I wanted to first start with an attempt to describe the scene here, although I realize now that will be difficult. Growing up, I’ve heard numerous times that doctors here in India can average seeing >100 patients a day, and I just couldn’t imagine how that’s possible. But just after one day, I realize what that means.

I’ll start by describing the clinic and my first impression:
The clinic is a two bed office space with a 7-bed in-patient hospital upstairs. So, I walked in and joined my attending in doing rounds on the inpatients. And in the first room (which I believe had 5-6 beds) was a patient with possibly recurrent tuberculosis, directly adjacent to a patient with CVID (a congenital immunodeficiency!). I’m not even sure I need to add in any more words there to express my shock about that!!

And then after rounds, the remaining of the day we spent downstairs in ‘clinic.’ This was a true test of brainpower for sure. The doctor has the scheduled patients, but in between the patients, other patients would bring in their lab results and xrays for additional follow up (here radiology doesn’t come with a written impression, but the patient instead just brings in their own copy). In addition, the doctor would receive phone consults. So, at a given time – there were up to 5-6 patients in the room – one on the bed, 2-3 in the consulting chairs, and the rest crowded behind.

But yet, the doctor with precision could manage this, and I believe the patients felt taken care of (that I can’t vouch for yet). There most definitely isn’t HIPA here. One thing I’ve learned in the past few months in outpatient internal medicine is that these doctors are truly geniuses – they have an impeccable memory, not only for diseases and medicines, but also for the patient’s entire story! Even amidst what feels like a zoo to me, the doctor himself knows all the patients names and their family’s entire history, whereas I’m still trying to figure out if the xray in front of me is from the wife or the husband.

My first step in my training here is unconditioning my instincts – for example, an elevated MCV = B12 deficiency here, not alcoholism. Elevated IgE isn’t a sign of allergies here, but rather worm infestations… and learning gujarati for all these fun things!