Don’t Shoo Away Medical Students by Jazar Shahul.

“What is your problem? What do you want? One after the other they come popping in. Nuisance!”

This was what one of my batch mates, S (let’s call her S), had to hear from the bystander of a lady patient when she went to take a case in one of the hospital wards. S had her clinical postings in the Obstetrics and Gynaecology ward, popularly known as the OBG in India. I guess they call it the Ob & Gyn in the US and Europe. Anyway, whatever they call it isn’t the question.

A clinical posting starts when a medical student begins his second year of undergraduate medical education, which is the MBBS degree. (This is how it is in India. But it is not the same in America, Europe, and anywhere else following the American or British systems.)

The student has to go from one department to the next, imbibing all that one can, according to the semester he or she is in, which means, things get tougher to comprehend and understand as you work your way up the ladder. It starts with the basic clinical departments, namely: General Surgery, Internal Medicine, and Obstetrics and Gynaecology. Though I call it basic, these three are the most important and relevant departments in the life of an undergraduate medical student. You may ask me, what about the other departments like Dermatology, Pulmonology, Psychiatry, Paediatrics, Otorhinolaryngology, Orthopaedics, Ophthalmology, and so on and so forth? They are important, yes, but they cater to the needs of a lesser population that come with related diseases and disorders, compared to the number of them that come under the primary departments. The basic objective is to slowly master your knowledge and skills in these three areas. Rest of the departments are part and parcel of these three areas.

Now what happens in a clinical posting?

Students come to the ward/outpatient rooms, and they are taught, live, how to communicate with patients, establish an appreciable rapport with them, diagnose their problems (both physical and mental; it is said never lie to your doctor, which usually makes things easy,) treat it properly, and give them useful information on how to cope with said problems. Both outpatient as well as inpatient diagnoses are equally important, but a little stress needs to be given to the inpatients as they were admitted for a reason, which was not the case with the outpatients. Students learn a lot from these experiences, and this forms the base and the foundation of their future medical career. They learn from their professors, senior residents, junior residents, nurses, from each other and most importantly, from the master teacher: the patient themselves. In medical education, the dead and the living, both teach the medical fraternity an ocean of things that can never be acquired from any book. This is why they say, ‘See, observe, touch, feel, and talk.’

Now for seeing, observing, touching, feeling, and talking to, patients should co-operate and be a part of the process. Yes, it is not as easy as it sounds. Yes, it is embarrassing when you are being seen and observed with many sets of eyes wide open. Yes, it is even more embarrassing when you are being touched and pressed, and sometimes even in your most private parts, in front of many people, however, try to see it from the doctor’s and nurse’s point of view. Yes, it is much more embarrassing when you are asked to strip nude in front of all these people without impunity.

But, do you think that the doctors and medical students enjoy any of this?

The answer is a big ‘NO.’No, they don’t. Who would like to come right in the morning to check upon patients?

1) They might not have bathed for a week.

2) They might be so full of bacteria, viruses, fungi, and all other brother microorganisms on their bodies, clothes, daily use objects, and fomites that even a toilet would sound safer.

3) They might have blood or its stains all over them; or yellow gluey mucus sticking onto some part of them, or vomitus clinging onto their bodies or clothes or on the hospital bed sheet, or urine, or stools, that the doctors will only come to know after they have had to handle anything that has been stained.

4) They might be burning with fever, and in a situation where they are capable of maximum transmission of diseases, and the doctors and associated staff carry this enormous risk of getting infected via any of the routes listed above.

Now, tell me, would you? What if you are eating a meal, a hard earned meal, say fried chicken and parathas with your family, and all that comes to your mind is your patient throwing up in the ward that morning? Doesn’t sound good, does it?

Which is why I want to say, and reiterate, that doctors, medical students, and nurses, DO NOT enjoy this. Doctors do it because it’s their job, and it’s one of the most sacred jobs in the world. They do it because they care about their patients and want them to be diagnosed, whatever they can do to find out the cause, so that they can start the treatment and get their patients out of the hospital and back home as soon as possible. ASAP. Yeah, that’s the acronym.

All those doctors you see and consult when you are in a topsy-turvy condition did not fall out spontaneously from the sky after the big bang. They, every single one of them, all those great world renowned specialists that you see and hear of, had to go through intensive and rigorous medical training in the beginning of their careers. All of them have experienced sleepless nights, when they were given back-to-back shifts of work. All of them have experienced pangs of hunger, when they did not get even a minute off from work because they had to do their rounds, write case sheets, or take their patients to some or the other area of the hospital, like the scanning centres. All of them wanted to take a nap, lie-down, because they felt really sick and physically tired due to this never-ending work.

But they don’t complain, do they? They still do their jobs irrespective of the respect and honour you give them, and irrespective of the physical abuse they are subjected to. Now, that’s for another blog, which I’ll write soon.

So, when medical students like my dear colleague S, comes to you to take your case, please do not offend them. Please do not scream at them in fury. Please do not say anything that might hurt them. Please do not manhandle them in any way. They are coming to you so that both of you, and the coming generations, benefit from this little but great venture. Because, one day when you or your loved ones end up in an accident, you will come to these doctors and demand for them to be saved. And on that day, if these doctors need to give you and your loved ones’ lives back, safe, secure and sound, you need to co-operate with them now.