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Gospel Music & the Gurukul system of Medical Education May 16, 2006

Posted by scan man in medical blogs, Medicine.

Bloglines alerted me to a new post by Dr. Hebert a few days ago. I read a few lines and thinking that it was about Jazz and Gospel Music, something that I don't know anything about, I quit.

I came across the post again in Grand Rounds (hosted by Dr. iBear at Doc Around the Clock) today…

Dr. Hebert of Michael Hebert's Medical Gumbo talks about apprenticeships in medical education and eloquently contrasts that with the gospel group the Zion Harmonizers in Med Ed and the Zion Harmonizers. Where is the future of medicine headed unless we take a little tip from the Zion Harmonizers?

Curiosity aroused, I went back and read through the entire post.

To echo Dr. Flea, I'm Speechless.

This is the best thing that I have read about medical education in the sixteen years that I have been a medical student and a doctor.

Dr. Hebert has quoted the Hippocratic oath to make a point about apprenticeship as a way to learn medicine..

It was not always thus. The history of medicine is rich with preceptor-apprentice relationships. At one time, this was the expected method of medical education. The Oath of Hippocrates, written 2,400 years ago, gives more than a passing nod to apprenticeship:

I swear . . . . To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; To look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.

If we look further east (and a few centuries earlier), we find an obvious parallel in the haloed Gurukul system of education in ancient India with its Guru-Shishya tradition.

Knowledge passed on thus to generations of students in the ancient Greek and Hindu civilizations are at the core of most modern science and philosophy. The reason why we still remember them and their methods.

Medical educaiton, which was essentially an apprenticeship until the nineteenth century, has become, over the past century, more 'scientific' and 'professional'.

I wonder if anyone will remember this 'information assembly line' system of 'education by committee' two thousand years hence when, presumably, the chief medical officer would be assisted by computers, robots, medical droids and holograms.


Why aren’t the medical students in Tamil Nadu protesting? May 14, 2006

Posted by scan man in caste, Life in India, Medicine, News, Politics, reservations.

I am distressed.

There has been an ominous silence in Tamil Nadu's usually spirited medical student community.

Their brethren are being beaten up and water-cannoned by policemen in Mumbai, on hunger strike in Delhi and on protest marches in Mangalore and other cities.

The Mumbai and Delhi chapters of the Indian Medical Association have called for strikes on Monday.

Why isn't there any noise in Tamil Nadu? (more…)

Close Encounters Of The Alternative Medicine Kind – II May 14, 2006

Posted by scan man in Life in India, Medicine.

For those who read Part-I of my Close Encounters, this story is different. This is more in line with the usual kind of stuff that 'real doctors' write about Alternative Medicine.

It ought to be titled "Quactitioner Alert". I refrained from doing so out of deference to Dr. Crippen who coined the phrase.

This story starts with the ringing of my office intercom on a busy morning… (more…)

Close Encounters Of The Alternative Medicine Kind – I May 11, 2006

Posted by scan man in Life in India, Medicine.

This is the first of two stories based on two incidents that occurred last week.

I am not a fan of any of the systems of Alternative Medicine. My limited experience of the world of medical blogging tells me that I am not alone. For those of you who are familiar with what 'real doctors' write about Alternative Medicine and its practitioners / quactitioners, this is a different kind of story…

..that started with a referral for a Brain CT scan by a Siddha Medical Practitioner from a nearby small town.

The patient was sent to me with a letter which said:

To The Radiologist, Big Town Hospital.

Dear Doctor,

Please do a CT scan of the Brain for Mr. P, a 60-year-old man who is semiconscious and has left-sided hemiplegia. Please admit him in your hospital and do the needful.

signed Dr. Sidha Practioner, B.S.M.S., Small Town.

I was intrigued.

It is not unusual to come across referrals for 'western / allopathic' tests from practitioners of the many alternative medical systems that the Indian Government recognizes (Ayurveda, Siddha, Yoga, Unani, Homeopathy & Naturopathy).

As a Radiologist, I have come across several referrals by these practitioners for various imaging studies. The majority of such referrals have been for questionable indications and for inappropriate imaging studies. In most of those instances, an allopathic practitioner could have come to a reasonable diagnosis based on history, clinical exam and some lab tests.

This referral sounded almost like what I would get from one of my allopathic colleagues. My curiosity was aroused to the extent that I did something that I rarely do for a CT Brain referral. I got out of my comfortable chair and went over to see the patient.

The patient, lying on a stretcher, had a large bandage swathed around his head covering the right side of his face and jaw. He was not arousable. His ABCs were ok. His blood pressure was normal. I could not get any relevant history from the worried-looking rustic old lady who was with him. I assumed it was his wife. After a cursory examination – the only kind that I know – I concluded that he did have a left-sided hemiplegia. I told my nurse and techs to get him into the CT room and went back to my office.

I was worried about the bandage. Was there a history of injury?

I needed more information. So I pulled out the referral letter, checked the number and called Dr. Sidhha Practitioner. I introduced myself, thanked him for the referral and asked him for clinical details. This was his story…

Mr. P had come to see him about a few days ago with a painful swelling on the right side of his jaw. Dr. SP thought it could be a Parotid abscess. Knowing that he would not be able to do anything for it through Siddha, he referred Mr. P to the local Government Hospital. The surgeon there had done an I & D, prescribed some antibiotics and sent him home. His wife and some neighbours brought Mr.P back to Dr. SP today, saying that he had not been arousable in the morning. After examining him, Dr. SP concluded that Mr. P had a stroke, so he referred him to our hospital which he knew had a CT scan and a Neurology Department.

By this time the techs had completed the scan. It showed an acute infarct in the Right Middle Cerebral artery territory. The scan also showed signs of facial cellulitis on the right side and small air pockets in the right Parotid, consistent with a recently drained abscess.

I alerted the Neurologist and sent the patient to the Emergency Department. I saw him again two days later when he was sent for a repeat CT. The infarct had not progressed and his facial cellulitis was subsiding.

In the course of a few days, Dr. SP had correctly identified two different medical conditions in Mr. P, had recognized the need for proper care and had sent him to the appropriate places.

This is one Practitioner that I will not forget. May his tribe increase!

State of Indian Mothers and Children May 10, 2006

Posted by scan man in Life in India, Medicine, News.

I saw Dr. Tara Smith's post at Aetiology today and read the CNN article that she linked to. As there was no mention of India in the best and worst 10 ranks, I was curious to know how we fared in the rankings.

I went over to the Save the Children homepage and downloaded the State of the World's Mothers 2006 report.

India was ranked 93 in the Mother's Index (MI) out of 125 countries; 105 in the Women's Index (WI) out of 131 countries and 128 in the Children's Index (CI) out of 167 countries.

I sort of expected this so I was not too shocked.

Here is the nitty gritty – the parameters that were studied to rank the countries. The numbers following the parameters are the Indian figures. For comparison I have included the corresponding figures for the topper Sweden (Ranks: MI – 1, WI – 1 & CI 20), the People's Republic of China (MI – 39, WI – 34, CI – 91) as it has a bigger population than us and the Islamic Republic of Pakistan (MI – 107, WI – 109, CI – 141) since we Indians are obsessive about comparing ourselves to the Pakis. For the record Denmark was ranked first in the Children's Index.

  • Lifetime risk of Maternal Mortality – 1 in 48 (Sw 1 in 29,800; Ch 1 in 830; Pak 1 in 31)
  • Women using modern contraception – 43% (Sw 72%; Ch 83%; Pak 20%)
  • Births attended by skilled personnel – 43% (Sw 100%; Ch 96%; Pak 23%)
  • Pregnant Women with anemia – 50% (Sw 0%; Ch 52%; Pak 37%)
  • Adult Female literacy rate – 47.8% (Sw 99.9%; Ch 86.5%; Pak 35.2%)
  • Participation of women in national government (seats held by women) – 9.3% (Sw 45.3%; Ch 20.3%; Pak 20.6%)
    • I really can't believe that they have that many women in high positions in the Pakistani army
  • Infant Mortality Rate – 62/1000 live births (Sw 3/1000; Ch 26/1000; Pak 80/1000)
  • Gross primary enrollment ratio (expressed as %) – 108 (Sw 111; Ch 115; Pak 68)
    • The figure for Pakistan may be more if madrassahs are included.
  • Population with access to safe water – 86% (Sw 100%; Ch 77%; Pak 90%)
  • Children under 5 years suffering from moderate or severe malnutrition – 16% (Sw 0%; Ch 0%; Pak 13%)

Truly appalling to know that after nearly 60 years of independent democratic rule we have fared only slightly better than a country which spent half that period under military dictators and worse than a country which has been ruled by autocratic communists for nearly the same period.