Medicine, Mind and Me: 2014

Organzing a fest

The work on saMMsCRIthi '14 started already.

The website is here: saMMsCRIthi.in
The facebook page: fb.com/saMMsCRIthi
The twitter profile: twitter.com/saMMsCRIthi

Sponsorship committees are starting their work. We, Malayalis are going to all the hotels and restaurants. It was a good start today.

One Day Discussion on Developing Curriculum for Masters in Human Rights in Mental Health

Introduction
Dr Narendra about
Dr Vijayaraghavan about child psychiatry
Dr Krishnaprasad talked about his interest in providing affordable child mental health.
Dr Muralikrishna about his interest in old age mental health.
Dr Sumanth about Diabetes, Hypertension, Chronic Diseases.
Dr Manjunath about education in general, and medical education in particular.
Prof Niranjan, from University of Mysore, HoD Dept of Communication and Journalism
Dr Anilkumar about psychopharmacology, sexual medicine and spiritual psychiatry.
Dr Rajgopal about self-harm.
Dr Sushama about bipolar disorder, coercion.
Eunice Severity of cognitive impairment in age over 60.
Dr ... Old age, Alzheimer's etc.
Dr Kishore about undergraduate medical teaching.
Dr Tony Ryan? Community health services
Dr Catherine about self harm, suicide, coercion.
Dr Rob Poole social psychiatrist - substance abuse, alcohol deaths, suicide, self harm.
Dr Raveesh - legal psychiatry, ethics and human rights, including policy making.

Aims for the Day

Share information about collaboration
Hear about people's views and experiences relevant to research
Peer review ideas

Mysore - Bangor Collaboration

Experience and Concerns
Professional help is not received, non-professional is; and we are okay with that.
Husband is tied up by wife. Neighbours do nothing. Finally,, the paramedical staff had to find it out.
In Dargas, everyone is tied up.
Older people who are stressed out, can't openly come out because of the cultural restrictions.
Awareness, Accessibility, Affordability, Acceptability.

Sometimes children/adults do not know they are being taken to a psychiatrist, but just a family friend or someone.

What if we are barging on the caretaker's human right by not allowing him to coerce a patient into treatment citing his human right.

Coercion needs to be defined to allow for positive coercion.

Tea

Boundaries of spiritual practice in professional care.
We were asked to give a 10-word description of several clinical vignettes. Then there'd be a discussion about how we should respond to those situations.

Lunch

After lunch we're supposed to create clinical vignettes of our own. Battery running out.

Looking Back

Today I went through some of the first posts in this blog. I do not think I have changed a lot. But a lot of things have changed. Curiosity has given way to boredom. Anxieties have dissolved into indifference. And the way I look at people has become more sceptical than the optimistic it was.

Maybe it is natural to feel this, but I am feeling "toska" (as Sneha would describe it). I have discovered the meaninglessness of life. And I am still living it. I have no idea what I am living for, and I do not know whether I am happy or sad. I am sad that I am not sad. I am living mechanically.

From today, I will try to start afresh.
And I will try to keep starting afresh in the coming days. After all, that is one good thing about starting afresh, you can do it again and again.

Mysore Medical College & Research Institute Admission 2014 - Documents Required, Fees Structure, etc

Hello future student at MMC&RI, Mysore.
It is quite possible that you've been searching all around for details of admission procedures and fee structure of Mysore Medical College & Research Institute, Mysore for the year 2014.
But trust me, as a student of MMC&RI myself, you'll find it hard to believe that "skmediaworks.in/mmcri" is the "official" website of our college.

Since there's not much we can do about that, here's the information you're looking for.
http://skmediaworks.in/mmcri/files/latestnews/document_fees_structure.pdf

I'll summarize that:

First MBBS Admission 2014-15

Passport Size photo - 2
All original certificates below

Allotment letter (CET/AIQ)
SSLC Marks card (10th)
PUC Marks card (10+2)
TC + Study certificate
Cast certficiate Income certificate
(Cat I/II A, /IIB/IIIA/IIIB/SC/ST)
Physical fitness certificate with blood group (any govt hospital)
Eligibility certificate / Migration certificate (AIQ / CBS)
From RGUHS, Bangalore
CET & PMT (AIQ) marks (net copy)
Total 3 sets xerox copies of all certificates

E - Stamp bond paper Rs 100
First party - Student Name
Second party - Director & Dean
College Fees Structure

CET General - Rs 8375
CET Sc/ST - Rs 15875
AIQ - Rs 25075

Hostel advance boy - Rs 7500, girl - Rs 7500

Note: I just typed that information from the above linked pdf file. Here's that once again. http://skmediaworks.in/mmcri/files/latestnews/document_fees_structure.pdf
Since I've a class at 9, and it is 9:10 now, my typing could be wrong. So, refer that link.
AIQ above stands for All India Quota. (AIPMT, NEET, whatever)

More: If you're an AIPMT student, the certificate number 6 in item 2 above, the eligibility certificate, need to be obtained from Rajiv Gandhi University, Bangalore. Yes, you need to first go to Bangalore and get that. (Takes a day or two, depending on your luck). And then come to Mysore. Book tickets accordingly.

Even more: You can ask me, a third year student, for any detail you want. Look for my phone and email here.
Btw, here's the office phone number in case: 0821 2520512 .

All the best. See you in August.

First Thinks First - a workshop on first aid

The Academic Society and St John Ambulance gave this workshop on first aid in the Anatomy lecture hall on 6th June.

Schedule

--
Behind the scenes
Dr Abeer, Bhavika, Dr Chandrakumar, Dr Gurudatt, and Dr Manjunatha (possibly more or less people) shaped this workshop.
Volunteers (who were present while we were practising the skits at the Lion's waiting shelter) included: Pratibha, Swathi, Shruti, Vivek, Madhu, Nivedha, Noor, Meghna, Terese, Prashasth, and Me.

Volunteer meet at Lion's hall

I made this PowerPoint at CCD with Dr Abeer and Bhavika. The skit would go along with the presentation.--

On the day:

I went searching for printing facility (for this) in different shops in landsdowne building to no avail. And reached the Anatomy Lecture Hall about 15 minutes late (at 9). Connected the laptop. Bhavika had brought her speaker too.

The inauguration was done by the dean.

Dr B Prakash, Dr B Krishnamurthy (speaking), Dr CL Gurudatt

Dr B Krishnamurthy giving a memento to Dr Prakash (left)

Dr B Prakash handled all the sessions - including demonstrations.

While I was taking photographs behind the audience, Bhavika called me to the stage (for a computer problem?) and I ran to her to know that Dr Prakash needed a volunteer to demonstrate mouth to mouth. Thus, I became the brave volunteer.

Me lying dead, and Dr Prakash checking for breath sounds

I also received 4 CPR strokes, which almost made my heart stop (ironically).

Lunch was served in Histology practical hall.

Skit team doing something and all

And then we staged the skits.

Following these Dr Prakash demonstrated different bandages, carrying methods, etc (which I fondly recalled from my old scouting days)

By the end of these (at around 5) everyone was in a hurry to leave and there were only about 55 left to do case scenarios. I had a broken clavicle and the team of first aiders managed to identify my problem and bandage me up pretty accurately.

And after a squabble with the Anatomy department attenders we packed up.

CME on dissertation and synopsis - a statistical view

The Department of Community Medicine, MMC&RI organized a CME on statistics today in the P&SM lecture hall, which was being renovated all this week for just this occasion.

The first talk was on the importance of statistics in medical research.
I missed the second talk about synopsis.
Then Dr Ganagaboraiah talked about which statistical tests are best for which methodology, the pitfalls in using different tests, the importance of correct sample size, avoiding bias, the importance of confidence interval, significance, power, etc.

This was followed by my favourite session on R by Dr S Ravi. He showed R studio and gave some reasons to use R in a beautiful latex (beamer?) presentation.

And ironically, systat (who was sponsoring the day?) gave a talk about the systat software in the end. The conversation revolved around how systat is at par with SPSS which highlighted the generalized apathy towards R. Makes me wonder if I should quit medicine and build a GUI for R and sell it.

The Wait While The Dosa is Baked

Read how to make Dosa here

I finished Ophthalmology postings.
And I started Orthopaedics postings.

These days are very rainy, very clam, very eventless.

NIE has a quiz fest from today. I'm participating in all that I can. Because tomorrow I'm going to attend the Firefox Launch party. It's unfortunate that "biz-sci-tech" quiz is on the same day.

I have registered mbbshacker on quora too. I will put less personal stuff there.

Downloaded all the videos in Duke University medical neuroscience course on coursera. On week 2 now. It is interesting. I might even skip neuroscience if I finish this course.

The rain is quite heavy in South India. It's 35 inches back home, says dad.

There are two internals back to back next week. ENT on Tuesday. PSM on Wednesday. I am yet to start ENT.

I'm living on my bed (literally) these days. Never get to wake up before 8, never goes for a jog, nobody plays football in the evenings.

The fact that I could gulp down all the knowledge on earth if I wanted to is exhilarating! It leaves me confused about what course to take after MBBS. Clincial Neurology might be too "clinical". Psychiatry is a very good option. Community Medicine is where my aptitude is (I believe). I am not sure I am research type. I might find practical research boring. Theoretical, maybe yes! But I don't know if there's theory in medicine. I might have to start my own research lab. Or I could join this guy:

Whatever is my future, I'll have to wait till the dosa is baked to eat it.

Holidays and working days

General election is definitely making a wave. I did my first vote on April 10 standing in queue for just over an hour in Maruthayi LP school. I resisted the urge to rub the indelible ink right after the officer put it on my index finger. I wanted the mark to stay, at least till the first day after holidays.

The polling day was April 17 in Karnataka. The finger was thumb.

On Vishu I went to Nagarahole National Park with my family for the third time. It was also the third time we returned without being able to go for the wild safari. This time it was none of our mistakes, it was the summer rain the evening before.

r/getDisciplined is my new hope to get better at academics.

On the way back to college I had two great ideas - upgrade Ubuntu to trusty tahr, and advertise a one on one, home workshop for website creation/Linux basics/Python for students. The former was done. Latter needs a website.

Classes are going as slow as it ever have been after 6th term began. I could have failed a subject in second year, there is enough free time to learn a subject. Or to watch House of Cards.

MAA grant

The medical education unit room in the first floor of Platinum Jubilee Hall is a neat place.

There is a projector with a flexible base that stays where you put it.
There are excellent rotating chairs and static cushioned chairs with nice tables that go along.

And last Thursday the room hosted the MAA grant interview of candidates.

There were 17 projects which sought the 10x10000 and 2x5000 grants by 1961 batch and 1984 batch respectively.

Dr Manjunath had already informed everyone how their presentations should be outlined.
Dr Shekar, Dr Balu, and a few elders from 1961 batch was present to discuss the presentations.

It went in alphabetical order except for a few changes.

I was second to present my "Study on the Respiratory Effects in Road Construction Workers".
Somehow the title had to include the word "prevalence". Also, unlike what Dr Sumanth, my guide, and me thought, there is some problem with smokers and non-smokers being included in the study.

The inclusion criteria should not be one year. It should be more considering how chronic bronchitis is defined to be two years.

And peak flow meter can measure only obstructive diseases.

Totally, I was apparently "just coming and doing research" which is "not the way research should be done".

To be frank, I felt like I am going to be better off not wanting to do any research. After all, I'm not going to be patient enough to do data collection. I should rather switch to statistical analysis (my opinion). That's where all the fun is. And that won't have to go through all these trouble of convincing people about ethicality and practicality of stuff.

Others presented projects about tobacco, birth asphyxia, and stuff.

From today, I'm a research analyst :p

Workshop on Coercion

What could be called the 2nd Indo-European symposium on coercion, started today morning at 9 in the first floor of Platinum Jubilee Auditorium, JK Grounds, Mysore.

Checkout their website here: mysorecoercion.com

First, Prof. Tom Palmstierna talked about various forms of coercion used in Europe. Belts, net beds, clothes, so on. The interesting thing is, these practices are not the same in different regions. Some countries practise seclusion, some countries practise restraint, and mental health workers in different regions consider their own methods as good, and others' method as terrible.

He went on to point out cochrane reviews which said that there is no evidence to show that coercion is useful. By which he only meant that coercion per se is not helpful. And this point was clarified in questions, when Dr S said that coercion or physical restraint is the first step to treatment.

Although it was argued that coercion and restraint are not the same, Prof Palmstierna said that coercion is a spectrum which goes from restraint to strong advice.

The discussion about CTOs will happen later.

The second session - about the definition of coercion in the Indian setting, was made into a discussion session because Dr Murali Krishna was unable to reach.

The crowd was asked about different forms of coercive practices followed in India. It was said that people are tied up, that it is mostly the family that does it rather than the doctor, that religious leaders and institutions have a role in how psychiatric patients are managed. That sometimes there is nobody to coerce the large population of India - people who walk on streets, talking to imaginary friends. Chain cannot be used after Erwadi incidence. There are physical, mechanical, covert medication, etc. Covert is common. Seclusion is not so used. Coercion is a necessary evil, it needs to have a law. Different opinions will always exist.
Family's concern, patient's concern. Autonomy of patient vs freedom of society. Coercion is not a punishment. Role of BOV in MHA 1987 is not explained. Non-Indian citizens have to be considered. Is coercion always in the best interest of patients? Mental Health Care Review Board has only a role in supervision.
Shouldn't we be bothered about treatment more rather than the right of the patient?

We should try to achieve general good clinical practice. There should be no difference in hospital or community. Legislation will delegate the powers to execution.

Mysore Declaration on Coercion
Last year, in the Indo-European symposium, a small step towards setting up guidelines about coercion was made.
In India, covert medication, etc is common place. But we do not have data about the use of coercive measures and other forms of leverage. This makes international comparison difficult.
There is a need for recognizing the rights of the mentally ill.
Disproportionate, unsafe or prolonged coercion or violence against persons with mental illness is a violation of human rights.
There are barriers like lack of awareness about the treatment and outcomes expected, the assumption that mental illness is always accompanied by mental incapacity, lack of provision for advanced planning in the event of future incapacity and compulsory admissions; lack of resources, lack of training.

Long term goals would be to involve patients in decisions made about them. To develop strategic plans, benchmarking, regular analysis of data, regional and national and international comparisons and transparency.

And so on

Time to Fly

It has already been half a month since I turned 21.

The sedentary life was giving me a heart attack. So I started jogging. Three days later replaced that with football in the evening. Only "Campnow stadium" (or hostel ground) is so full of dust that playing there is equivalent to smoking 2 cigarettes.

Postings in community medicine is proving useful. Though I have not taken any case seriously in the wards, I have been reading about parallel stuff - like the story of tuberculosis (that led me to the understanding that tuberculosis has a very important role in the history of medicine) and the Indian national programmes for children.

Here is a beautiful quote:

2000 B.C.—Here, eat this root.
1000 A.D.—That root is heathen. Here, say this prayer.
1850 A.D.—That prayer is superstition. Here, drink this potion.
1920 A.D.—That potion is snake oil. Here, swallow this pill.
1945 A.D.—That pill is ineffective. Here, take this penicillin.
1955 A.D.—Oops . . . bugs mutated. Here, take this tetracycline.
1960–1999—39 more “oops.” Here, take this more powerful antibiotic.
2000 A.D.—The bugs have won! Here, eat this root.
—Anonymous

Classes are still going slow. OBG is the only subject that is proving interesting.

Outside the classes, things are going faster.

Last Monday Dr Dharav Shah, a psychiatrist from NIMHANS took a beautiful session on how doctors can stop the alcohol epidemic.

The Kreida 2014 team is beginning to rev up. All teams have been decided. I am doing sports quiz, one of the new items in this year's kreida.

Academic society will also kick up some dust soon with its activities.

Fest: To hold, or not to hold - that is the question. Because October is too close to the exam. May is too close to today (which prevents fund collection) and to rain (which prevents outdoor fest)

Trip: To go to Goa, the best time is November to March. Due to Kreida, March is blocked. I am sure I will have to walk without clothes if we go in this month itself.

3rd year

Community medicine department became the first to suggest reading a textbook that was written for a different subject when the HoD asked us to read Harrison's, Davidson's and Hutchinson's , McLeod's instead of community medicine textbooks like Park.

He also suggested one important thing - to stop getting involved in college activities, politics, etc and to start pouring in hours after hours reading those standard textbooks and others. Genuine. Why should students be spending any time doing things that are not useful for them, but probably harmful, in the long run?

Thus, my resolutions to disregard anything that isn't directly related to my career henceforth, got some cementing.

He also said of the need to stop depending on parents. And that gave me some more reasons why I should start earning some bucks on my own.

Technically, I'm motivated.

Pathology Practical Examination

After revision on 4th (coming back from a quick visit to home) and 2 days of not studying anything related to pathology, today on 7th I took the Pathology practical exam.

As usual, it started with the spotters. I remember fatty liver, and peptic ulcer; WBC Pipette, bone marrow aspiration needle, Wilm's tumor, CLL. And the rest of the histopathology slides were too confusing - what I thought emphysema was probably CVC lung, and I don't even remember if I wrote the others right.

Then, I got to sit down at my chair where a chart, a peripheral smear, a discussion slide and a urine sample was waiting.

Peripheral smear was probably dimorphic anemia. I got really confused till I adjusted the condenser for the high power. (Always remember. High power, high condenser). Nevertheless I was asked the causes of eosinophilia, microcytic anemia, macrocytic anemia.

Urine - my question was a sore-throat kid with burning micturition. Proteins present, Blood absent. Had to explain how phosphate coagulum gets dissolved in acetic acid, while protein doesn't. Messed up by pouring nitric acid over urine in Heller's test, instead of adding urine to nitric acid.

(I remember the other side were being asked reducing sugar (diabetic neuritis), and ketone bodies)

The discussion slide I got was that of a 56 year old man with burning micturition. BPH was an easy find, but I didn't know about the serum markers of Prostatic cancer (which I answered in the evening - Prostate Specific Antigen, and Prostatic Acid Phosphate) or about the grading PIN-1,PIN-2.

The chart was of CSF examination with cobweb formation, increased protein, presence of lymphocytes. Straightaway TB meningitis. Had to say other inflammatory conditions in the brain.

With blood grouping, I got my answer paper soiled. The slide was kept right next to my microscope, right above the answer paper. And after I finished answering some other examiner, the slide was nowhere to be seen. :P The front page, where "RGUHS" was printed was very nicely coloured red and blue, red and yellow and red and colourless :D I almost did the same with the second slide I received too. Put the Rh on the backside of my answer paper. But luckily, by then I had found out that the group was B-ve. Had to tell the examiner about the minor blood grouping systems too.

With the morning session done, I was too stressed out having a headache, just wanted to sleep. Came back to hostel. Had lunch, and went back to college so that I don't sleep in my room.

At 2 o'clock the viva-voce started and it was very quick for everyone.

First room: Specimens on the table - Fatty liver, squamous cell carcinoma, lobar pneumonia, TB lymph node. But the questions were causes of fatty liver, define shock, types of shock, define necrosis, types of necrosis.

Second room: Specimens - Osteoclastoma, Polyp intestine, hydronephrosis etc. Questions were PIN (which I forgot earlier), describing osteoclastoma, describing polyp, classifying polyps, cause of hydronephrosis, describing the specimen.

Third room: Specimens - TB Lung, seminoma, Breast cancer, and so on. Questions - describe TB, describe seminoma, describe breast cancer. The important thing was to describe only what was visible. :D

Fourth room: Instruments. Wintrobe's, Westergren's. Had to tell the anticoagulant used. Pasteur's pipette (I never knew it was called that. My "dropper/pipette" answer didn't work)

And in about 10 minutes I was finished.