The most exciting day of my undergraduate life at medical college was the day when I put the stethoscope on a patient’s chest and asked ‘can you take a deep breath’. Through the years at college, life completely revolved around patients and their diseases. In fact, our introduction to clinical medicine focused on comprehensive details that a student was expected to procure from patients during the course of history taking and clinical examination. To fare well in exams we were instructed to examine as many cases as possible and memorize exhaustive details of the innumerable diseases infecting people and populations.
The wait for us, would always be for an exotic disease like Kawasaki disease or a Marfan’s syndrome. The early morning walks, cancelled classes and evening tea times, would be filled with excited discussions on eliciting a particular murmur or a classical sign of the rare disease. Word would spread around and the spot light would suddenly dawn on patients infected with the rare diseases. Herd of students would bombard the patient with never ending questions trying to match the disease features to that as mentioned in ‘Harrison’ or ‘Bailey and Love’.
Looking back today, I try to reflect upon what I learnt 10 yrs ago. The search was always for something that was new, unknown and unheard of. I wonder how different would have been my learning if I was taught to ask patients some fundamental questions like ‘how far did they had to travel to reach hospital? Or ‘how could someone who struggled to earn 3 meals a day was able to pay medical bills running in thousands’ and ‘in quest of becoming healthy, how poor had they become?’.
From Reorientation of Medical Education (ROME) scheme in 1977 which aimed at developing medical doctors for the rural poor to the Vision of Medical education in 2015 which envisages creating a basic doctor, physician for first contact of urban and rural community, I see major changes. These have been mainly on the duration of the course, the curriculum and the delivery of the subjects. In every effort to transform medical education, the larger objective has always been to expose the medial undergraduates to the community, to provide insights into field realities of the country. But the conversion of this objective into action has been only through posting them into rural health facilities, sometimes during the course and some as interns.
What would multiple pages of a case sheet with in-depth information of the disease mean to a woman who is wondering what went wrong with her healthy son, the only earning member of the family?. She runs from pillar to post in a completely unfamiliar environment trying to follow and fulfill every instruction of a busy doctor, who cannot devote few minutes to explain why her son was so much in pain. I wonder which subject or part of medical life sensitizes medical students to the pain, sufferings, fears and anxiety of patients and their families.
The focus of medical education needs to shifted from treating the disease to treating the patient. While signs, symptoms, investigations and treatment are all vital, the situation and the context of a patient’s life are most fundamental to understand and internalise.
I am constantly in search of students who while can rattle out causes of maternal deaths, can also ask questions like why did the ANM discriminate the mother while providing ANC care? Why was the medical officer attending to private practice during duty hours? Why did the health facility fail to provide ambulance when it was most required?
I wonder when the search will ever come to an end.
Blog by: Dr. Kavya R
