempt NEXT more than once for a better rank?” “How will one complete the huge final year syllabus within November?” “Is it really possible to check the clinical knowledge of students by making them solve MCQs?” “With no importance of practical classes or lectures, can we really end up making good doctors?” “Is it possible for students to attend clinical postings everyday and at the same time prepare for this MCQ exam? And if not, which should get a higher priority?”

As the fear for our seemingly bleak future looms in our minds, we hear comments for non-medico friends and relatives, which make us laugh and cry at the same time. “MBBS was always difficult. You knew what you were getting yourselves into. A few years from now you people will charge in lakhs from poor patients. Please don’t forget to give me free treatment then.”

Aunties and friends, we promise we did not know what we were getting ourselves into. No one does, until they reach the point of no return. For us, it was like going for a surgery without any MRI or CT scans done, and suddenly spotting a crucial anatomical anomaly which, if not taken care of, has the potential to change the prognosis for the patient entirely causing unexpected death on the table. We need to make some big decisions but do not know what to do and unlike the surgeons for whom decision making skills develop with experience, we don’t even have enough time to gain any clinical exposure or experience.

It is a popular yet infamous opinion that medical field follows the principle of “Survival of the fittest”. This makes many of us wonder, “Am I fit enough? Can I do justice to the profession I chose and to all my future patients?” This is a question only Time can answer. Till then, spend all your energy on surviving this battle, maybe you will automatically end up being the fittest.

 P.C-Shuvojyoti Rakshit

 

 

The Song of OT

 

The first day a med student sets foot into the Operation Theatre, the experience she has is unique. It cannot be compared to anything else one comes across in day-to-day life. For some, the sight of blood seems so scary, that just before fainting, they make a quick vow never to go into a surgical specialty! While for some others the experience is exhilarating!

 The soft buzz of the surgeons and nurses speaking, the continuous beeping of machinery, the intermittent high-pitched scolding from the nurses when they feel that there are too many people inside the OT compromising sterility, the loud whooshing sound of the suction pump and the occasional ‘peeeeee’ sound of the electro-cautery, all sum up to form a beautiful musical composition- “the song of OT”.

At times, especially in case of surgeries that occur under local anesthesia, this song is also mixed with songs from the radio. The surgeons play their favorite stations on the radio while operating and at times one might happen to catch them humming the tune, an indication that the surgery is going really well.  It is fun to watch the surgeons asking patients not to concentrate on the pain but on the song in case the patient happens to stir during operation (it doesn’t happen always though, as the patients are mostly heavily sedated before surgery). It makes one realize the beauty of music therapy- where one simple song comforts the patient who is undergoing the operation, helps the surgeon to concentrate better and calms the scared intern assisting the operation who is often scolded for handing the wrong instrument to the surgeon. Also, for the med students, who many a times do not understand what the hell is going on and are too scared to ask, this same music is something to occupy their minds with.

There are different kinds of students who go for surgical postings- some are nauseated by the blood (as I already mentioned), some go just to click selfies wearing the OT scrub and are never seen again after the first day. Some belong to the studious kind who understand and explain procedures to their not-so-diligent classmates, ask a multitude of questions to the surgeons and save others from the blow of the occasional unexpected questions hurled at us by the professors. Lastly, some belong to the ‘well camouflaged’ variety. The people of this last category are probably the most in number during clinical postings- they neither ask nor answer questions, they listen quietly, stand in a corner, and try to absorb whatever bits of information they come across. If driven away by one surgeon, they simply move to the next OT table. Their insignificance is almost to the point of invisibility and they just enjoy it!

Operation theatre is a serious place, where one swift move of a scalpel can save or end a patient’s life. So many of my readers might be wondering, is it proper to speak of these things so lightly? Is it okay to listen to music while performing a major surgery? For them, I would say, the best decisions are always made with a calm mind, and mind cannot be calm under a mountain of worries. If you ever enter an operation theatre, as patient, nurse, surgeon or as a confused student, leave your bag of worries outside with your shoes and clothes, and get ready to lose yourself in “the song of OT”.

 

 

 P.C-Shuvojyoti Rakshit

 

 

In the name of Horace and Jupiter

 

Prescriptions are an integral part of every doctor’s practice. What one writes in the prescription determines whether he/she will be worshipped as a savior by the patients or will be laughed at by pharmacists for writing grossly incorrect doses of drugs.

The word “drugs” is first introduced to us when we hear about some dark alley beside school where some precocious kids assemble to taste this forbidden pleasure of “doing drugs.” While for them it is “forbidden pleasure” for most of us its just “forbidden”. We are made to do long projects about the ill effects of “drugs” on body, mind, and society.

It is when we step into the first pharmacology class of second year of MBBS that we find out that drug is something that is “used or intended to be used” for the “benefit of the recipient”, that too it is administered in the names Horace and Jupiter who are Gods of health and well-being. That’s when we start mugging up the long definition of drugs, with special emphasis on “benefit of the recipient”, which is the polar opposite of what we learn during our teenage years. If a student cannot answer anything else in the viva, the definition of drugs is the deal breaker which makes her pass or fail.

A huge part of our second-year coursework consists of mastering the art of writing prescriptions. We are made to write hundreds of long and short prescriptions each with its different sets of drugs and doses. The prescriptions are supposed to be written in a specific format; a format which varies from teacher to teacher, book to book and semester to semester. One can never be sure about the format, even on the exam day. One must memorize hundreds of drugs, their doses, diseases for which they are used, and sometimes an entire set of drug regimes for a single disease (like malaria or leprosy). Prescriptions can drive you crazy (if you were not already driven crazy by the first-year subject that is)!

Another painful part of this subject is to remember the side effects of the different drugs. While the ones with eidetic memory go on to write long lists of side effects during exams, for most of us, the list of side effects ends at “nausea and vomiting” every time, so technically it can’t even be called a list! Some great people even write nausea and vomiting to be the side effect of ondansetron, which is a drug used against nausea and vomiting in the first place!

I remember a fun incident which happened during our pharmacology viva where we were faced by an external examiner who was obsessed with etiquettes and was scolding every student who dared to wear an apron which was not ironed properly. Now, he was a soft-spoken man too, and when he asked one of my batchmates, why she didn’t iron her apron, she misheard him and presumed that he was asking a question about the different iron supplements. She went on to tell him a long and detailed list of oral and intravenous iron preparations only to find out later that he was just talking about ironing clothes!

This subject of drugs may seem boring for some and scoring for some others. But one must remember to take it seriously because this is the subject which teaches us that, when the pain of MBBS grows unbearable, all you need is 650mg of paracetamol to obtain relief.😉😉

 

 

 

 

AETCOM: Extra Marks for creative writing

 

As per the new NMC guidelines, a new topic called AETCOM (Full form: Attitude Ethics Communication) got recently introduced into the medical curriculum. AETCOM classes are supposed to train budding doctors for dealing with patients and their families in a more understanding and intelligent manner. In short, they are trying to make sure that doctors themselves do not end up being responsible for the violence against them. In these classes students are taught about the intricacies of patient care and sometimes the medicolegal impact of their decisions as doctors.

AETCOM questions come in exams for five marks in every paper and of course these 5 marks are our favorite among all the two hundred marks we have to write for. Reason? Its basically creative writing. The questions which come are like:

1.       Write a short note on doctor-patient relationship.

2.       Write a short note on the rights of a patient.

3.       Write a short note about the care of patient sample.

While writing these answers the Shakespeare inside every medico wakes up, and people end up writing some unique, phenomenal and awe-inspiring answers which have been a constant source of entertainment for the examiners for the past few years (alongside our other answers which tend to be laughable too)!

We are actually supposed to read some really long PDFs on these topics from the NMC website, but literally no one does that. This is the beauty of AETCOM, this is the only part you don’t have to study but you can expect to write in the exams. Though most of us write other answers too without knowing anything about the topic, but that’s a tale for another day.

AETCOM classes come with fun activities too, for students. Like, once we were asked to perform a play about the correct and incorrect approach of a doctor towards his/her patients. I remember having immense fun while writing the script for this good doctor-bad doctor play with one of my batchmates.

At other times random pairs are made and they are asked to do role play as a doctor and a patient and communicate about some prevalent disease like, malaria, dengue or tuberculosis. I must mention here that the poor person who has to play doctor is the one to suffer in these plays. Why? This is because the teacher expects him/her to know everything about the treatment plan, long term complications and preventive measures of the disease and communicate the same to the patient who at times (especially if it’s me) asks some really difficult questions just to add to the trouble! And if he does not know the answers then he’d better get ready for impending doom!

In today’s society however violence against doctors and AETCOM classes exist and thrive simultaneously. Every time a doctor is wrongfully accused, provoked to commit suicide or is manhandled it leads us to wonder, can AETCOM classes really prepare us for the things we might face as interns or doctors? Only Time can tell.