The Rat Race

Introduction:

Life of a medical graduate is a rat race. Right from the point when a student starts preparing for pre medical tests till he/she becomes a specialist or a super specialist, they keep running to ace some exam.

In this race no one ever questions the road on which they are running. Most of them don’t even know why they are running. They are on that road just because they were told to. All that matters is to reach the finish line.

The Start Line:

Lets start from the PMTs.16 year old students are supposed to study Physics, Chemistry, Botany and Zoology to clear their high school exam. At the same time they are also expected to study the same course more thoroughly for medical entrance exams. When the course is same and the kids are same why do we need different exams to judge their aptitude?

In practice this system has only led to rote learning of course syllabus over years. Students cram up their study materials without understanding completely, not because they don’t have the aptitude to understand but because the system doesn’t need them to.

And that’s just the starting. Once the students enter into healthcare courses after clearing PMTs they are met with a curriculum completely different from what they were taught for 10+2 years.

The same race repeats the next time they have to give an entrance for Post Graduate courses. Instead of focussing on treating maximum number of patients during internship a student is supposed to study anatomy and biochemistry that they learnt in 1st year. This not only leaves them unprepared for the challenges in the real world when they start practicing alone but also puts the general population at risk.

The Race:

The curriculum of medical education is such that it promotes the rat race. In the first year you race to ace anatomy, physiology and biochemistry without realising it’s application. What would a 1st year understand by dissecting a digastric muscle in 1st year when he/she doesn’t even know when and why to reflect it? Till the time students reach 3rd year to study surgery all the dissection they had done in 1st year is forgotten.

Teaching medicine subject wise is a wasteful exercise. Medicine should be taught system wise. Say you are dissecting the tongue today on a cadaver, if you are taught about the anatomy, its blood and nerve supply, its attachment and functions, associated pathologies and surgical modalities  during the same course, it would be more helpful and easier to retain.
Instead of making students run blindly towards scoring marks at the end of every year we need to ask if that exercise is fruitful or not.

The Finish Line:

Medical students study for years to become doctors and specialist, but even after one finishes the course it’s hard to understand where they stand. The race doesn’t end here. Once they step into the world they race against the next doctor in their city to get maximum number of patients. The competition based result centric education system has changed the core of medicine in our country. While trying to fight the battle between passion vs examination protocol we lose the sight of why we wanted to become a doctor: the patient.

That folks, is the funny thing about rat races. It doesn’t matter if you are a winner or a loser, you end up being a rat.

rat-race

About The Author:

This article was written by Dr Prerna Motwani .

Breast Cancer in patients with breast abscesses

In the last week, I have seen two patients who have presented with features of a breast abscess but they ultimately turned out to be breast cancers. Although, inflammatory breast cancers are a known entity and they can present as breast abscesses but this fact is not well known among patients and many general practitioners, which leads to late detection of these cancers.

With this case, I want to highlight some pointers to diagnose these lesions early. A 39 year old, non lactating mother presented to with complaints to swelling in the right breast for the last 3 weeks. She had already taken a course of antibiotics from a general practitioner but did not get relieved of her symptoms. On examination, she had a swelling involving the skin fold below the breast (infra-mammary crease) with swelling and hardness spreading till the lower part of the breast. In addition to this, she had lymph nodes (glands) in the underarm area (axilla) as well.

An USG revealed a lump in the breast associated with fluid collection, which on biopsy turned out to be an invasive cancer. Fortunately for the patient, on further examination, the cancer was found to be restricted to the breast and the underarm area only.

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When should we suspect that a breast abscess can actually be associated with a malignancy (cancer)?

  1. A non healing breast abscess – which is persisting despite antibiotics and surgical management
  2. Breast abscess in a patient who is not lactating. 
  3. Breast abscesses in elderly patients
  4. Breast abscesses associated with hard lumps in the breast

Patients with these symptoms should get an ultrasound and biopsy done to confirm the diagnosis. In India, another entity which should be ruled out is Breast Tuberculosis.

 

Breast Cancer Screening in “mohalla” clinics in Delhi

Yesterday, we had the privilege of meeting the Delhi CM, Mr. Arvind Kejriwal, regarding the idea of conducting breast cancer screening in the upcoming ‘mohalla’ clinics in Delhi.

The AAP government is planning to launch 1100 mohalla clinics by the end of this year and a major thrust in these clinics will be early detection of cancers.

Mr. Kejriwal & Mr. Satyendra Jain analysed a novel breast cancer screening device, which has been manufactured by UE Lifesciences and they agreed to carry out a pilot project using this device in some of their mohalla clinics.

I was personally impressed to see the CM already aware of the burden of breast cancer in our country and I admire his vision to screen patients for this dreaded condition.

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Electronic Health Records (EHR) – A necessity for Indian Doctors? 

The latest edition of eHealth Magazine highlighted my views regarding Electronic Health Records ( EHR’s). I have been regularly using EHR’s since I entered practice and I personally feel that all doctors should use it, as they simplify data collection and analysis.

   
 Another big advantage in our country is that patients often forget or lose their medical documents. In that case EHR’s can help doctors in retrieving the patient’s medical information and treat them in a better manner.