Medicine at CMC

This week I have been on Medicine II at the main CMC hospital. My general impression boils down to 2 observations: they have an insane number of people and some disease are found everywhere.

To start, yesterday Medicine II was in the outpatient clinics all day. Due to the crazy number of people that need to be seen and the small amoung of space, there are 2 doctors (often an intern and upper post-graduate) sharing one exam room with one exam table and one computer...but their own patients plus whatever family comes with them. So in one room you can have up to 8 people! Interns see roughly 30 patients a day and residents 40! Don't they get tired, you may ask--well, dont worry! They take regular tea breaks throughout the day, something I think we should start in the US. It would definitely make me happier!

In clinic, it was a little difficult to follow as they have a crazy number of patients to see, and while speaking primarily Tamil, they dont really have time to translate. Cristina and I tried to follow as best we could but it became challenging during many of the cases.

Today was Grand Rounds for Medince II. Imagine this: around the bed of one patient +/- their family, add 2 attendings, 3-4 interns, 5-6 residents, 7ish CMC medical students, 2 what I think are nursing students, and 6 international students...at one time, there was 27 people around the bed of a patient!! Talk about overwhelming. In addition, people here tend to be soft-spoken. So the 3 American and 3 Singapore students would do our best to put together what we heard--we did pretty well for a while!

During the Rounds (of course with a tea break about half way through), I realized one thing: common diseases are common. Seeing strokes, the attendings lectured on the importance of tight blood pressure control. Seeing meningitis, the attendings asked questions about cerebrospinal fluid findings (often asking the local students, fortunately!). Seeing hemiplegia came questions on upper versus lower motor neuron findings to help identify the location of the lesion. He talked about side effects of antibiotics, need for anticoagulation coverage, and many other topics one would find in Texas. In addition there was some malaria and a few snake bites--and it seemed almost everyone was on anti-TB meds, but overall it could have passed for the county hospital, except I can follow some Spanish!

One rather incredible difference was how they handle terminal illnesses with the patients. One woman had what I believe is a abdominal mesothelioma (details are a bit blurry), but I am not quite sure she was or will ever be told. It seems in India, if the family does not feel the patient should know, that is honored and the patient is not told. A student from Detroit said he saw an elderly woman with gastric carcinoma who was receiving treatments without ever being told a diagnosis. I have heard that this happens, and once or twice, there has been the patient's family who doesn't want us to tell the patient, but it is not honored unless the patient states he or she doesnt want to know. Again the cultural difference is present.

Tomorrow, I believe is a normal day with MedcineII--maybe that will mean less people. Other than that, I continue to assimilate into the culture. More international students came--including 2 more girls from Maastricht!--so we continue to learn about medicine all over the world, another advantage to this trip. It is still hot...and the food is still spicy, even if they say it isnt (although I think I am slowly acclimating my tongue to spicy foods...). This weekend we head to Kerala for the houseboat experience! I will add pictures soon I hope...but for now, go to Chris's blog--pictures a plenty!