Transitioning from text book approach to patient centered evidence-based medicine.
This was during my clinical electives and internship in India during 2017-2019.It was a patient centered learning opportunity for students who had an interest in medicine. I started my clinical rotations, excited- It was the transition phase where I started applying my theoretical knowledge clinically for patient care. I followed my attending physician, Dr. RB, both in inpatient and outpatient settings. I was really fascinated by the time he spent with each patient, reviewing every minute detail for better patient care, and looking for the consequences which brought them to the hospital. I was fascinated by his idea of evidence-based medicine for patient care.
I have learnt to take detailed history, listen to patients, understand their perspectives, the social factors influencing them and their barriers to medical care. All these experiences made me think in a much broader aspect. Every patient I came across has taught me something valuable. My interest in medicine was taken a step further by these experiences.
To mention, not all my experiences are good.There were a lot of shortcomings which I faced during rotations.
1.Patients need immediate relief without proper investigations and knowing the exact cause.We may end up in giving symptomatic treatment and I feel that should not be done.We need to be empathetic and try to explain everything in simple language which can be understood easily by the patient and the respective family.
2.Not all the labs can be done easily,few labs need to be sent outside and it may take quiet a long time.Most of the patients might be quiet depressed for the long wait times.Still ,we should accept that and spend some valuable time answering all their questions.
3.In some situations, we need to have a long follow up but it may not be possible especially in rural settings.
Although these are few shortcomings which I faced,there also also great experience which I came across.Here are few such instances-1. A young female admitted to ICU (Intensive Care Unit) with abdominal discomfort, abdominal distention, and shortness of breath. Her family was very much concerned about her condition. After taking a detailed history and running necessary investigations, she was diagnosed with Budd-Chairi syndrome. She was started on anticoagulants, and measures were taken to treat her distention and shortness of breath. I answered all their questions with empathy and compassion, counselled them and mentioned the need for surgery. I still remember the day Dr.RB told how important it is to counsel the family so that they can come out of the shock and think about the medical condition.
2. One day, while I was following Dr.RB during rounds at ICU, a patient suddenly had an attack of PSVT. The residents were frantically trying to get adenosine. However, the physician had one look at the monitor, and suggested they try vagal maneuvers instead since the vital signs were stable. And sure enough, the patient recovered in no time. This experience taught me how important is it to follow protocol while we treat a patient instead of directly going for the last resort.
3. A young male presented to the department with recurrent episodes of flaccid paralysis and labs showed hypokalemia. He went to various hospitals where they treated him symptomatically. He asked us ‘I want to know the cause of my condition, and no one could figure it out till now.’ Here, he was correctly diagnosed as having renal tubular dysfunction and treated appropriately. And later he left the facility with happy tears.
4. A middle aged man was admitted for alcoholism. After rounds, his mother came to me and told me all their concerns, the issues running in the family due to her son’s alcoholism. Later in the evening I had a long discussion with my patient and counselled him. He promised that he will return after 2-weeks to get admitted in the rehabilitation facility at our hospital. Two weeks later, to my surprise, he was searching in the hospital for me!!! He told me he had come to get admitted for rehabilitation. In the end, he was treated. His mother and wife blessed me, and I was left in tears. I always remembered the words Dr.RB told me that counselling and digging deeper into the patient’s life could make an enormous difference.
From all my experiences, I could tell that medicine is just understanding in an uncomplicated way. I would say rather than naming the patients as cases or subjects, they are our human fellows, and we need to spend some valuable time to listen to their stories and treat them with empathy and compassion.
I would like to conclude with the beautiful words from my attending -Patients are our teachers, and all are equal to us irrespective of their culture and religion.