For the new overseas doctor

So, you have recently arrived in Britain. You are
in a state of bewildered excitement, getting used
to a strange new world. All four seasons occur in
the same day. Strangers smile at you warmly
while people avoid your gaze in the London
underground. Everyone despises the party that
seems perpetually in power. You believed that
this country was class-ridden, yet you call your
boss by first name. Trains run on time, but
everyone complains about them. You are 'gob
smacked', and still uncertain of its meaning.
Here are a few tips to help you find your personal
niche as a psychiatrist in this strange and
fascinating country.
Names
Announce your name clearly when you meet
people. The diversity of accents in Britain is most
entertaining in its treatment of foreign names.
The successive distortions of one's name can be
an endless source of amusement or pain. After
the Preet in my name was changed to 'Preep' and
later 'Creep', I decided to drop it completely when
introducing myself. Venkat, a friend working in
London, still winces every time he is called
'Vacant' by the switchboard.
Food
You are likely to eat in the hospital mess for some
months before the assault of the insipid on your
taste buds forces you to start cooking. There is
no need to believe that hospital cooks are experts
in black magic, able to boil away every remnant
of flavour from a wide variety of food items. It
won't be long before you can appreciate the
inherent qualities of a boiled potato. Consider
yourself truly integrated into British society
when you start looking upon Indian food as a
fitting challenge to your machismo, to be boldly
confronted after a few pints. The British have
been led to believe that Indian food is made by
throwing lumps of meat into an oily mixture of
chillies and gunpowder. A quick way of making
friends is to invite people over for some authentic
Indian cooking and dispel the notion that Indians
consider dripping sweat over food, bleary-eyed
and runny-nosed, an uplifting experience in
spiritual or culinary terms. Remember too, that
the British have dinner at noon and 'eat' their
tea.
Meetings
George Mikes wrote that forming queues is a
strange passion that the British indulge in, a
single person often making an orderly queue of
one at bus-stops. In psychiatric practice, holding
meetings has a similar fascination. You may
find yourself spending more time talking about
patients than to them. The result of these meet
ings will often impress upon you the truth behind
the saying that a camel is a horse put together by
a committee. So it is important to understand the
rules of conduct.
(a) Never disagree with anyone
Everyone has a right to be right. This conceals
the greatest advantage of multidisciplinary team
work: no one can ever be blamed (contrary to the
conventional wisdom that to err is human, to
blame it on someone else is even more human).
People will say 'interesting' when they agree with
you and 'very interesting' when they think you
ought to be locked up for your views. Maintain
this noble tradition by vigorously agreeing with
social workers when they denounce ECT as
diabolical, devious, dangerous and politically
incorrect.
(b) Don't show off your theoretical knowledge
You may have been taught the importance of
phenomenology in your training back home. You
may also naively believe that knowing the differ
ence between euphoria, elation and exaltation is
important in describing manic symptomatology.
Perish all such grandiose ideas. "This rather
pleasant young lad has been up and down re
cently and is now rather on the high side" is more
humanely descriptive, especially if you describe
the same individual as a "pathetic wimp" in the
discharge letter to the GP.
(c) Learn the key issues
Every patient in Britain has a key-worker. These
are easily identified as the individuals who are
away on holiday when the patient is being dis
cussed. Sometimes they may have just returned
from a holiday or sick-leave to convince you that
they are not abstract concepts but are living
entities. Their existence justifies everyone else's
ignorance of the case. You may discover at the
end of two hours of considered, and rather seri
ous sounding discussion, that you are still un
aware of the age and gender of the patient.
Queries in this regard will usually be answered
by other team members with a pleasant "I don't
know, I am not the key-worker". You may some
times meet the elusive key-worker, usually in the
corridor. Remember then that key-workers are
profoundly philosophical and carry grave re
sponsibilities. So questions about the age or
gender of the patient may evoke the response "I
am still struggling with that one". Many a keyworker
has brought me close to tears with images
of such poignant struggles.
(d) Use appropriate jargon
Don't talk to your patient - have a 'one-to-one in
a therapeutic setting'. Always insist: 'there are
family dynamics', disregarding the fact that this
is as meaningless as saying that 'the patient has
a blood pressure'. 'Struggle' with answers - don't
simply know facts (see above). When a drunk
throws a chair at you with the idea of cracking
your skull, consider this 'the challenging be
haviour of a vulnerable individual'. Patient's
attempts to fool you are 'maladaptive coping
strategies'. 'Community care' 'purchased' by
'consumers' that allows 'autonomy' and 'empowers'
the 'clients' is desirable, everything else
results in 'institutionalisation'.
When in doubt, blame 'financial constraints'.
(e) Appear busy
When in corridors, rush frantically, even from
the coffee room to the sandwich bar. If you meet
colleagues on the way, project the heavilyweighed-
down-by-the-woes-of-the-world look
iannda sfeuwggwesetektshattimtheeypromvaidyedbe naebwle rteofetraralkls todoyno'ut
turn up. For instance, a query about what time it
is may reasonably be answered in about ten
weeks.
It is remarkably easy to feel comfortable and
relaxed in this country. You must not allow
nostalgia to colour your judgement. Follow the
instructions provided, and you may soon, in the
words of Ogden Nash, find yourself "thrilled and
tinglish" at belonging to an exclusive club:
"A club to which benighted bounders of French
men and Germans and Italians et cetera cannot
even aspire to belong.
Because they don't even speak English, and
Americans are worst of all because they speak it
wrong".

Tips for doctors

Doctors need tips too...suggest some to them if you can!!!

• Demonstrate to your patients that you understand their situations and feelings by showing empathy during patient interviews. Empathetic communication is one of your most valued modalities and goes along way to ensure a trusting relationship between you and your patients. The following steps will strengthen your patient communication skills:
1. Seek to minimize distractions and interruptions when visiting with your patients. For example, try putting your beeper on a silent mode during your visit. Close a door if outside noise is a distraction. (However, ask your patient’s permission first.) Remember, too, that patients can offer you a great deal of insight into their condition just from what they tell you. So limit the number of times you ask questions or otherwise interrupt when your patients are presenting their chief complaints
2. Engage in active listening. Concentrate on what the patient is communicating verbally and nonverbally. Take into account both facts and emotions.
3. Be deliberate about the nonverbal cues you send. Lean forward, maintain eye contact, nod appropriately and don’t cross your arms.
4. Offer concrete feedback. When you summarize what you’ve heard, frame your responses by saying, “Let me see if I have this right…” Seek to identify or clarify the patient’s feelings by saying “Tell me how you’re feeling about this” or “I have the sense that…”
5. Allow the patient to correct or add to your responses until he or she confirms your understanding – “Did I miss anything?” According to several sources, the effective use of empathy promotes diagnostic accuracy, therapeutic adherence and patient satisfaction.
• Enhance your counseling and listening skills by using a simple five-step process. Gather information about the context of the patient’s visit by asking: 1) What is going on in your life? 2) How do you feel about that (or how does it affect you)? 3) What about the situation troubles you most? And 4) How are you handling that? Then show understanding and empathy by observing: 5) “That must be very difficult for you.” This technique is identified by the acronym BATHE (which stands for background, affect, trouble, handling and empathy).
• Remember to ask about any alternative treatments that the patient may be using. More and more patients are turning to complementary and alternative medicine (CAM) providers for help with their symptoms. Knowing this information will help you make an accurate assessment and develop a treatment plan for the patient. Do you need more information about this growing trend? Some schools include information about CAM in their curriculums, but many do not. The National Center for Complementary and Alternative Medicine, part of the National Institute of Health, has a Web site at http://nccam.nih.gov that includes fact sheets, consensus reports, complementary and alternative medicine databases and more.
• Talk with your patients about lifestyle issues. Many students and physicians alike are hesitant to bring up unhealthy behaviors with their patients. Remember these tips to guide you in this process:
1. Expect resistance to change. Solicit feedback from your patients on their thoughts about changing their behavior and use these conversations to gauge how important changing is to them. (Understand and appreciate the fact that many people derive pleasure from unhealthy habits, such as smoking.)
2. Avoid merely listing the negative effects of your patients’ actions; instead highlight the positive effects a new lifestyle could bring.
3. Allow your patients to express their concerns about changing their behaviors.
4. Ask your patients how confident they are that they can change, what will be the most difficult aspect of changing for them, etc. Open communication is key to being the best advocate for your patient. For more guidance on this process, consult the book, Communicating With Your Patients – Skills for Building Rapport, published by the American Medical Association.
• When taking an H&P, practice writing your notes while interviewing the patient. Many students jot down responses, then transfer them a couple of times before writing the actual SOAP or Progress Note. While some practice may be necessary before you are comfortable writing and talking to the patient at the same time, eventually it will save you considerable time.
• Don’t just write an order – be sure to tell either the nurse or clerk what the instructions are. By verbalizing the order, it will be implemented more quickly, which is ultimately better for the patient.
• If possible, look at your patients’ X-rays instead of relying on reports. Although this may seem time-consuming at first, in the long run it will save you time. You’ll gain valuable experience in reading and interpreting X-rays, a skill that you will rely on throughout your career.
• Develop a way to keep track of the patients you see and the procedures you do. Personal Digital Assistants (PDAs) are revolutionizing the medical community, with the number of uses for a PDA in a clinical setting growing every day. Tracking your patients with a PDA can virtually eliminate the need for putting patient information on numerous note cards and scraps of paper that could easily be lost. Take time to explore these programs to see if PDA patient tracking software is right for you.
• Gain a new perspective on your patients by assessing your own biases. You will encounter patients who, for one reason or another, cause you frustration, grief or even anxiety. If this is the case, take time to examine why you feel this way. The reason a particular patient gives you trouble might be found in your own past. For example, if your uncle was noncompliant with his diabetes management, perhaps you now have less tolerance of patients who exhibit similar behaviors. Or if your mother died of a heart attack, maybe you do a lot of second-guessing when dealing with cardiac patients. Acknowledging your biases and feelings toward certain behaviors or conditions will help you reduce those feelings of frustration or anxiety and make you better able to focus on each patient as unique and in need of your medical counsel.
• Pay special attention to how your attending or preceptor approaches patient encounters with difficult patients. Observe the way these physicians react to verbal and nonverbal cues, such as body language. What types of questions do they ask? How do they tailor their questions and behavior in response to the patient? There are specific coping mechanisms that physicians can utilize during “problem-patient” encounters, such as allowing patients to vent, trying not to judge, remaining calm, finding out underlying psychosocial factors and modifying the patient interview. If you don’t understand why your preceptor or attending did or said something, ask. Thought processes are just as important as words and actions.
• Take steps to overcome language barriers with your patients. Encountering patients who speak a different language presents a barrier in effective communication. The ideal means of communication is through an onsite professional interpreter. This person will be your most objective resource. Many hospitals offer professional translating services. In some cases, you must request an interpreter several days in advance. You may also use a telephone translation service, which works well, but may not provide the most
accurate translation due to the translator’s inability to read the patient’s nonverbal cues. If the patient has an English-speaking relative accompanying him or her, you may be able to use this individual. However, the relative may not be the most objective interpreter. There is a risk that the family member might withhold or euphemize information in their translation to your patient, especially if your news is bad or they personally do not agree with your advice.

The Patient's Doctor: Medicine 2.0 Blog Carnival

The Patient's Doctor: Medicine 2.0 Blog Carnival


check this out ... a really useful blog for patient's empowerment.

Slip Of Tongue By Doctors

• The lab test indicated abnormal lover function.
• The baby was delivered, the cord clamped and cut, and handed to the pediatrician, who breathed and cried immediately.
• Exam of genitalia reveals that he is circus sized.
• She stated that she had been constipated for most of her life until 1989 when she got a divorce.
• The patient was in his usual state of good health until his airplane ran out of gas and crashed
• Between you and me, we ought to be able to get this lady pregnant.
• The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.
• Exam of genitalia was completely negative except for the right foot.
  
• Examination reveals a well-developed male lying in bed with his family in no distress.
• She has no rigors or chills but her husband says she was very hot in bed last night.
• She can't get pregnant with her husband, so I will work her up.
• Whilst in Casualty she was examined, X-rated and sent home.
• On the second day the knee was better and on the third day it had completely disappeared.
• The patient has been depressed ever since she began seeing me in 1983.
• I will be happy to go into her GI system, she seems ready and anxious.
• Patient was released to outpatient department without dressing.
• I have suggested that he loosen his pants before standing, and then, when he stands with the help of his wife, they should fall to the floor.
• The patient is tearful and crying constantly. She also appears to be depressed.
• Discharge status: Alive but without permission.
• The patient will need disposition, and therefore we will get Dr. Blank to dispose of him.
• Healthy-appearing, decrepit 69 year old male, mentally alert but forgetful.
• The patient has no past history of suicides.
• The patient expired on the floor uneventfully.
• Patient has left his white blood cells at another hospital.
• Patient was becoming more demented with urinary frequency.
• The patient's past medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.
• She slipped on the ice and apparently her legs went in separate directions in early December.
• Patient has chest pains if she lies on her left side for over a year.
• He had a left-toe amputation one month ago. He also had a left-knee amputation last year.
• By the time he was admitted, his rapid heart had stopped, and he was feeling much better.
• The patient is a 79-year-old widow who no longer lives with her husband.
• The patient refused an autopsy.
• Many years ago the patient had frostbite of the right shoe.
• The bugs that grew out of her urine were cultured in the Casualty and are not available. I WILL FIND THEM!!!
• The patient left the hospital feeling much better except for her original complaints.