Daily Musings and Life's Little Pleasures

Hi and Welcome! I'm Rahul, budding doctor-entrepreneur, still on my exploration trip around the world and currently in Philadelphia. This blog is a reflection of the thoughts and happenings that we experience in day to day life here...all in a day's work! Feel free to post your comments, nicer the better, and enjoy! :-)

Sunday, February 05, 2006

doctors as teachers

a nice article, coming at a time when i'm working with a great teacher Dr Ronald Rubin and yet another batch of budding interns and medical students!

"You're the worst medical student I've ever met."
I had just started my clinical rotations in 1980 when my instructor, a senior resident in internal medicine, gave me this blunt appraisal. My crime? I had asked a "stupid question" about something that, according to my critic, I should have looked up myself.
The instructor—I'll call him Bob Daniels—was an unsmiling despot with a Napoleon complex and a teaching style straight out of the Inquisition. His method was to interrogate medical students, usually without warning. The sole purpose of these exercises, it seemed, was to demonstrate how little we knew. He said he was trying to motivate us. Mainly what he did was demoralize us. He nearly chased me out of medicine.
For most of the past 20 years, I've taught medical students myself, vowing to do a better job than Bob Daniels. Based on my experience, I've come up with a few guidelines for mentoring tomorrow's doctors. It's a responsibility many of us have, whether we work at a teaching hospital, have medical students rotate through our office, or simply see them while we're rounding.
Never teach by shame. I try to follow the tenet that if I don't like being humiliated, then I should never humiliate somebody else. Abused students can become abusive doctors. And another generation of doctors perceived as arrogant and dictatorial by patients is the last thing our profession needs.
Be positive. In addition to Bob Daniels, I've had teachers who were warm and caring human beings. They educated not through intimidation, but inspiration. They exuded positive attitudes about medicine and tended to complain less about "we poor doctors" in the hospital cafeteria. For them, being a doctor was a calling, not just a job.
Make learning fun. I try to emulate a medical school instructor named D. J. Hennessy. He was a wry, impish little man doing a fellowship in infectious disease, and the love he had for his specialty was infectious, too. He once said that he pitied us because we only had six weeks to learn about his specialty, whereas he had an entire career to do so. "So let's not waste a moment!" he'd say. "Let's get started." He questioned us non-stop and gave prizes like free lunches and candy to students who answered correctly. He might as well have been hosting a TV quiz show. None of us wanted the rotation to end.
Focus on the basics. I tell students that we should never lose sight of why we are doctors. We are trying to help real people with real diseases. It could be your mother. Or it could be you. I recount my experience of undergoing neurosurgery for a meningioma. Suddenly I had a completely different perspective on this doctoring business. I recall how it felt when the chief neurosurgical resident asked me if I was "the meningioma in room 404" and how I replied, "No, I'm Noah Gilson. Who the hell are you?"
Exhibit a good bedside manner. I can teach my students a lot with the body language I show patients. I learned much of this from an internist I'll call Jack Fisher. At first glance, he appeared to be the least likely person to have a good bedside manner. At 6 foot 6 inches and 280 pounds, Jack still looked as imposing as he did when he flattened opponents on the gridiron at the University of Notre Dame. His size, though, belied his gentle manner. He took the time to listen to patients, answer their questions, and impart a reassuring touch with those big hands of his. Jack was careful not to be too invasive in his questions or physical examination. Aware of a patient's vulnerability, he seemed to be asking permission to probe as deeply as was required—but no deeper.
Value your students' comments. Yes, we can learn from medical students. Sometimes they have information that we lack, often because they're more computer literate. My students frequently have directed me to useful Web sites that helped us care for our patients. By dropping the patronizing attitude and actually using the information presented by students, I make them part of the management team.
Initiate your students into the "fraternal order." I make it clear that physicians belong to an ancient guild. We take oaths committing ourselves to high standards of conduct and specific obligations to our patients. Sometimes we have no choice but to run to the ED at 3 a.m. or answer the 37th call from Mrs. Jones about her migraines. I teach them to do this cheerfully and enthusiastically. After all, nobody forced us to become physicians.
I also remind students that they must be completely honest in reporting findings. This may require admitting that "WNL" means not "within normal limits," but "we never looked."
Uphold the patient's dignity. I never refer to patients as gomers, frequent fliers, dirt bags, or other pejorative terms that doctors sometimes use. I insist that students adhere to respectful speech and common civility. It's not courteous, for example, to interrupt a patient's breakfast so we can examine him at our convenience.
Teach students to be compulsive. I tell students that intelligence is only a small part of being a good doctor. What counts the most is the relentless and compulsive pursuit of the tiniest details. This attentiveness can be the difference between making the diagnosis and blowing it. Sometimes it's the difference between life and death.
Teach students to trust their judgment. I favor the "total immersion" method of teaching. I send the student out to learn as much as he can about the patient, using the history and physical as an outline for information gathering. When he presents the case, I ask a series of questions. What did the patient say and what did he show you? Did you pick up on nonverbal clues? Did you have a full understanding of his cultural context? And finally, what do you think is going on? What did your gut say about this patient? What other information do you need from the patient, the family, the labs, diagnostic studies, or from your reading to either substantiate or to rule out your clinical impression?
This sort of learning, though it may initially terrorize novices, is powerful. The more the student knows, the more confident he becomes in making diagnoses. So aim at cultivating confident doctors, even if it means they have to spend hours in the library seeking information.
Preach humility. Whenever I feel myself getting pompous, I think of how much I don't know. I encourage students to do the same. As an exercise, I tell them to think of physicians in the Middle Ages who spoke with absolute authority about "good and bad humors" and the value of bloodletting for all ills. Perhaps this is how we will sound to doctors in 2100.
Likewise, I tell students that it's okay to say, "I don't know, but I will try to find out." We don't understand everything about human disease. In fact, we're not even close. So we must keep reading and studying. I show students through my own pursuit of continuing medical education that learning is a lifelong endeavor.
Be yourself. Finally, present yourself to students as the person and physician you really are. Don't become some preconceived notion of what a physician teacher should be. Be flexible and innovative. Do whatever it takes to get your point across. Have fun. Relax. And remember that you have only one goal: To pass on your noble profession to the next generation. Good luck!

Saturday, January 28, 2006

wharton at its best

worth a read...what wharton is doing to help out HIV pts in Botswana


Experimental Entrepreneurship: Removing the 'Tin Cup Dependencies'


Although it has one of the most dynamic economies in Africa, Botswana also has one of the world's highest known rates of HIV-AIDS infection. In response, the Botswana government, along with the Medical School of the University of Pennsylvania and Wharton's Sol C. Snider Entrepreneurial Research Center, is helping develop a more efficient system to manage and monitor HIV/AIDS therapy. According to Ian C. MacMillan, director of the Snider Center, and James D. Thompson, associate director of Wharton Entrepreneurial Programs, the Botswana project illustrates a new concept called "Societal Wealth Creation via Experimental Entrepreneurship." By working to develop societal wealth enterprises in places like Africa, MacMillan and Thompson hope to sidestep two obstacles that often plague business development around social problems -- low profitability and lack of seed funding.

Visit http://knowledge.wharton.upenn.edu/index.cfm?fa=viewfeature&id=1376 for the complete story.

Monday, January 23, 2006

You're from Philly when...

You Know You're From Philadelphia When...

You punctuate every sentence with, "You know" at least twice.

You want olive oil, not mayonnaise on your "hoagie".

You hate the Redskins

You hate Dallas.

You realize that your favorite dessert is "wooder ice".

You find yourself using "yo" and "youse guys" when talking long-distance to family members.

You know how to spell Schuylkill.

You pronounce ACME "ACK-A-ME".

You think that $2,500 a year for insurance on a 1977 Toyota Corolla is a bargain.

You find youself at a nice restaurant thinking "I wonder if they have cheese steaks?"

You sleep soundly through gunfire and ambulance sirens.

You visit New York and are impressed by how clean it is.

You can't eat french fries without Cheese Whiz.

You call sprinkles on top of your ice cream cone "jimmies".

You don't think Wawa sounds funny.

You snub a cheese steak that isn't on an Amoroso roll.

Your parents, brothers, sisters, aunts and uncles all live on the same block.

You know who Jim O'Brien is and how he died.

You can't imagine lunch without a Tastycake.

You're still not sure about Jerry Penacolli.

A vacation at the Jersey shore (pronounced "Down the shoore") is better than going to an island (there's more stuff to do, plus you know everybody.)

You know where to find the Rocky statue.

You know that only tourists go to Geno's, Pat's and Jim's for authentic cheese steaks.

You only go if you're drunk and it's 3:00 a.m.

You can make a cheese steak and you've never been taught

You've never been to the Liberty Bell, or the only time you were there was on a class trip in third grade.

You know what and where "Boathouse Row" is

You will buy a pretzel from anyone, anywhere without even thinking of where it was - or where his hands have been.

You can't imagine a breakfast without scrapple.

You don't know what a sub is, but you think they are trying to describe an imitation HOAGIE.

You aren't a bandwagon Sixers fan?you loved them when they sucked, and before they had A.I.

You go to The Gallery or South Street in the summer time just to chill.

You have the pizza place on speed dial.

You actually get these jokes and pass them on to other friends from Philadelphia.

This was just a little humor to add on to the stereotype of a "Philadelphian."

Sunday, January 22, 2006

medical transcription humor (awesome)

Came across a book today called "The Empty Laugh Book" by the American Association for Medical Transcription, containing some of the funniest dictated and transcribed quotes from the world of medicine that I've ever encountered.

Some of the best follow: (c) 1981 AAMT

d: Hesselbach's triangle t: House of Ox triangle
d: Foot is cold with a purplish hue t: Foot is cold with a purple shoe
d: Patient is a primip. t: Patient is a prime rib.
d: Patient was followed up by the Neurology Service. t: Patient was fouled up by the Neurology Service.
d: Varicose veins t: Very close veins
d: Patient underwent a tubal ligation. t: Patient underwent a two-ball ligation.
d: Dr. Blank concurred with the diagnosis. t: Dr. Blank conquered the diagnosis.
d: If I may be of any help to you in the future along the way, please feel free to make an appointment for further evaluation in the meantime.
d: When this man straightens his head and puts it under his chin, he gets some relief.
d: The patient was placed under the microscope.
d: Extremities: The patient wears a toupee and there is a right inguinal hernia.
d: Patient has pain after intercourse in his chest.
d: Mother died at age 91, has good health and is active mentally.
d: Surgeries: Appendectomy, T&A, and bilateral breast bi-zippies.
d: [On an operative report, the surgical assistants]: In the left corner we have Billy, in the center puttering around with her little paws is Molly, and dancing around to my right is Daisy, and this is yours truly.
d: Get this: 100 mg., enough for a small hippo!
d: This is a letter to O.B. Tate. Dear O.B. No, Dear Ms. Tate -- I don't know, maybe it's a man. Dear person Tate. I don't know what you say. Dear person Tate. No, you can't say that. Dear Ms. Tate. Oh, make something up.
d: The patient was taken to delivery where she gave birth to a male-female infant. Oops! There isn't any such thing, is there?
d: His tongue was slightly hairy. Yes, that's what I said, hairy.
d: The patient had a deformity of the chest, the name of which I can never remember at the proper time.
d [On phone to the x-ray technician]: I'm sending over a hand. Maybe an arm will come later. Maybe a body will come with it.
d: This is the phantom of the phone.
d: The patient is here with a rash which I sent over to Dr. Blank.
d: The patient went to the bathroom shortly after the sigmoidoscopy and produced a prolapse, which she brought back to the office.
d: He was discharged to home with the Visiting Nurses following him.
d: Despite treatment, the patient improved.
d: She slipped on the ice and apparently her legs went in separate directions in early December.
d: Smokes two packs per day and consumes one quart of alcohol per day for past 10 years. Admitted with diagnosis of shortness of breath and increasing abdominal girth, etiology unknown.
d: Family history: Mother, age 87, is a diabetic. Father lives with an ulcer.
d: We do not feel this patient has any significant physical disease at the present time, and for this reason we have advised her to return to you.
d: The patient said she was too sick to be in the hospital and would return when she felt better. d: Patient became pregnant with an IUD.
d: Because of the age of the patient, speed was increased for fear of the patient going bad on the table.
d: Both marital problems are teenagers.
d: Patient took 6 Zactrin tablets given him by his dentist with a bizarre suicide note.
d: On exam, he has cigarettes in his front pocket.
d: He breaks out with cats.
d: Patient slipped on the porch when she went out to feed the birds and broke her ankle. The birds were not injured.
d: Patient had a spontaneous vaginal hysterectomy.
d: The barium enema on the phone was within normal limits.
d: Contusion of the leg secondary to nausea and vomiting.
d: It is my feeling at this time still that Mr. Blank is still in need of surgical correction in order to provide a more definitive direction and solution to the problem that is at hand.
d: The patient, be he dead or alive, needs a doctor's order to be released.
d: Here a pain, there a pain, everywhere a pain, pain.
d: Past History: Four children and an appendectomy.
d: The only complaint of this 74 year old woman is that the wind keeps blowing her off her motorcycle and she suffers aches and pains because of this.
d: This child will probably be shorter than he wants to be, but he should have picked different parents.
d: I gave the x-rays to the patient to carry with him so he could show and tell.
d: Preoperative diagnosis: Had enough kids. Desires tubal ligation.
d: The patient had waffles for breakfast and anorexia for lunch.
d: Patient was in an auto accident in 1965 and sustained a whiplash injury for which she received heat and exercise and $3,000 compensation.
d: Physical examination revealed a garrulous, obese woman who was short of breath on motion but not on talking.
d: Patient is a 28 year old white male who was playing his first league game of the season when he was sliding into home plate. The patient was safe, but his ankle was out.
d: He was a very pleasant person to talk with until he discovered that I am a psychiatrist. At that point, he became markedly hostile and belligerent, threatening to do great bodily harm to me if I did not leave the room immediately. The interview, therefore, was terminated very rapidly and a complete mental status is indeed not possible.
d: I don't think I have ever run into anything quite like this patient; however, I think with a great deal of courage, keeping our eyes upward, moving onward and upward, maybe we shall push through to the ultimate victory as England did in those dark days of Dunkirk. I now find that she is tired and she is nervous and she is not awake enough and she is not asleep enough. She is not right enough, left enough, up enough, and she is not down enough. I have decided that this whole thing can be cured by that magic pill which I will get from the pharmacy. This little bottle of pills will probably go into her purse along with seven other bottles of pills of which she takes only about one half. She can't handle the _____ so I told her to take [a vitamin preparation]. This has a little booze in it and may help her. She will return in one month.
d: He has never been married except once for three days when he was on an acid trip.
d: History and Physical: Mrs. Blank is a 64 year old black widow.
d: The patient was evaluated by an orthopedist, but impression of his con- sultation is unknown, as I cannot read his writing.
d: She was taken to surgery on the 9th, as per operative report. She made a good postoperative recovery and was seen in the clinic the morning following surgery. Following that, she was lost in confusion, and repeated attempts to locate her through the hospital information center failed to locate the patient until the morning of the 15th when she phoned me stating that she was still in the hospital in room 5309 ... Her unusual length of stay in the hospital was not intentional and it was due to misunderstanding and confusion and inability to locate the patient until Tuesday ... The patient's hospital course was uneventful and she was discharged.
d: She states that her husband took downers and she took uppers so the relationship did not work out.

coming back to life

Hi friends

So the blog is back, and we'll try to make up for the silent few months! The adventure continues, and next up on the agenda is a plan to make the blog more colurful and with pictures from Philly. Just hold on long enough till i gather the $$ to buy a camera.

Since the last post, i worked in my 4th hospital and moved into my 4th home (not to count the two shelters my friends gave me when i was homeless!) since coming to the US a year and a half ago. How i had laughed on seeing the travel brochure before starting from India initially which showed the average American moved home once in 1.9 years. That seems a long time to me now. Not to forget the unforgettable yearend India trip (more on that later)

The nice thing is that i've been happy in all of those homes and hospitals! My big YES to the "who moved my cheese " strategy in life.

My ID (infectious diseases guys!) news of the day

Dirt 'may hold clue' to superbugs

French bird flu case is negative

I got my fourth interview call yesterday! And i'm headed to the beautiful city of Chicago for my march vacation :-)

And last of all...something to think about while sipping that hot cup of coffee in our homes
Kidneys put on distress sale
Debt-Ridden Farmers Seek To Raise Capital & Draw Attention
By Ramu Bhagwat/TNN
Nagpur: ‘Farmers kidney sale centre,’ proclaims a banner put up at Shingnapur village in Nandgaon tehsil of Amravati district. Cotton-growing Vidarbha region has witnessed 244 farmers’ suicide since June this year. Unable to bear the burden of debts, unsustainable farming and life in penury, Shingnapur is a small village searching for new ways to draw the attention of the world to the plight of poor farmers. After a young farmer Jagdish Deshmukh committed suicide in the village last month, village elders held a meeting on January 15 and decided that all able-bodied farmers would offer a part of their body, kidney, for sale to raise money for the next crop. The meeting also decided to invite President A P J Abdul Kalam and PM Manmohan Singh for formal inauguration of the kidney sale centre. Shingnapur is not the only village to come up with novel ways of drawing the attention of the people and hopefully of the authorities to their plight. It all started with Dorli village in Wardha district declaring itself up for sale, followed by Lahegaon and Shivani Rasulapur in Amravati to raise capital to clear old debts of the villagers and making them eligible for fresh farm credit. People of another village have sought the ‘permission’ of the President and the PM for committing enmasse suicide. With the poor yields of around three quintals from an acre of land, returns are hardly enough for the yearlong needs of the farmers, leave alone the mounting dues from co-operative banks or an unsparing and ruthless ‘sahukar’ (private money lender). On its part, the Maharashtra government has announced a Rs 1075-crore relief package for farmers of six district of Vidarbha, five of them in western Vidarbha’s Amravati division where 180 farmers have died in the last seven months. But farmers’ leader have dismissed the package as ‘eye-wash’ and said it failed to address the urgent requirement of a better price for cotton or need for easy, fresh farm loans to farmers, majority of whom had defaulted on earlier loan repayments and barred from getting further credit.

Saturday, November 12, 2005

NYC here i come

off to new york city for the first weekend of my vacation...just chilling in the American way :-)

meeting old friends...

and just having lots of fun...

NYC here i come

another day another adventure :-)

Thursday, November 03, 2005

dream on

this is my personal statement for my infectious diseases fellowship...sounds more like a daydream mixed with a mission statement! here goes...

There will always by dreamers, to make “what is” “what can be”,
And there will always be doers, to make “what can be” “what is”

I always wanted to do Medicine. And I am glad I did it. I was born and brought up in the mystic Indian subcontinent. The rich tradition of spirituality and human service inspired me to take up Medicine as my profession.

The same virtues attract me again as I step into the next phase of my career towards specializing in Infectious Diseases. My inclination to stay in a field close to Internal Medicine, the positive exposure to the wonderful ID faculty at Temple and Chicago Medical School, and the amazing opportunities (rather dire need) in my own country for expertise in this field have attracted me to make this choice. It goes well with my desire to work not just in the traditional hospital settings but in the field as well; and the long term goal of organizing forces back home to help tackle existing and emerging infectious diseases.

The journey till here has been a hard trek, full of adventure and excitement. It began with my getting selected to Maulana Azad Medical College, New Delhi, one of the best medical schools in India. After medical school, I prepared for one year to get into Internal Medicine, doing research part time, as I was drawn towards problem solving and patient contact which was the heart and soul of medicine. I did 3 years of medicine residency, and then a year of chief residency in my alma mater Maulana Azad Medical College. Here I learnt the art of medicine…learning, teaching and practicing… in 4 beautiful years of my life. My most enjoyable and unforgettable experiences in India were being at the forefront of battling a Dengue Fever epidemic in 2004, community efforts to eradicate Polio by mass immunization for eight consecutive years (ongoing) and a voluntary drought relief mission into the desert state of Rajasthan in 2000.

I came over to the US to enhance my training in Internal Medicine with the wonderful atmosphere of learning, state of the art technology and emphasis on evidence based medicine here. It certainly has been a very fruitful journey so far, and my varied experiences in Chicago and Philadelphia have made it a well rounded experience. It has been worth coming from thousands of miles away just to meet some of the amazing people over here. Participating in the Digestive Disease Week in Chicago, ACP annual meet in San Francisco and the Philadelphia chapter of ACP gave me the chance to interact with other residents and faculty from all over the US and widen my horizons.

I greatly admire your institution and aspire to be molded into a better physician and an even better person by training there. If selected, it would be an honor for me to be part of your team and the next step in realizing my dream.

Rahul Anand

Saturday, September 17, 2005

Freaking out with Freakonomics!

had been looking forward to reading this book for a long time! finally got my hands on it!!

back home soon

Nothing can match the thought of being back home...even if only for a few days...even if still a few months away!

delhi...here i come!
i love it...believe it or not!!!

and great food lest you forget :-0
although i have learnt to cook now...looking to give my mom a surprise with my cooking!
and maybe even learn a few extra tricks by learning to grill american style
so long...the dreams of going home keep me going when the going gets tough!!!