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Patient Inclusiveness in Rounds, Sex Between Serodiscordant Couples, Role-plays, PrEP, PEP, Anti-Retroviral Drugs, Drug Resistance, and what not!

This weekend was fun! I am grateful to a lot of people for it being so.

It started Saturday morning with grand rounds, as usual. We were joined by Dr Ramakrishna Prasad (RK), Dr Ashoojit, and Dr Praneeth Sai. RK was leading the rounds. And he introduced the concept of patient/family centred rounds wherein we include the family in the discussion and make them feel a part of the process.

That meant I talked to the patient in front of everyone and let him describe his problems in his own words. This allowed gleaning certain facts of his life that were also much useful later in the day while talking about other aspects of care in HIV.

What followed was journal club by Dr Swathi in the training hall. She presented "Living with the difference: the impact of serodiscordance on the affective and sexual life of HIV/aids patients" a topic that greatly interests her.

They interviewed 11 carriers and based on the theme of sexuality after HIV infection between serodiscordant couples foun…

Documentation in Medical Records

I have documented my love of documentation elsewhere. I blog to document my life.

I'm not perfect at it. Nobody ever can be. Because perfect documentation would take more time than the original act of knowing.

Imagine. If you were documenting a visit to a nearby tourist attraction. How would you document it perfectly? You could definitely write about it in much detail. But how much detail is enough detail? Would you be writing about everything that you saw on the way? Would you be writing about your thoughts on what you saw? Would you document the planning process? Would you care about other sensations like smell, warmth, etc?

Recording a video might capture more detail. But a video can't really capture your thoughts unless you speak into it. Even then it can't capture your reflections unless you reflect loud while shooting yourself. But how much can you videograph? Where do you store these videos

Maybe it's possible to categorize and selectively review any moment fro…

Fellowship in HIV Medicine - Interview

A day before independence day, after the long wait of more than three months, the FHM interview took place at SVYM office.

I was on duty and was checking on a newborn with tachypnea (probably transient tachypnea of newborn) when they called me upstairs for the interview. I had others fill in for me and ran to the interview room.

My friend Swathi went in first and sitting outside I could hear them talking about the challenges faced by a clinician and public health worker in managing HIV because of the stigma associated with it and how by consistent effort we can influence at least families of HIV infected people to look at it like any other disease.

I had practised multiple times the answer to why I wanted to join FHM. I look at it as a course in infectious diseases and India is a country still struggling with infections. My personal interests and career choices are probably going to take me to places where being good at managing infectious diseases would be an advantage. Also, SVYM…

Do Cats Get HIV?

Blalock-Thomas-Taussig shunt is a surgical technique used in colouring Blue Babies pink.

Last week we had a baby who was referred for cardiac evaluation come back with a report saying she had Tetralogy of Fallot and needs a BT shunt. The parents had not gotten it done yet. Still, the baby wasn't blue. Because she was too anaemic to have enough deoxygenated haemoglobin to be cyanotic.

I had to watch Something the Lord Made that night. It is the heart-touching story of how B(T)T shunt was developed. If you don't cry with Vivian Thomas at the end, you should probably check your cardiac functioning.

In the backdrop, there are dogs. Blalock and Thomas would perform their surgical experiments on dogs. Countless dogs who have lost lives for (human and animal) science. Thank you dogs!

Talking about dogs, there are cats too. I found this post on reddit.

Cats don't get HIV - it's Human Immunodeficiency Virus, for viral Lords' sake. Or maybe there is a Feline Immunodeficienc…

CPR - To Terminate Or Not To - That is the Question

Unlike with many other resolutions I figured out that today is the first day of the month only after resolving to be productive today. As a part of that I woke up about an hour early and started seeing my babies in ground floor general ward. (Oh, did I forget to mention, I'm in charge of Paediatric patients since more than a couple of weeks now).

But I hadn't even figured out why Atenolol was prescribed to the child with hepatorenal syndrome and not so high BP when I was informed that I had to cover general OPD in Kenchanahalli hospital today. As I had the experience of missing the van going there for being a minute late last time, I didn't take risk and ran away after instructing the nurse to withhold Atenolol.

It was only when I was halfway over the bridge that connects our hospital to the other side of Saragur that I realized that the Atenolol was not for BP, but to control the heart rate - tachycardia and gallop rhythm. I told the consultant paediatrician about how du…

The Sour Grape

I have been told by at least one person (and I think many more might have the same idea) that "I have disregard for postgraduate entrance examinations and am working where I am currently working like it is something heroic because I find entrance examinations difficult to crack, because I'm incapable of getting a good rank, and I am just finding excuses that I can't figure out what postgraduation to do, that I don't want to lock myself in a garage to learn".

To them I would say, maybe you are right.

Maybe I am an idiot.
Maybe I barely passed MBBS.
Maybe I should not have been a doctor on the first hand.
Maybe I do not have the aptitude to crack entrance exams.
Maybe I am not even smart enough to do the "right" things in life.
Maybe I am stupid.

But, guess what?

I don't care.

My choices are entirely mine. My outlook is formed by my thought processes and I can live with the same. Maybe I don't fit your definition of success. Maybe I don't fit …

My Idea of a Perfect Electronic Medical Record System

The COWs are coming to our hospital.


Our hospital might soon switch to an Electronic Medical Record system. And this will bring in Computer on Wheels, COW as they're affectionately called in other hospitals.
While that makes me more happy about where I'm working, it also brings back a lot of ideas I've had during medical school. I have seen hard problems for humans that are pretty easy for computers to solve. I have seen processes that could be hastened by leaps and bounds if computers were involved even partially.

The Perfect Electronic Medical Record System The perfect EMR does not just record what the physician or nurse puts in. It is an intelligent assistant that does some thinking of its own and comes back with suggestions and autofills for the physician or assistant.

For example, when a child comes to you and her mother says she has fever, you start entering "fe..." and the EMR autofills fever. Next you can enter the duration from a dropdown menu. Also asso…

Joining Swami Vivekananda Youth Movement

Till yesterday, I had thought that I had joined Vivekananda Memorial Hospital.  But, yesterday there was an orientation session for new employees at this organization. And the events made me realize that I have indeed joined, or want to join, Swami Vivekananda Youth Movement, the parent organization of VMH.

SVYM's story is very heart-touchingly written in the blog of Dr R Balu (RB).

I am not aware of any other organization which has the story of its inception so beautifully and lucidly laid out. RB's experiences that led him to start SVYM are relatable. And he has made it possible to connect dots from those strokes of inspiration to the concrete structure that exists today.

But Dr M A Balasubramanya nevertheless described the same in a couple of hours yesterday. Some of his words dug deeper than I expected them to go inside my mind. I was expecting him to speak about how they had to undergo a lot of hardships and struggle to reach where we are. He did. But I wasn't expectin…

VMH - first few days

Getting to Saragur from Mattanur is a tricky business. The shortest route isn't necessarily covered by public transport. My initial plan was to reach Mysore via Virajpet-Hunsur and then take a direct bus to Saragur. But later, I dropped it in favour of what my mom suggested - get down at Hunsur and take a bus that cuts through the corner.

So I did get down at Hunsur. Turns out, in Hunsur there are two KSRTC bus stations. One is for urban buses - the one I got down at. The other, inter-village rural bus service, is where I would find buses to Saragur. Luckily it is walkable distance between the two stations. At the rural bus stand, there was a bus to HD Kote. It's 11 more kilometres between HD Kote and Saragur. But there was no direct bus to Saragur. So I got into the HD Kote bus.

And that was the slowest bus ever. It stopped at every house and couldn't accelerate faster than a turtle. At HD Kote bus stand, there was a city bus going to Saragur waiting for me.…

Joining Vivekananda Memorial Hospital, Saragur

I joined Vivekananda Memorial Hospital as a Resident Medical Officer, on 18th April, Tuesday, around noon.

VMH is a secondary care hospital started by Swami Vivekananda Youth Movement at Saragur which is a place almost 1.5 hours by bus from Mysore, but just one hour by private vehicles.

There is a one year course called Fellowship in HIV Medicine offered by this hospital and educational institution that I plan to join later.

I had visited this place a couple of times earlier. First as an attendee in a research workshop back in my second year of MBBS and then, in the first week of April, as a prospective student and employee. At both times, I have felt that this place works in a well organized way.

I am sure this place will help me become a better physician and a better person.

Losing an Ear-Tip

"Which is the most important part of a stethoscope?" asked the Professor.
"The diaphragm", "the tube", "the earplugs", came answers from students.
"No. The most important part of a stethoscope is the one between the two earpieces", said the Professor with a smile. 1
It was a regular "free" day in Orthopaedics. That means you get to eat either breakfast or lunch. I ran to ward at 8:15, after gulping down a cup of milk shook with the chocolate malt powder that my grandmother lovingly packed for me the last time I went home.

None of the patients had absconded the night before. Which meant all of the five 70+ year olds with femur fracture where sleeping comfortably on their bed. Only those patients whose perpetual complaint of pain were awake. Even tramadol would not help them. The nurse had just arrived. And I started putting notes, as usual.

All the patients looked alright. So, there was no need to check their pulse. I checked…

Disillusionment

After graduation, almost everyone I know went away to different so called "coaching centres" for getting into a preferable post graduation seat. I was uncomfortable with the way health education works at colleges and at "coaching centres". So, I went away to Malki hoping to figure out everything.

Daktre was waiting with a vane to fan the fruit flies away. We talked for an entire afternoon and evening (and the next day morning along with my community medicine professor).

Several trains of thought departed at that station. Here are a few.
Who am I? I am a self-described narcissist. The question though is, is my narcissism clouding my judgement about my abilities and possibilities? Is it making me go in directions that I would not want to if I were to think clearly without the pressure of having to be "me"? The "me" here is also questionable. Stereotypes are bad. If I have an idea of "me" it means that I've stereotyped myself into some…

Bye Bye Mysore

An incredible journey has come to its natural end. I started this blog more than 5 years back while waiting in college for my admission procedures. The things that transpired in these 2048 days, I could never have imagined.

The journey doesn't end here though. I am going to continue writing about the funniest things that happened during college, especially during internship. And I'll be writing about all the new things that happen in my life as a doctor.

Now, it's time to move on from the hostel. Bags are packed.