Ethical way of taking history from a patient with a classical case

This is to all the doctors and medical students in the world, let's go back to the days of your medical school...

I joined Seth GS Medical College and KEM Hospital in 2013 and in the last 4 years I have had the privilege of interacting with two good conditions on two separate occasions.

One was Dr Michael Glynn, Consulting Physician, Gastroenterologist and Hepatologist, Barts Health NHS trust England. He is also the co-editor of Hutchinson's clinical methods.

And the other one was Dr Ravi Ramakantan, Director of the department of Radiology at Kokilaben Ambani Hospital in Mumbai.

On two separate occasions of a guest lecture students asked them the question ie:
" When we medical students go to take cases to the clinical wards, we see that lots of medical students gather around the same patient who generally has a good classical history and examination findings and they fail to see the discomfort and inconvenience they are causing to the patient. This is especially true before the practical exams. How do we prevent this or decrease the agony to the patient?"

Frankly speaking this is a very difficult situation. But the two vastly contrasting answers and I got from these two clinicians, has been etched in my mind.

Dr Michael firstly agreed that it is indeed a very difficult situation. He suggested that may be a first person can take a video while the other person is taking a history and eliciting examination findings, and the other person can see the video although he pointed out that watching the video will not be as much educational as taking the history first hand.

However Dr Ravi Ramakantan said, you can go and talk to the patient and develop a special bond with him. You should show the patient how much do you care for him. Of course it is an art to engage with the patient. But once you succeed in doing that the patient with himself or herself tell you the agony that he faces and will allow you to examine him/her.

Disclaimer- these are personal first hand accounts. I thought that sharing these answers with everyone we help thousands of medical students who are facing the same problem. It is in the interest of the students as well as the patient that I have written this. I may not have perfectly reproduced the words and the sentences spoken by them and this is just my interpretation of the same.

In a way, both the answers show the empathy that is needed. The first one tells you should not go ahead when the patient is not at ease. The second answer asks you to understand the same pain that the patient is going through and wait is a patient is ready.

We medical students, still have a lot to learn from the stalwarts of our own institutions, in the field of medicine.

Why does brain control opposite halves of the body?

This picture shows three diagrams.

The circles show the retina, the lines are optic tracts and curved lines resemble the cortex

The third diagram in the picture shows what may have been the arrangement- the right cortex receives visual signals from right eye. But the images on the nasal side will be seen on the temporal retinas of both eyes, which will be seen as double. So the arrangement is not feasible.

Now we come to the first diagram, this is what actually is-

The nasal fibres (carrying impulses of temporal field of vision) cross over. 

And since right cortex receives impulses from left side, it sends motor impulses also to the left side

Now here is my question-

Why don't the temporal fibres cross?

If that would happen, the same half of brain will control same side of the body! Human anatomy could have been so much simple 

If you get answer to this question-

Plz post it as comments 

Thanking you

Future of surgery

      It's 12.39 am and I'm trying to sleep. That's when all weird thoughts start coming to our minds. And I couldn't stop my brain from thinking about the surgery of the future. I don't know how did this thought come to my "Cosmo-cortical" pathway, but that was enough to fire some corticospinal neurons to direct my hand to pick up my phone and begin writing. 

       If we can manage to miniaturise the robots and teach them how to...

      Hey wait, it just occurred to me how did I begin thinking of this-

I had this doubt about- why the peritoneal cavity in females is open. I finally got the answer in embryology. That reminded me of what a sir in my college had commented about embryology, "embryology is not real. There's nothing like embryology. All what we are studying is abstract". That lead me to pondering over the fact that our embryology is limited to- explaining why the defects occur and the underlying basis of that anomaly. (How fascinating it is that we don't need to think of the whole sentence to think of that whole sentence that my sir had told. In a jiffy, I am reminded of all the words that my sir had told. I mean, to recall an entire day of your life, you don't need to spend that much time recalling it, it will take the same amount of time as you take to recall one word! That's just by the way). Then I started thinking of-if we would use knowledge of embryology to help people. Then it came to surgery while an embryo is still growing. But how can a human approach it? So I thought of robots. Microbots, the size of bacteria may be handy at that time. 

   After making giant leaps in the sphere of technology, we may one day be able to produce robots that have the capability of normal robots. Storing power, computing, operating, commanding, seeing, hearing, connecting and doing its job. 

     So imagine, a women is on the operation table half a globe away from me and a friend of mine just invents a new way to fight a disease. He codes it and instantaneously sends it which I forward to the master computer over there. It is then shared to the million Microbots all piled up in an injection. They are made to connect to the computer via wifi and download the lastest technique to fight the disease. They all also can talk to each other. When first one goes in the body, he may send a message to all others like- "oh it's dark in here. Oops I just got pushed into the right coronary artery. I ll do my work over there. Take care and good luck". The other Microbot may reply, I m having some difficulty in the 8th zone of the right lung. I need backup immediately". Robots will be carrying packets of drugs that can be injected selectively into each cytoplasm. They may be able to enter the nucleus, obtain copy of the main DNA via PCR and replace the mutated DNA with the new one. 

They all will work as a team. 

   That I think will be the future of surgery. :)

Tracing the roots

I would like to share a message that I received-

"The 8 Monkeys

(This is reportedly based on an actual experiment conducted in the U.K.)

 

Put eight monkeys in a room. In the middle of the room is a ladder, leading to a bunch of bananas hanging from a hook on the ceiling.

Each time a monkey tries to climb the ladder, all the monkeys are sprayed with ice water, which makes them miserable. Soon enough, whenever a monkey attempts to climb the ladder, all of the other monkeys, not wanting to be sprayed, set upon him and beat him up. Soon, none of the eight monkeys ever attempts to climb the ladder.

One of the original monkeys is then removed, and a new monkey is put in the room. Seeing the bananas and the ladder, he wonders why none of the other monkeys are doing the obvious. But undaunted, he immediately begins to climb the ladder.

All the other monkeys fall upon him and beat him silly. He has no idea why.

However, he no longer attempts to climb the ladder.

A second original monkey is removed and replaced. The newcomer again attempts to climb the ladder, but all the other monkeys hammer the crap out of him.

This includes the previous new monkey, who, grateful that he's not on the receiving end this time, participates in the beating because all the other monkeys are doing it. However, he has no idea why he's attacking the new monkey.

One by one, all the original monkeys are replaced. Eight new monkeys are now in the room. None of them have ever been sprayed by ice water. None of them attempt to climb the ladder. All of them will enthusiastically beat up any new monkey who tries, without having any idea why.

And that is how most company policies and religious traditions get established and followed.😃"

The human brain

   We humans are the most evolved children of Mother Earth.  Man has dominated the planet since eons and will continue to. But what has made a man so powerful!?

   Man does not have the strength of an elephant, the speed and agility of a cheetah, neither the ability to fly like birds, the sharp claws of a tiger, the venom of a snake, night vision of an owl, ability to camouflage like chameleon, and the list is endless...

   But what is it that has allowed man to dominate all the five kingdoms of life? It's his ability to think, invent, discover, decipher, ponder, wonder, create, dream and realize the dreams. It's our well developed brain!

  So, Our brain is a master piece. No doubt...

It helped us create- machines with the strength more than hundreds of elephants, cars that ensure quick mobility, aeroplanes that breach the speed of sound barrier, prehensively created tools sharper than anything,  chemicals and bombs poisonous enough to wipe off the last bit of mankind, camera for night vision, computers to manipulate, calculate and formulate. 

   We have used brains to solve many mysteries. But the irony is, we don't know many whys and how's about our own nervous system!! We have many open questions in this field, challenging you to take the plunge and solve them. Like-

   •What are dreams? Why to we get them? Why is it that we see that particular dream that we see?

   • why is nature of people different? What controls emotions?

   •why does right side of the body control the left side and vice versa?

   •why some are more intelligent than others?

   •which part of brain is responsible for a particular action?

   •why nerve cells do not regenerate?

   •what part of the brain is the real "you". Where is the soul in our body?!

   •how is a thought or a new idea generated! I mean, it's something big out of nothing!!! How does it happen!?

   •what part in my brain provoked me to write this blog?

The mysteries about our own nervous system are such that our own nervous system is unable to solve so many mysteries about its functioning. 

So is our brain so complicated that our complicated brain cannot understand itself!?

Or is it possible that will evolution make our brains even more complicated that will help us understand it one day or will it make it even more difficult to understand it!?

 The purpose of this blog was to strike a spark of thought in your brain, and just think about it- how is a thought being generated in me...