Saturday, July 28, 2012

Medicine Posting Story : Language Barrier

 Fuhhh..fuhhh..!!! Its dusty here!

Its Saturday and i just finished making my bed. I've been waiting so long to update my story during my medicine posting.


In our 9th term posting, we had 6 weeks of medicine posting. Never thought that weeks gone by in a blink and suddenly the time to shift from Unit 2 to Unit 1 will come so soon. Head Unit 2(HOD) ,Dr A was so nice and very helpful. He always smiles       and treat us well. No hard hitting questions asked and always gives very detailed explanation in regard of the case presented.

It had been 3 weeks in the unit 2 and i find myself finding cases that i really want to see. This time we had 3 cases of ascites which i find very difficult to deal with during junior times. Now, that i have mastered the history taking skills as well as the physical examination part, all went well and i was lucky enough to get such a cooperative patient. Why is it important to get co operative patient?

Well, imagine if you were a poor and absolutely incapable of financial support. You were so sick and had to take a leave from work for a very long time. You had no choice but to go to either a government funded hospital or a charitable hospital so as not to worry about the money when you were so sick to pay for the bills. Our hospital is a charitable hospital in which the hospital reduce the doctor's charge, and medications were so cheap. However, since this is a teaching hospital, all patients in huge wards have to be willing to be inspected and used as subject during class( if they want more privacy, pay the tenth fold price of a private deluxe room).

At least, all patients who are well enough are expected to co operate with the students learning in this hospital. If the patient does not give their consent, even if the case filled with interesting positive findings, you can't force them to be palpated by so many students and at the same time give you detailed history of their sickness.I heard from my friends living in Egypt, as well as in hospitals where majority of the patient came from a very financially capable background were so reluctant to cooperate with the students. Yeah, it is well understood.You were sick and sensitive, you had to pay high bills and you want to be treated well and you expect no one bothering you every hour asking the same questions and touch your body for so many different reasons.

Sometimes, i do respect and amazed of the poor people who came to our hospital and become so cooperative to us. Thank You anna! Thank you amma! Thank you for being such a lovely understanding patient! I've learnt a lot from you guys!



You know what?In Indian culture, patients regardless of financial background were so respectful towards doctors that when they came to to the out patient clinic, they would open their snickers/slippers/chappals outside the door cubicle! They did that in spite of knowing the floor was not carpeted and dusty and we were all wearing our shoes inside. It shows how respectful they were towards the doctors! Not to mention towards the doctors-to-be too! In Malaysia, i think no one will give themselves to be examined or less getting an advice from a medical student. I think , all well educated patients are highly suspicious to doctors and would never see quack doctor for treatment. Nowadays, patients are willing to trust the internet rather than doctors advice and prescription. Thank you God for sending me to India instead of Poland. I hoped that my choice of staying in India instead of Malaysia were the best. Yes, it did in terms of clinical cases and as well as polishing my skills. Read How i end up in India.




Ehem,back to track. What we do exactly in medicine posting? Posting are divided to two. The wards and the out patient department(OPD) also known as clinics in Malaysia. On Tuesday and Saturday we had OPD and the other days we had to go to wards and take cases to be presented at the end of 3 hour class.

In OPD, we went there by 9.30am. Divided ourselves and go to respective doctors in charge at different cubicles. Lagi bagus kalau pegi kat head unit lah. Banyak cabaran!Heheh, dirang suka ajar dan tanya soalan. Kalau anak-anak buah dia, buat kerja dia je. Malas nak layan kitorang. Lagipun ramai patient nak layan lagi. 


Me and my unit friends in OPD!


We stood there and wait till the Dr say something.This time, HOD want do some inspection on how well i took blood pressure. With so many patients during OPD, i doubt that my skills will go rusty. Do everything the way it should be. The beginners way. No shortcut to take blood pressure. It took me twice or thrice the time needed to take blood pressure compared to him. Dr A said, as time goes by you will get your way to find the blood pressure in a short time. You have to find your way. If one day a doctor have 50 patients at evening, how much time does he need to ask the history,examine the patient and give the diagnosis? Practice! Practice!Practice! Be fast and save your and patient's precious time!

Other than taking blood pressure, we had to auscultate the heart and lung sounds if there is a case with positive findings. If the interns we busy clerking, and the doctors were busy talking to patient, he would ask us to take the height,weight and find the BMI.To all readers aspiring to study in India, please learn a bit of their language if you don't want to be blurry and spaced out in class. Majority of the patients here in Mangalore  spoke Kannada and Malayalam. Only few well educated Mangaloreans speak Hindi. Some patient also speak other language like Tulu and Bangla in which we had to us our God-given limbs to try to communicate through sign language although we looked like clowns at circus.

Language barrier is a problem if you don't have the initiative to learn basic orders and common words used in wards and OPD. At least learn how to say : here,there,pain here?,flex you leg,extend your arm etc... I tell you, it will be useful during examination where no translators are provided for us foreign students as well as the non-local students. Haha! Believe it or not, only locals speaks their language. 40 % of Indian students coming from other state like the northern area only speaks Hindi. Most of our patients don't speak Hindi which puts my fellow Northern Indian friends in the same shoes as mine.

Be friendly and ask nicely!

In ward, we came early at 9am and started to take history from the patients. We looked through the patients files lied on the bed which were meant for doctors doing rounds. We looked through each and every files to see whether it is worthy of being presented or not and it must be adequate with findings. Once we did, we jot down the name,age,place of the patient. Read the history ,findings and impressions in advance.Never believe what is written in there. The history could be wrong and doctors expect you to take the history yourselves. They want to know the history in  detail and expect you examine the patient before presenting the case. Wrong moves could sent you to bottom of self-mood-destroying-mode.

So, the challenge here is how to take the history in detail if you don't even speak their language? How do i do it? Easy! Even though you don't ask the questions directly, you can at least prompt the questions to you fellow friend. He or she might be submerged in the conversation especially when talking to old folks. So, your  job is to bring them on track by asking questions pertinent to the case. Involve more in conversation and remember the details translated. Doctors expect us to present the case without looking at the case sheet. Most of them will took the case sheet away anyway.Be prepared of the investigations and treatments needed by the patient. Find the differential diagnosis if you have more spare time. In the end, doctors will ask other diseases that comes with the same sign and symptoms and teach you how to rule out each one to come down the real diagnosis.

Fuhhh...

Its a long essay for now. I should stop here or else my arms won't move at all.

Da!



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