Dear Doctors, Don’t Get Bullied By Idiots. 

Another short lesson for all starting their practice/ learning:

Yesterday, a patient’s husband was constantly answering his phone while his wife was consulting me. His phone and nonchalant loud conversations were a constant disturbance and he pretended not to listen to my nursing assistant when she requested to either go out and talk or switch off. 

The wife had seen a neurologist and  ENT surgeon the previous day. Based on what they understood, they’d ordered relevant tests worth about 10,000 rupees at least including scans. 
The husband was a rich guy who behaved as if money can buy him everything. Big businessman. But obese, and on the verge of terrible health problems which he was least bothered about. He threw around the typical VIP attitude throughout and the wife was not much different though she was less obese and more polite. 

During the course of the 20-30 minute history, and physical examination, I got the diagnosis, explained to them the flow of events, starting from the onset of her symptoms till the probable diagnosis that was reached now. They agreed that what I have discovered about her condition might be correct. 

At the very end, I wrote them a single confirmatory test. But I told them to review with some other physician of their liking, and not come again to me. 

I told my nursing assistant not to give them review appointments and I put a little note about his behaviour in my records even as they watched what I typed and saved. He uncomfortably got out of the room. The wife apologised for his behaviour a couple of times, but I told her that if you both are not concerned about your doctors comfort and disturb him during the process of diagnosing your problem even without testing, I am not bothered about your measly 300 rupee fee that you think gives you the license to misbehave. 

The nursing assistant was very happy to see this. That’s what makes my staff loyal to me and stand up for me during my busiest days. Such “patients” eat up other patients’ time and create a negative atmosphere in our otherwise cheerful lives, whether you tolerate them or not. 

***

When you’ve to put your foot down, put it down. Do not tolerate nonsense in practice and do not fear if you’re right, fair and have documented everything clearly and have explained it crisply. 

Doctors have a right to refuse patients who’re not in an emergency. I am generally forced to use it 1-2 times per year. So far, not a single who’ve been dealt with this way for misbehaviour one has come back and created trouble, nor complained to any authorities. In fact, sometimes, the next patients in line, especially your regular patients, will have worked out what’s happened and will be supportive and thankful! 

Let the VIPs complain or go to social media if they dare to. Bullies must be dealt with tactfully and firmly. 

I’m sure that with unity among doctors, and consistently no-nonsense tolerating behaviour from our side, we’ll be gradually appreciated even by such people in the long run.

Jai Ho!! 

Advertisements
Posted in Uncategorized | Leave a comment

DNB Family Medicine Training (2007- 2010): Some observations and Experiences (written in 2013)

Hospitals, specially private institutes, see two major advantages in having DNB trainees:
1. Assured workers for three years at lower costs, without the conditions of employer-employee contracts or special privileges.

2. Academic interests keep most of the senior doctors updated and on their toes. So overall, confidence, quality of care is felt to improve.

———————–

Back in 2007

Initially, those doing FM were primarily rooted in one department. Usually it used to be Internal Medicine.

This seems to be true even now, in 2013, in many hospitals. Some colleages in FM training have had more than 6-9 months of posting only in the Casualty, or Neurology, Gastro, Surgery, etc.

FM trainees were “fillers” for departments such as casualty, ward calls, etc. as and when the need arose. Actually, this was a very much felt need (versatility). This versatility of family medicine trainees  could not be met by other specialty trainees. This was a very important point to note. 

Though there used to be a NBE-recommended schedule of training, it was hardly put into practice. When we entered into training in 2007, our group grew to six. We made a sincere request to the hospital management to let our training proceed as per rules. That was permitted. Life improved.

We had a good library, access to relevant journals, a PHC, a nursing home attachment, some excellent and supportive teachers, excellent research opportunities, etc.

There was initially a distinct feeling of being treated as “below par” compared to other trainees.

Some trainee colleagues from conventional specialties made it explicitly clear on more than one occasion that we were “temporary parasites” in “their” department (my suspicion is that they felt insecure that we put in more hours of work and study than them). Some peers jestingly coined terms such as “free radicals”, “jokers in the pack of cards”, “guests of the department” and “step-specialists” (as in step-children).

On the other hand, many senior doctors were keen on helping us with relevant tips and training whenever possible.

Back then, there were no exams/ bed-side classes/ etc specifically for FM. We had to merge with other specialty trainees. Some topics which were discussed during classes had little relevance to FM. While we gained useful clinical skills and knowledge, it was mostly “technical”, not holistic at most times.

There was little opportunity to liaise with FM trainees from other institutes. There were no FM CMEs, and no FM teachers. 

There was no AFPI then. So no mentors for most part.

Appraisals were inconsistent. They used to be conducted by various specialists, based on guidelines from the board, mixed with the particular individual appraiser’s personal ideas and assumptions about FM- which again generally appeared to be generally disappointing.

I was part of three appraisals, first by a Internist, second by a FM professor and third by a Gynecologist. There were many notable differences in the manner in which all were conducted. The internist was disdainful throughout and did not provide constructive feedback. The other two very methodical and guiding.

After the FM professor’s appraisal feedback, there was a remarkably positive difference in the way the management supported us and the way we trained. (This interaction probably saved a few careers too). This Professor was none other than Prof Sunil Abraham, who was the first real FM person we saw in flesh and blood after spending three years in FM training! Later on, I fondly  remember 3-4 of us trainees huddled around my mobile phone, kept in speaker mode, listening to Sunil sir guiding us on how to train better, prepare better, keep spirits high and positive, and be a better doctor. 

We felt there were very good opportunities to learn in every posting; nature of work was almost the same as other trainees in the respective departments.

Few days preceding the final exams were reserved for preparations. We used them properly and studied as per a plan. They were of immense benefit. Our teachers taught us wherever they could- even over tea and snacks in  the canteen, and during drama dress rehearsals for the annual day. 

All the candidates who made sincere and reasonable efforts passed DNB or equivalent exams. When the results came, it was very clear that those who failed were the ones who were negative in attitude, half-hearted or not interested.

Presently, training of the lone FM candidate remaining here is much better and steady compared to 5 years ago. Most importantly, a nucleus for forming a Dept of FM is in place.

But due to less candidates joining (2011), and mainly due to absurd excuses form the board to deny FM seats in spite of good results and trainee feedbacks (2012, 2013- apparently as per their new policy of trying to finish off DNB FM), the present candidate does not have a peer to train with.

The institute provided stipend and leave facilities as per National Board guidelines. Extra duties were compensated as per prevailing institutional rules. Decent hostel accommodation was provided.

In short, holistically, I would rate the training we got as 4/10 in 2007, steadily improving to 8/10 by 2011. There was a marked change in the systematicity of training, attitude of the institute and colleagues, etc. The results were there to show.

******

NBE’s role in training and support: Pratical considerations:

The board has outlined a decent syllabus for FM.

The board does not provide training material to FM trainees as much as provided to other specialties- but this is overcome to a good extent since a lot of training overlaps- e.g Thursday broadcast topics, theory and practical training CMEs etc.

When FM training is perceived by some teachers as just “mixing with normal trainees”, the “essence” of FM i.e holistic care is never a component in such CMEs or training programmes. Many teachers simply feel that aspects such as empathy, social atmosphere, shared management etc are trivial, not applicable or irrelevant.

The National Board is an extremely unfriendly place to deal with, from trainees’ point of view. They don’t answer telephone calls (I used to keep the phone on loud speaker and wait for them to pick up- which was sometimes after 20-30 minutes. This went on 3-4 times a day, for about 20 days! My mobile bill posted a record that month.)

They didn’t reply relevantly to queries. They discover lack of (practically insignificant) documents with them (because they misplace it) and withhold results at critical junctures- putting months or even years of trainees at stake. They are hardly bothered about doctor’s’ careers.

It happened with me in 2010, it happened with another Doctor from Mumbai this year.

All this news adversely affects other trainees’ morale.

Curiously, such hassles only seem to happen to FM trainees; others with amusingly bigger issues are left unharassed. For example, I have a friend in pediatrics who passed in 2010, with me. His just-completed, un-submitted thesis is lying on my table right now, in Apr 2013! He or colleagues from other specialties never had to suffer the agony which FM candidates suffered due to incompetence on part of the NBE staff!

During the convocation in Feb-2012, the 32 FM doctors were seated in the farthest, dimmest corner of the upper-most balcony of Siri Fort auditorium, even beyond other “less glamorous” specialties such as PSM and Ophthal.

Radiology, Medicine, Surgery were in the best, nearest seats right in front of the stage. Behind them were the pediatricians.

In our remotely accessible seating area, where the loudspeakers were barely audible, we could make out intermittently that radiologists and surgeons were selectively praised by various wise speakers.

Simply from the well-thought seating it could be made out which specialties were the NB’s pets.

FM found a lone mention towards the fag end of the day, when the handful who remained in the massive auditorium probably saw 2-3 FM specialists disinterestedly rise for the oath.

There is no gold medal for FM yet!

So much for moral support from the board, during training and even after passing! 🙂

P.S. In spite of all the cribbing, I am sincerely grateful to those few in the NBE for having provided a few of us the opportunity to have become FMs.

Jai Ho!! 🙂 

Posted in Uncategorized | Leave a comment

Tips for DNB-Family Medicine seekers: Updated

During PG admission times, online fora buzz with a lot of anti-Family Medicine chatter. Most of the negative chatter is by people with anonymous names and profiles. There is a strong suspicion that these are people who scored low ranks in PG entrance exams. They start commenting against FM in online fora and chatrooms such as RxPG.
The reason? The only hope of these people landing any PG seat is by scaring away those ranked higher than them from taking those seats. Such people exist in most fora (not only FM) and will be usually seen attacking a particular hospital/ city/ state (where they actually desire to get their own seat).

Think twice before reaching a conclusion based on anonymous chatter.

FM seats in better centers are being taken well before conventional specialties such as surgery, medicine, anesthesia etc in average places over the last several years. Most non-clinical specialties no longer figure anywhere near Family Medicine in comparison anymore.

However, FM is not for everyone. 1. Do NOT take FM simply because you are not getting anything “else” in your preferred institute/ city/ state etc.

Read up about FM on the net. FM has a lot of strengths and a few boundaries.
Understand the concept.

Depend on advice from those who KNOW about it, not from those who know nothing about it. Be careful who you seek advice from. Make an informed choice.

2. Do NOT take FM under the mistaken belief that it is “light” training.

In fact due to the vast scope of FM, it becomes crucial that you see as many patients as possible, spend as much time with teachers as possible, and know as much of real-life applications of medical knowledge as possible. In simple terms, it demands a vast breadth of knowledge, and more efficient learning. icon_wink.gif

The hard work and genuineness in attitude always pays off.

3. An odd FM-trained person here or there sporadically gives negative views about FM as a specialty.

The usual story in such cases is that – the person failed as a “person”, and the specialty was never to blame. Not every Neurologist/Cardiologist etc is a smashing success; the same applies to FM too.The problem with the the odd person who “failed” or “left” FM is that such people fail to look “within” and need something to deflect blames on. In all likelihood, such people never passed FM finals due to various reasons and “warn” others accordingly.

So again- be watchful. Seek balanced, unbiased opinions.

4. State/ National level Family Medicine CMEs are held every 6-12 months somewhere or the other.

Attend and interact with seniors to get a clearer idea what it is all about and what all is going on world-wide in the field of FM. While at it, don’t be surprised with the strong, ubiquitous presence and progress of FM in several developed Nations.

5. Outside the syllabus, FM training demands a good attitude, willingness to learn from everything and everyone (humility), a highly logical thought process, ability to see, analyze and manage a variety of scenarios in practice, several managerial qualities, empathy, communication skills, patience and an open mind- some of these are traits which can be done away with in several other specialties, which need different personal aptitudes and skill sets.

As a career, FM is awesome; let there be NO DOUBT about this. Go through this link  for an idea about how it is at least in the corporate sector. It was published in an International journal as far back as 2013 and the scenario has only improved for competent FM specialists.

But if FM doesn’t suit you as a person, better NOT take this .

*********************

Looking back, for example, the movie “Munnabhai MBBS” was all about Family Medicine! The movie exploited the public’s desire for the need for doctors with technical + apt humane qualities, which was the basic message of the popular movie.Scene: Dissection hall;

Munnabhai, to the Dean:
” Dekh, apun ko na, ek “full-to” Doctor banneka hai. Specialist nahi- ke gale ke Doctor ko pata nahi, ke ghutne me kya chalrela hai”.Remember the cheering and whistling in the theater to this dialogue?If you love that kind of concept, go ahead, and join. Otherwise, better look for something “better”.icon_biggrin.gifCheers!Dr Bijayraj R
MBBS, DNB, MRCGP (INT), MNAMS

Consultant and I/C, FM.
Dep. Co-ordinator, Dept of DNB, AsterMIMS- Calicut.
Founder-President, Academy of Family Physicians of India- Kerala Chapter.
Secretary, IMA-CGP, Calicut.

 

Posted in Family Medicine | Tagged , , , | Leave a comment

We “cost” little to you. But we deal in something priceless.

There are times when I LOVE discussions with self-proclaimed VIP patients!

***
Background:

The typpikkyyal Mallu VIP (pronounced ‘Vyee-iyy-pee’) is a boisterous, oversized, middle-aged male. He insists on smilingly referring to himself ‘small and humble’- something he will remind you of again and again. He invariably flaunts a Rolexed, Rado-ed or Omega-ed wrist. His fingers are studded with  multicoloured precious-stoned rings, irrespective of religion, each stone for a particular reason and season. The key to his Mercedes/Audi/etc is usually placed on the doctor’s desk, very prominently, as if he’ll gift it to the doctor if he’ll be made happy (though he never will). There’s at least a couple of thick gold chains around a fat, multi-layered, acanthotic neck. He smiles 24 X 7, as if the plastered smile is the reason that the world is still a happy place to be in. In reality, a look into his eyes will reveal that the smile is often a sinister mask.

The VIP is always well-dressed. Which means, if he’s male, he wears a superbly starched and stiffened, spotless white shirt. Usually, the saying now-a-days is that the whiter the shirt, the darker will be his secrets; and the stiffer his shirt, the looser will be his morals.

He’ll keep looking at his watch every half-a-minute. Not because he’s in a hurry, but because he spent 2-5 lakh rupees on it- he may well make the most out of it. OK, he behaves like in a hurry, but that hurry disappears when he’s speaking, and reappears when the doctor takes more than ten seconds to put his notes into the computer.

Most of them have a stereotypical sycophantic “friend” strategically seated behind them. The friend is not paid any fixed salary, but him and his family eke out a healthy living from the tips and incentives that he leeches out of “guiding” his richer friend. He is the person who cares for his VIP friend the most in the world. Maybe he even watches what he eats and exercises daily on the VIP’s behalf.

Somehow, my consulting room chairs, though decently broad, seem to magically shrink when some people try to fit themselves into them. The VIP has to maneuver particularly hard to fit his heavily fat-padded, enormous behind into in the semi-cushioned patient-chair which is meant only for the aam aadmi. The maneuvering is probably the best exercise he’s had to do by himself in recent times. As he adjusts himself in the chair, he reveals that he’s actually got a hi-tech treadmill at home, but he doesn’t use it to walk; he finds the machine more useful to hang his underwears to dry. He grunts as he makes a mental note that the chair is so tight- when he decides to get out of it, he’ll have to go through another round of immense physical strain to free himself off its suffocating clasp; or else it’ll remain stuck to his posterior- a nightmarish scene he’d never want to be caught dead with.

The VIP finds it a challenge to do all that maneuvering and wisecracking while trying to convey a “chilled VIP” attitude. All this hard work is usually meant to convey a strong social message to the small-time doctor that I am- “I AM VERY IMPORTANT”.

***

This is roughly how a conversation went, about a year ago. This conversation was worth remembering, considering the extent this guy went to. To my pleasant surprise, he came back to see me very recently!

(In between the medical discussion, he abruptly started off…)
“Doctor, how much experienced are you?… I don’t think you know the extent of my business dealings. My dealings are in hundreds of crores…. (later)… I know so many doctors… (later) … I have access to so many best hospitals in Gulf… etc..” … and then the arrogance-laden stunner: “doctors consultations fees are so cheap with you all… nothing compared to what I make!”

As usual, I expressed awe when faced with the stereotypical grandiosities, but was back to my professional interests in him in an instant, every time. I wondered if it was mania- a psychiatric condition- and it was not. Overall, he appeared to be pretty sane.

The consultation proceeded alright. It was pleasant overall and I managed to create a workable rapport. “Sir, its great to hear of your vast empire. Your businesses are really impressive to hear about. Thanks for placing your trust in me, though maybe for a short while.”

He seemed to be happy to hear this.

“We cost little, but we deal in … priceless … lives … like … yours.”

(Pause for a few seconds).
The measured tone usually works.

“Lets start simple before we go on to you uncontrolled diabetes, BP, knee pains and the rest. Maybe, say, let’s start planning with managing your obesity. Actually, let’s start a step before that. What you feel about your health?”

***

He left happy.
And came back now, after a year. To my surprise, he had stuck to the prescribed medicines, but not changed his lifestyle, and had not followed up elsewhere either. So overall, not much had changed in his health. But he was way more polite, and instead of blaming doctors and medicines, was gracious enough to reveal his amazing discovery that his unhealthy lifestyle was the main reason for his persisting ills.

We discussed again.

***

He won’t be back for another year, if I read him right. But he’ll be back- of that I’m almost certain.

He’s a different sort of a VIP. Like most ‘VIPs’, he came across as a person who wants to be nice, but is incurably tempted to maintain the typpppikkkkyyal aura of invincibility and “immortality”; in reality, masking his insecurities, and lamely hiding his greatest fear- of one day, losing it all.

#Paradigmshift 🙂

Jai Ho!

Posted in General, Humor/Satire, Medical Policies, Uncategorized | 7 Comments

Satire: Quacks call for Papaya Tree to be canonized as “Saint Papaya Tree” for miraculous role in “curing” dengue.

Asansol, Feb 29th, 2015. By an honest reporter.

Every noble deed is followed by a slew of opportunists trying to cash in.

A delegation of quack practitioners eking a living out of various “belief systems” (i.e. non-scientific and devoid of any sense) systems of medical practice gathered here today. They have unanimously decided to confer the title of “saint” to the humble papaya tree.

Speaking to reporters, self-confessed quack “Dr” Jackup Veddakkan Sheddi raved deliriously in his routine rabid manner: “For thousands of years, the papaya tree has been used to cure low platelet counts in dengue patients. Modern science has never been able to explain how this happens. Hence, its naturally classifies as a miracle. Whether anyone cares for it or not, our pack has unanimously resolved to anoint Sainthood on the papaya tree!”

When a reporter pointed out that there were no words such as “dengue” or “platelets” in any ancient literature, and were discovered by science relatively recently, Veddakkan Sheddi snapped, saying that he doesn’t “believe” in modern scientific medicine, and hence refuses to accept the presence of dengue and platelets at all.

He quickly exited the conference hall with his mouth cleverly shut, ignoring questions from puzzled reporters about the mutually contradictory statements he had just given.

Meanwhile, a frank and ‘well-intentioned’ quack confided to this reporter: “Sir, in the recent dengue seasons, we hyped up this papaya juice myth among people and most of them fell for it. Sales of papaya-related products made many of us millionaires overnight, in spite of us knowing it to be scientifically unproven and useless. Secretly, we do know that dengue is actually a self-curing condition, if cared for properly. The papaya leaf theory is unproven as yet, and the jury is still out about its safety. The cost of each papaya-leaf pill is much more than any proper routine medicine too. This papaya tree hoax is the latest miracle to happen to us quacks’ pockets and several fly-by-night businessmen. Hence, yes, from our side, it definitely deserves worshippable status!”

CEO of Kubera chain of hospitals, Mr Kaisebi Kashbana, also welcomed the move. “See, obviously, platelet counts will rise, papaya or not. But for us too, people trying out papaya leaves turns out to be better business. You see, raw papaya products, if not used carefully, are known to cause various adverse effects, even abortion. In fact, qualified doctors have been suspecting that the recent spurt of complicated dengue cases may be due to the papaya trials that people are blindly trying out on themselves. Though even ethical doctors have been asking people to be cautious about such remedies, people don’t seem to be bothered. When such people land up with us in late or complicated stages of the diseases due to delay in proper treatment or as a consequence of quackery, our ICU’s get full. If people are voluntarily asking for trouble, what can we do?” he retorted, his face giving a hint of glee.

Sensing opportunity to gain minority votes express solidarity with agitators as usual, Delhi Chief Minister Mr Arvind Kejriwal has rushed into Asansol. “Raw papaya being a green coloured and nutritious fruit, yet being neglected for its miracle powers, is a perfect symbol of a certain minority in this country. I am firmly in favour of uplifting the papaya tree to Saint status, to attract international attention to the issue of minorities. By the way, the papaya tree is also believed to absorb radiations  in the atmosphere, and will be a life-saver when we flood the city of Delhi with free wi-fi in case we decide to carry out our election promises”, the once-aethist CM said.

The Congress is also upbeat. They are demanding sainthood status for none other than Mr Rahul Gandhi. Insider reports say they are sure that it’s a miracle that someone of his caliber could reach a top leadership position, lead the party to its worst losses in history, not once, but repeatedly, and yet retain a top party spot with unanimous support from its members.

However, Mr Rahul Gandhi seemed lost, deep in thought. “I don’t think I deserve this honour. When women empowerment is such a burning issue, how can we even think of glorifying a fruit that is called ‘papa-ya’?” he pondered aloud to his suddenly alert team of ministers. “We should launch a movement to get it renamed as ‘mama-ya’ or the more balanced ‘mapa-ya’. Once empowered, we will get it saint-hooded”, he told the audience in pin-drop silence, all gawking with open mouths over the sheer brilliance and humility of their baba.

PM Modi, typical of his all-emcompassing style, stunned everyone as usual in the end with his wisdom and eloquence. “Mitron, the raw papaya fruit is green on the outside, has a white sap just beneath the skin, and when the fruit ripens, is full of saffron and sweetness on the inside. It truly symbolizes India. Instead of fighting over it, let’s all come together, make more and more of the fruit in India, and enjoy its sweetness and nutrition!”, he appealed.

With PM Modi pointing out that the ripe papaya is “saffron from within”, Mr Kejriwal and Rahul Gandhi have both retracted their support to the ‘sainthood-for-papaya’ movement. A couple of notorious reporters have drawn out daggers, tweeting: “Modi hell bent on saffronising food?”; a fresh controversy appears to be brewing.

Not to be left out, AAP stalwart tweeted: “Why the Modi is forcing ppl to enjoy saffron scent? Aapsurd!”


Originally published in The UnReal Times, here.

Posted in General, General/ Politics/ Social/ Slapstick, Humor/Satire | Tagged , , , | Leave a comment

Ads promising a “Family Medicine career in a corporate chain of clinics” will blow you off your feet. But read this before you leap.

Some corporate chains have been exploiting young family medicine (FM) specialists in the name of FM. They show little interest in your family medicine, once that contract is signed.

***

Dear all, a word of caution / alert:

Please take corporate ads offering “Family medicine careers” with a bucket of salt.

  1. Look into the credentials and past history of employers.
    Look whether there is even ONE qualified family medicine specialist among the top management. If yes, then there may be hope.

    Some simple, obvious clues:

    If there is a non-practising doctor at the top, bad.

    If its a non-doctor, MBA-kind among the tops, maybe worse.

    What would they know about the real-life practice of family medicine, apart from what they may have heard, or read, or even imagined by themselves!

    If most of the above criteria match, then you can safely assume what their business is about: Feel-good, commercial thrash disguised as family medicine.

    A non-doctor MBA at the top of any healthcare system usually screams out that it’s a full-out commercial circus: Little of science, and no scope for art.

    Medicine is a science as well as an art, remember?

    So avoid any place that is all-out commerce. You’ll feel rotten from within as time passes.

    Are they employing innocent doctors in the guise of FM to do only corporate health check-ups, manage coughs and colds? And to simply serve as patient feeders to bigger corporate hospitals, from where there is a kickback arrangement in place?

    Are those patients going to be “your” patients?
    Really? Will you ever get a chance to say that aloud?

    Then where is even the chance to practice “family” medicine?!
    .

  2. Never forget to to enquire about the place with past employees: they’re most likely to be frank and honest with reviews.  [Exclude me please- I won’t give any hint to where I got my hard lessons from; so please catch someone else 😉 ]

    .Asking the current employees may be tricky; they usually get brokerage money (“special incentive” in corporate lingo) from their bosses for every doctor they suck into their system.
    .

    Ask: “Did they keep the pre-employment promises about the nature or timing of work?” – as promised in their ads or pre-placement talks?

    Ask: “Have there been any relevant, useful and adequate training opportunities”?  …. You may be very upset at the answers you get-if they’re frankly revealed, that is.
    .

  3. Look into their websites for how many of their so-called FM doctors actually have a recognized FM qualification.If one of their existing doctors have posted a job offer ad online or in social media, what are the credentials of the person who posted it? Is he/she a qualified FM..? If the ad is about such places, its unlikely that the person who posted it has any background in FM.Knowing my fraternity pretty well, I can safely say that even today, an FM person is unlikely to intentionally cheat a fellow FM doctor.

    If they have unqualified, or irrelevantly qualified, or “1-year online diploma in FM” (i.e. otherwise hopeless) certificate holders portrayed as “highly qualified” and “FM specialists”, it means they are cheating the public.

    If they portray pediatricians or internists or gynecologists or pathologists as “highly qualified family medicine specialists”, it’s again open cheating. Worse, most likely you’ll be paid lesser than them,  because you have been subtly but daily brain-washed into believing your “inferiority”.

    But how come? How does a genuinely qualified FM specialist, with a broad range of expertise in holistic primary care,  get paid any lesser than a pediatrician, or an internist, whose scope is severely restricted,  in a “family medicine” or primary care set-up?

    Beats logic, isn’t it?

    But here lies the very loud message: They won’t hesitate to cheat YOU, either.

     

  4. Check out their service reviews, or customer reviews. (Not in their own website, of course, where you’ll find only goodie-goodie awesome stuff)

***

5. Think twice before migrating to a totally new city for such a job.
For, if you don’t like the place, it’ll become a torturous hell .
Not only for you, but also for your own family.

So think – not twice, but many, many more times, before jumping to “what a good offer for someone like me!”.

***

6. DO NOT COMPROMISE ON YOUR OWN SELF RESPECT…..

Hmm…. OK, don’t compromise too much 🙂

DO NOT SETTLE FOR BELOW PAR SALARY BELIEVING THAT YOU WON’T GET ANYTHING BETTER ANYWHERE ELSE.

Some of them offer salaries as if you have applied for the post of a …… never mind.

If they tell you “See, we have this chap who’s your senior who is working for peanuts, so we’ll give you the same, since you won’t get anything better anywhere else”, then well….. that senior has either been fooled, or has no aspirations in life, or wants to settle in that locality only for some reason and has some better plan, or… is a selfish plain loser who stupidly spoilt the job scenario for deserving people like you.

NEVER let them exploit your desperation at the start of your career.

7. Finally, keep this universal rule in mind:

THOSE YOU LOOK, THOSE WHO WAIT, THOSE WHO’RE REALLY GOOD, GET REASONABLY GOOD PLACEMENTS, including some excellent ones overseas.

Nearly every doctor has a passing phase of struggle at the start of a new practice- may it be internal medicine, neuro, cardio, whatever.

Struggles are not restricted to FM.
Nor is struggle new to us.

With care and patience, each one of us has reached reasonably happy places 🙂 🙂

***
You may also be interested in this article regarding corporate job scenarios for FM, published in the Journal Of Family Medicine and Primary Care: Click here.

Moral:
If something looks too good to be true, it probably isn’t.

One who learns from own mistakes becomes wise.
One who learns from others’ misadventures is wise AND lucky.

All the best!
Jai Ho!

—————–
With inputs from Dr Shantanu Rahman, GP, NHS, UK.

Disclaimer: This article not against corporates in general. There are several corporates clinics/ major hospitals actually supporting good primary care and its doctors with better intentions. The aim of this article is to alert you to the 100% commercial frauds who are abusing the name of this wonderful specialty and it’s doctors.

Posted in Family Medicine, Medical Policies | Tagged , , , , | Leave a comment

Patient encounters: The scared sufferer-manipulator.

It happens routinely in 100% literate God’s own country. Maybe, even more so.

***

A healthy-looking lady walked in to the clinic.

“Doctor, I’m feeling much better”

(She was in a near-crippling state 1-2 months ago).

“I want to stop medicines now”.
(She had been explained about VERY severe hypothyroidism when it was diagnosed; that her severe sleepiness, constipation, weight gain, puffy look, high BP and cholesterol are all probably because of that, the need for long term but simple and low-cost treatment, careful follow-ups, good chances of improvement, safety v/s minor risks of the medicines earlier. Cost of the medicine was NOT AT ALL an issue).

***

I am usually very liberal with patients- very much to a fault at times. Both with listening, time, and explanations. Hypothyroid people are frequently sleepy and less alert, and forgetful, and may not remember everything discussed during initial visits. So maybe that made her forget our previous discussion, and re-think now?

Dr: “Do you remember the last conversation. We’d discussed it in detail”

Well-educated Pt: “Yes. You’d told me that I’d need to take medicines for a long time.”

So our lady remembered it pretty well.

Dr: You could hardly walk last month. You say that you feel much better. Do you really want to stop the medicine?

Pt (proudly): In fact I already stopped it last week. I’m going back to *****pathy. I just wanted you to see the lab result before that.

Dr’s thought bubble: “See” the lab result, and then what? You go back to *****pathy, a well-proven hoax which kept you in distress for all those months, promising “cure without side effects” … “if you waited patiently long enough”?

And mind it- they cost her multiple times the cost of her current, simple thyroid hormone replacement therapy.

Her lab report suggested excellent improvement- which meant that she was well on track.

Dr’s words: What do you want me to do for you now?

Pt: Tell me to stop the medicine.

Dr: Why?

Pt’s summarized narrative: Gives the usual story- heard of side effects, no guarantee of cure, “knowledgeable” neighbours, friends, and media articles pushed by quacks.

Last week another learned patient told me: “We keep hearing that all you doctors are working for pharmas and for hospital targets and don’t really want people to get totally cured, because only then you can keep writing medicines for our lifetimes.”

I had thanked him for his frankness in divulging that.
Being frank with most patients is something I love to do 🙂

***
(Back to this Pt)…

The Dr listened patiently and discussed. Urged re-consideration.
No luck.

Dr (puts it bluntly in the end): Sorry, I understand that you wish to stop the medicine, but I cannot advise you to do that, since it’s very likely that you’ll slip back into the previous state.

Pt (suspiciously- and was there a threatening tone in it?): Dr, I’ll go for a second opinion.

Dr (Politely): Please, go ahead.

Pt (the bluff is called; now on second thoughts): OK, then I’ll take your medicine for 2-3 more months.

Dr: All all these discussions, if you conclude so, proceed as you wish. You are free to decide the mode and course of your treatment. I just hope you stay healthy and safe.

A short discussion follows, about testing after 3 months.

Pt nods head, says OK, gets up and leaves.
Not a word of thanks- that’s a rarity anyway. Its business. Give money, get the service. Where the scope for a “thanks” there? 🙂

Dr: Thanks for coming for an opinion today.

No word. Walks out. Almost slams the door, but the next patient has been eagerly waiting outside, and he stops the door from closing with a bang. He walks in smiling, happy with his results, and goes on to unknowingly make this doctor’s day back to a GREAT one!

***

Similar encounters routinely happen in day to day practice with most doctors. Its nothing special. But they seem to mock the concept that “educating patients” and “literacy” will pretty much ensure that commonsense and trust will arise by default.

OK, lets keep away from extremes of judgement. In any case, we’re used to it and live with it 🙂

Feel sad for such needless sufferers, though.
The “sufferer- manipulators”, a not-much-mentioned breed.

***
But sometimes, one is left speechless. 100% literacy. At times, it is worth a re-think before tom-toming literacy alone as a panacea for all social ills and unhealthy attitudes.

Jai Ho 🙂 !

Posted in Family Medicine, General, Medical Policies | Tagged , , , | 1 Comment