“…are yeh toh kitna bada mass hai , iska biopsy toh aaram se ho jayega.”

“Look at this dude, this is such a classic exam “CASE”

“Are yeh dekh isme kya superp De Musset's sign hai, kya solid AR hoga isko”

“F!*# man, iski toh puri wat lag gayi hai.”

                These are a few of the common dialogues we have come across in our wards at the patient’s bedside, failing to realize that the person lying in besides us is far more than just an exam “CASE”.

                For the past six odd years I have spent (rather I should say the six years I have “earned”) at this amazing place called KEM, I have said /heard/overheard many things I shouldn’t have .The aforementioned statements top the list. It’s such a common scenario at GS when such a rare/classic/ideal exam “CASE” gets admitted in the war. The usual pathway being:

               

The ignorant second years gather around the case and the houseman meticulously shows (-off) the “CASE”. After seeing such a classic/ rare case their enthusiasm knows no bounds. The entire class follows suit, poking the patient (sorry am I supposed to call him the “CASE”?).And like every news at the GS campus, even this one spreads like wild fire.

          Fearing the exam (or rather the examiner who is “expected “to conduct the Final year practical exam) the library/clinic-philic Ghasu joins the line of the innumerable students examining the “CASE” (The “Ghasu Paradox about visiting wards” states that-“At any given time during your undergraduation, the time you SHOULD be in the ward is inversely proportional to time you ACTUALLY are!). The registrar/housie who has already impressed a bunch of Ghasus re-demonstrates his expertise intermittently.

                Out of the innumerable patients that get admitted in our wards there will be very few who will be aware of what disorder they have. Even if they are aware of what their condition is called (thanks to the not too “soft spoken Ghasu” visitors they cater to everyday), they have no clue about what it really means. There was this one patient who was admitted in the ward for a bleeding gastric ulcer .While wandering (that’s the most apt word to describe what we do in the wards during our clinical postings) in the ward his relative showed us his endoscopy report and asked us to explain me the same. We explained him whatever little we knew (Our first posting in the wards just after finishing first year is the only time we have the enthusiasm to do all such things). The patient’s relative couldn’t stop praising us as no one had told them all these days what was wrong (And then our ). The ignorant patient and his relatives deserve to know at least this basic information. When we recruit patients for our research projects, we are supposed to get an informed consent document signed from the patient. Many a times it’s a misnomer ,its patient is neither informed , nor he consents .Its just a document which the bade dactar  hands over and instructs “jaldi se yahan sign karo.”

 Many a times we expect the patient to have that rare diagnosis we suspect or that rare sign which we have just rattofied from Harrison, for e.g. One of us had said during the emergency hours “Kash isko intracranial hemorrhage detect ho CT pe. I have never diagnosed one before.” Do we fail to realize what the diagnosis means to the patients?

 You will find the most passionate students at KEM, trying to “know” as much as possible. But few of us realize that for the patient we are not someone who comes to learn and experiment on them, but to treat them. I was a subject for a mock USMLE practical exam for one my friends and was amazed at the protocol they follow abroad. You are supposed to introduce yourself, explain the purpose of your visit and seek the patient’s permission before you touch him. How many times have you seen that happening in the wards here? I guess never. What we do is this “Are yeh dekh, (holds the patients knee and knocks the hammer at the patients knees) Kya mast knee jerk hai na!” .We are used to making remarks on the remarks of the patient’s condition, often in colloquial terms like “Kitna bada lesion hai “. We never really care how traumatic can this be for the already dampened morale of the patient. Try conveying the prognosis of same to the patient. I bet you will be short of words. Also how many times has it happened that while examining the patient we indulge in some random conversation with our colleagues which is totally unrelated to the patient? The worst part being is all this is happening in a language the patient and his relatives understands. This conveys a wrong message to the patient (and makes some more sensational news for the “research team” of Satyamev Jayate.) The one thing we must learn from all senior professors is the way they communicate with the patients in the OPD. The argument against it being they see a lesser number of patients so they can afford to spend so much time on each patient, but we can at least try to be as polite as them. Its beneficial not only for the patient but for us too. Personal experience says that if you have just talked to the patient before the procedure and made him feel important, it makes things much easier if any untoward complication arises if any.

                     I am no “ideal” student/doctor  to go around preaching how you should behave with the patients .I have been indifferent to the patients’ suffering the same way as you presently are. I have cracked the silliest of jokes and laughed on them in the wards besides patients. But you tend to realise the humane side of being a doctor when you actually manage patients, when he is more than “just another exam CASE” for you. You realise it when you need to convey the most grievous of news to the patient’s relative and you are tongue-tied. Retrospectively thinking (which is always easier), learning these things seem far more important than the hours we spent in the library rattofying the rarest symptom of the rarest Zebra syndrome. And then we realise (again retrospectively) why the KEM motto so appropriately states: “Non sibi sed omnibus “- Not for self, but for all.

So the next time you find that interesting “CASE” try to curb thy enthusiasm ,at least in front of the patient .Also when you are besides a “patient”(this sounds much more humane) ,avoid discussing the latest movie in theatres or the hottest girl on campus. There’s always the evergreen katta for these conversations!