Day 2-4

If theres anything ive learned in the past few days its that it doesnt matter what department youre in as long as the doctor is willing to teach you, the experience will be worth it.

Day 2

This was my second day in the internal medicine department. I was hoping that thintensens would be more wiling to actually talk to me and explain what was going on. However that was not the case. In the morning, 8:30am, we had a prayer session. It was all about forgiveness. The chaplain read a passage from the bibble about how many times Peter should forgive his brother. "An unforgiving heart is the root of many problems." After this the interns kept to themsleves while they discussed their rounds. A visiting observer physiology masters student struck up a conversation with me and it was incredible. We talked about the politics behind medicine in India from getting into medical school to getting a promotion. He specificially told me that he's interested in neuroscience but he's not allowed to rotate through the neuro department at CMC because the chief of the neuro department at his home institution and the chief of CMC's neuro department aren't on the best terms. 

High school

5.5 years medical school

1 year internship

2 year required service at secondary hospital

Residency

Day 3

Since I wasn't learning much in the medicine department I decided to switch into the ob/gyn department. As much as I dont want to be an ob/gyn I thought it would be a good idea to rotate through the department that handles the insane reproductive rate of India. This was my favorite day by far. The doctor I was shadowing was a graduate of CMC who spent some time at Mayo Clinic and eventually ended up back at CMC. He did an amazing job of including me in his patient encounter by giving me a quick preview of each patient before they came into the office amd then would ask me questions to test my knowledge of embyrology/reproduction. The following are some notes I made durig my time in his office:

-Do you have sugar? = Are you diabetic?

-He asked every family if they had engaged in family planning. Almost every woman who was done having children had a tubectomy

-Every female patient came in with a male escort who did all the talking. Even answered questions regarding the length and description of her menstrual flow

-Most doctors engage in a paternalistic practice ("Whatever you think is right, sir")

-The doctor always informed the male counterpart that he was going to preform a vaginal exam before he entered the examination room.

-A female chaperone must be present during the exam

-"sir"=doctor

- Medical tourism. IVF in US=$20,000 whereas IVF in India=$3,000

-A Bangladeshi patient got a bill for 10,000 rupees for tests. Add that with the travel and living expense for 5 additional family members. This is the caveat of family centered societies. Patient could have come with only 1 family member and saved a lot of money. 

-Doctor offered to let me do a pap smear but I chickened out

-I got the chance to palpate many abdomens where the doctor pointed out large masses. One felt like a brick.

-During the physical exam the doctor takes advantage of the time and does a fairly quick breast exam (oppurtunistic medicine).  Many women only come to the hospital when they are in extreme pain. If women are stil giving birth at home, the chance they'll come in for a routine pap smear or breast exam is unlikely.

-block slides=histology slides

-Even though problems are dected at these out patieny clinic, patients cannot get into the operating room until a month later. A very overrun system.

-EMR exists at CMC but has not been fully implemented

-Interesting patients:

  1. Woman who had a hysterectomy done 10 years ago but upon ultrasound a uterus was found

  2. Obese patient with BMI of 39.1who is also an asthmatic came infor abdominal pain. The doctor stated that obesity is rare and the patient was unwilling to exercise. Doctor literally said, "You are fat. Lose some weight, please."

  3. Woman with ovarian cysts that contained hair, teeth, nails, etc.

  4. Huge goiter

Day 4

Today sucked. I had planned to shadow Dr. Abraham, same doctor from yesterday, but he was pulled into surgery. So i went to rhe department to see if I could shadow another doctor. They sent me to her office and whenI got there she basicaly told me to GTFO. Mrs. Sheela, who does the department assignments, put down the wrong dates for my ob/gyn rotation. This hadn't been a problem until now. Even though I was supposed to be there, she kicked me out and didnt even let me explain. So rude. So my day was cut short and I came home. This also means that I don't have a hospital assignment for tomorrow either. Maybe I'll use that time to do some touristy stuff around here.

At first I rhought it was just the medicine department but almost every woman Ive met that is either a doctor or an intern has been very cold. I dont know if that is just their natural disposition or if they just dont like international students. 

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