Making a pact

The one thing I had to remind myself about “my” clinic here is that although I am not in the villages of Gujarat – the clinic is in the more rural areas of this city (Vodadora), but it also serves a majority of the villages’ population. The other day we had a family ride a bus for 4+ hours for this visit. We required them to get some blood work, and therefore, convinced them to take the bus the next day to allow for a thorough check-up. At first, I found myself comparing the patients those I took care of in Southern Maryland last month and felt so disheartened because these patients were so out of touch with the medical system, but I had to remind myself that I have to compare them to patients of Baltimore.

Today I think I want to focus on the fact that here, more so than America, patients are SO reluctant to believe in “medicine.” But that reluctance leads to an interesting pact. The way my doctor convinces his patients to take blood pressure medications, diabetes, or cholesterol medications – is by almost making a deal. That you can try to change your lifestyle, do yoga, take your herbs.. and in addition take this medication until we reach ____ goal. If you are able to do all that, and we reach that goal, then I will decrease/stop the medication… and we’ll see how it goes from there. Although this deal exists in the US, I haven’t seen doctors do it in such a forward manner there – its more implied. It is also more we have to stay on medications for life to maintain this goal… rather than the mentality that combining everything we may be able to maintain that goal without “external” medications. I think that integration is key because its hard to fight a battle against a disease while you’re also fighting the persons habits too, but its motivating to all when everything can be combined.

Obviously there are negative impacts of this disbelief in medicine as well, and actually almost disinterest in one’s health – in the past two days, I have seen more “resistant” diabetes and hypertension than I have in the US. These patients are stated to be on 2-3 diabetes medications or blood pressure medications, with really high blood sugar and cholesterol counts. But, I realized its not as much resistance, as non-compliance.

 

Welcome to India…

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!