The Volunteers

 

ENT and ophthalmology both are subjects dealing with very small yet very essential parts of the human body. Contrary to expectations however the instruments they use for examining and operating on these organs are huge. The students must develop the skill of using these instruments and demonstrate the same during practical examinations.

While the main exposure to these instruments and their uses comes from the clinical postings, we also have practical classes of these subjects wherein we get to learn about and practice with these instruments further. The main aim of these classes is to help us become more conversant with the instruments and cases that we must face during the final exam. However, they also have an occult aim of bridging the gap in learning of those students who are too lazy to wake up in the morning to go for clinical postings.

In these practical classes patients are generally brought from the wards so that the students can practice history taking and examination on them. While the patients mostly give us long and mostly irrelevant histories about their entire life on simply asking: “What brought you in?” during the clinical examinations they are not that generous. Only a few people get to do the examination before the patient makes up an excuse to run away from the forty pairs of excited yet novice hands waiting to examine them.

It is during such crisis hours that out respected and beloved volunteers come in to save the day. They offer us their eyes, nose, ears and mouth to examine. And most of us show our appreciation by making them gag, sneeze or wince in pain in return. They sit, though not very patiently, as almost 20 batchmates use them as dummies to sharpen their clinical skills, till finally they get to avenge this cruelty by trying out the same procedures on another poor spectator-turned-volunteer.

There are some procedures which the patients don’t let anyone perform on them ( not even the PGTs or Professors), mostly because they cause a lot of pain and discomfort to the patient. They simply refuse and walk away giving us dirty looks. Then volunteers become our heroes and we get to practice on them not even bothering to wash the instrument of change the gauze in use while switching from one volunteer to another! These procedures are mostly not done in routine clinical practice, because now we have better and more sophisticated tools for these procedures now.

However, this refusal and somewhat hostility on the part of the patients leads one to wonder about the changing relationship between doctors and patients. These techniques were invented years ago before the advent of digital and x ray imaging. Back then, these were the only techniques of examination and the patients trusted the doctors and medical students enough to allow them to perform such procedures on them, no matter how much discomfort they brought. Where is that relation of trust gone now?

While the doctor patient relations have changed, we still have that trust from our beloved volunteers who know that we will not make them swallow a roll of gauze accidentally, and we can also count on them, as we know that they won’t mind even if we pull their ears to hard or poke their eyes with our fingers while checking for intraocular pressure.

 

The Patient's language

 

The first thing that is taught to a med student when she steps into a clinical posting is history taking. Old timer professors are of the opinion that a good case history along with a thorough clinical examination allows the doctor to reach a diagnosis even before any laboratory tests are done. A quick clinical diagnosis can be life saving for many patients, hence this stress on history taking. But the main problem arises when different departments and professors teach different formats of history taking and students remain confused about which one to follow!

One of our seniors once told us that, there can be no correct or wrong format of history taking, as it is as much an art as it is science. At the end, it should help us formulate a clinical diagnosis, the format that we follow doesn’t matter. I couldn’t agree more with him. Anyhow, in the initial phases when we are novices in game of diagnosis, having a format to stick to does help at times. Reaching a diagnosis is like a game of treasure hunt where you have to find your way to the treasure, and this format can sometimes be a compass for this journey.

We have to record the history in the patient’s language as per instructions from our professors. This proves to be a major problem sometimes, especially when the patient speaks a different language. It becomes difficult to convey the medical terms to the patient. Since our textbooks are written in English, at times we end up speaking the English terminologies in front of patients who give us blank stares while at other times we struggle to translate terms like “mucopurulent ear discharge” into vernacular languages.

Sometimes even when we convey what we want to say to the patient, the patient might end up giving wrong information, especially to training med students, immediately changing their statements when senior doctors ask. I remember a patient who told me when I took his case history that he had no hearing loss in either of his ears. I recorded the history as per the information given by him and presented the case to our professor. Then the patient, as soon as our professor came to see him, reported hearing loss in his right ear! I was awestruck. Meanwhile our professor glared at me and said that I was sure to fail in the semester and started explaining the case to us. When the patient was sent to the nursing staff for hospital admission, Sir’s glare finally melted into a smile and he told me, “Never trust them completely, half the times the patients don’t know what they are talking about. Next time do all the clinical examinations thoroughly before presenting your case.”

This is a common problem faced by medical students as well as patients in government settings. While the med students try to learn as much as possible in their clinical postings the patients are tired of the several batches of students asking them to repeat the same history time and again and not being able to offer any help in return. This is what makes them non-cooperative or causes them to resort to malingering in order to derive some sadistic pleasure from the pain of these dumb students.

At other times it is difficult for us to even decipher what the patient is talking about as they use terms like ‘chirik’ or ‘jhilik’ to describe pain, terms which no dictionary or even Google can translate for us. Some patients say yes to whatever symptoms we ask about leading us to wonder, “How is this person even alive with so many problems?” Many patients, especially females can’t stop once they start describing their symptoms. You end up listening to their issues with their husbands instead of their vision problems or nasal polyp.

If you remember your language classes from childhood, learning “patients’ language” is also similar.   You master it slowly and gradually, and eventually learn to reach a correct diagnosis from the limited and often distorted information provided by the patients. So, happy learning!

 

P.C-Suchishubhra Roy