OPD

Out patient department

I got a tour of the hospital today and had breakfast and lunch with the staff. I noticed a few more cultural quirks that I should cronicle. Firstly, Indians are immune to the awkward silence. They will only speak when there is something to say and there is no fluff, which means that if you are having lunch or just sitting with people you know, you can sit for minutes without anyone saying a word. And people dont feel the need to fidget or twiddle their thumbs either. They just sit and stare. Not that the conversation isnt lively and interesting when it happens but there is less inane bable about subjects such as the weather and everybody's health. I originally thought it was me, but then i noticed other groups of people doing it too. Secondly, there is a strict heirarchy, everyone above you is sir or madam. I made the mistake of referring to a doctor by only his last name without adding sir, and even though i wasnt in his presence a freind of mine corrected me and told me how important it was to stick to this etiquette. Its particularly difficult when you come from a land where I have known all my teachers for the past six years on a first name basis.

So anyway, today I hung out at the outpatient department under the auspices of my preceptor, an incredibly efficient man. Whilst working he seems to have each second so carefuly planned out and rehersed that doctoring is simply a polished performance. With around 20 patients literally standing outside his door at any one time, the ammount of time that he could spend with each one was two minutes at a maximum. All the history taking techniques are completely useless when you are constrained by such pressures. Yet he stil managed to establish rapore, crack a joke everunow and then and give the imression that he cared. Issues of compliance. Sorry. Concordance, were in my mind constantly, but its not feasable to do anything about it. Luckily there allways seems to be an assistant doctor to write everything down for the patient which is no doubt helpfull. But then many patients can't read. Privacy is also a complete non issue, with both the previous patient and the next patient often in the room while the current patient's consultation is in progress. Plus often the whole family will be there. The amount of time we spent considering the legal implications of prescribing the OCP to minors is so thouroughly irrelevent here.

I felt throughout my entire day there that this is where real medicine is practised. All the presenting cases were so varied and each patient had waited so long to see the doctor that we could be sure that whatever their complaint was it was causing a major problem.

Theres so much more I can say and that I learnt, like I didnt know you can get cushings by taking oral corticosteroids for the purpose of bronchodialation. Patients don't realize that an inhaler can do the job better, but they are either too expensive or the patients preffer the tablets because tablets feel more like medicine.

I had dinner today for about 35 cents australian. I now get what they call here a 'tiffin' which is basically a bunch of different vegetable curries, bread and rice. One for lunch and one for dinner, allways different amazing curries for 30 rupees a day. or 1000 rupees a month. Thats about 25 dollars a month which is about 80 cents a day. And I can barely finish the portions. 9 dollar noodle house noodles. pfft, i might as well throw my money down the toilet.