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”The presence of the doctor is the beginning of a cure”-goes the proverb. It is something I firmly believe in. The art of healing patients begin at the moment the patient sees the doctor, not only when the medicine is prescribed. The practice of medicine is a combination of knowledge, compassion and love for the people we treat and fellow human beings in general. That’s the combination of medicine that will treat the patient as a whole and uphold the WHO definition of health:
” Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity”
Since childhood, the idea of treating people has inspired me. The house next door to where we live was given for rent and most of the time, doctors used to occupy it. They used to see patients at home as well. During the summer school vacation time I used to stay with the doctors during their working hours at home. I had the opportunity to see them interact with patients, provide them comfort and give them medicines. The patients used to return for follow up and thank the doctors for the help and care they had provided. I could see the gratitude expressed clearly in the patient’s eyes and even though I was a child and a mere spectator of the whole process, my mind was able to comprehend how well a doctor can change another person’s life for the good. The interest in the profession took its initial roots from there. When I was 12 years old there was an incident that further strengthened the interest for Medicine within me. One night my best friend’s dad collapsed, the doctor next door administered CPR and he was taken to the nearby hospital immediately. Further we came to know that my friend’s dad had suffered from a myocardial infarction popularly known as ‘heart attack’. I was intrigued by this and wanted to know exactly what it was and the doctor explained it to me in a way comprehensible for a child of my age. The working of the heart fascinated me. The intricate way in which our organs work; how a doctor can change another person’s life with timely action; all these intensified my interest in Medicine during my childhood days itself.
When I was a child, my parents left me with my grandparents. My parents had difficulty to take care of me in their hectic work schedule. Even though my grandparents looked after me in the best way possible, I always missed my parents. I used to feel a lack of love always, maybe from the absence of my parent’s proximity. Somehow I resolved in my sub conscious mind that nobody else should suffer from the absence of care. This decision had a tremendous effect in my life when I entered Medical School. I always used to feel that all the patients whom I used to come into contact with as one of my own relative.. My senior doctors wanted to know as to how I became like this and traced it back to my childhood. Now I believe everything that happens to us has a good effect in our lives sooner or later.
My interest in Internal Medicine started growing in the early years of Medical School. When the clinics started in the second year, I found myself drawn towards the Internal Medicine ward more than any other specialty. There were a variety of cases, and at times a specific disease will manifest with varied presentations. Puzzling diagnostic problems which would fall into place with a specific examination finding. All of us are made unique and hence, though two patients may share the same disease process, two treatment plans can not be the same. The doctors who taught us were veterans in their respective fields and instilled within us great interest and love for the vast subject. At times I would think in awe that Medicine is wonderful, vast and challenging. Every day the senior doctors used to have case discussions of patients in entirety starting from diagnosis and treatment of illness to offering support and counseling. The medical students were also asked to actively participate in such group discussions and ask all our doubts. During my student period I always made sure to see as many Internal Medicine cases as possible, the wide variety of cases always enthralled me and the different physiological systems acting with each other paves the way to list a variety of differential diagnoses as well. Our medical school was always conducting seminars and conferences of which the internal medicine department took a great interest to participate. I had the fortune to participate in state conferences as well. Each day a week, the hospital used to conduct a meeting which included the entire departments and hospital staff discussing the rare and interesting cases they have encountered; this was a good experience and played a role in deepening my passion for the subject of internal medicine. Our professors in internal medicine used to conduct seminars on ”what not to do in Medical Practice” as well, exposing to us the pitfalls they had in their life and how to be cautious against them. Another thing I found interesting about Internal Medicine is that we can take care of all the patient population. There is no restriction to any age group or gender.
In my third year of medical school, we had postings in a community health center. When I was working there, I came across a patient, he was a fisherman, and he had come for refill of medication for his hypertension. The doctor in charge asked me to examine him. Examination of his system showed Mitral Regurgitation. The doctor in charge asked me to write him a referral letter to the local hospital for further evaluation including ECHO and stating that his financial condition is poor. Weeks later I saw him in our medical school, he was referred to our institution for surgery, while I was speaking to him-he took out the old referral letter which I wrote from his pocket and thanked me for helping him out. He even called up my parents to tell them that I helped him. Though I couldn’t be directly involved in the treatment aspect, the way in which the patient expressed his gratitude touched me a lot and made me thinking that how much good we can do for people and improve the quality of their lives.
During my internship period the idea of treating the patient as a whole and not only the disease process itself took a firm grip in my mind. As much as we treat and cure patients, I understood that counseling them and giving advices on the preventive aspects of diseases is of paramount importance as well. In India the disease like Malaria,Dengue,Cholera,Tuberculosis,Chikungunya-just to name a few, are rampant. Such diseases can be easily avoided with proper counseling and for that good communication skills are required. These are skills, I understood, that we gain with experience and no text book advice can help us with it. We can always treat the disease, but I think it is more important to isolate the main cause of the same and eliminate it from the scene. For example- doctors treat childhood asthma, the root cause of the same might be due to passive smoking from a close family member; if we just spend a few minutes in delving more deep into the patient history we will be able to isolate the main cause and prevent the child’s future attacks of asthma and with good communication skills to stop the family member from smoking and protect his/her health as well. The importance of rehabilitating a patient is another important thing which I found during internship period. In some cases, the patient is treated and some unavoidable residual problem may persist. The patient may not be able to go back to work, if so, what to do next? In this aspect I found the meaning of rehabilitation-something I read many times in the textbook and regurgitated into the exam answer papers in a new and different light. It is again important to make the patient aware of support groups and help them find a livelihood which is suited for their present health condition. As an intern I saw that internal medicine doctors as primary care physicians doing this more than any other specialty the – treating the patient as a whole and concentrating on the preventive aspect as well. This augmented the my love for internal medicine and made me aware of the fact that an internal medicine doctor is a unique combination of extensive knowledge, sharp diagnostic and treatment abilities; with humanistic qualities of empathy, compassion and integrity.
I have always felt a particular liking and empathy for AIDS patients because they are always socially discriminated and the stigma surrounding AIDS even in this 21st century also is to such an extent that a diagnosis of AIDS means social death. During my internship period I saw many HIV positive patients. As tuberculosis and HIV go hand in hand, I saw many patients being treated for extended period of time and our consultants helped them through their ups and downs. Once again I was enlightened to the fact that humanistic qualities are important in a doctor treating patients with such a chronic disease surrounded by social stigma. As a part of our posting in internal medicine department three of us were sent to work in an AIDS hospice. The learning experience there was beyond any textbook knowledge that we garnered over the years and the summation of the time I spent there has helped become a better doctor and a better person I am today. There was a total change in the outlook I had for this chronic illness. The interest in this disease which presents in various ways with a large number of associated opportunistic infections , gave me the idea of making an ‘AIDS Man’-a full blown poster of a man with AIDS with all the possible opportunistic infections. This was effectively used in several health education campaigns we conducted from our Medical School.
I have always believed that doctors should not be anyone’s judge-don’t think as to how this person got this disease. A patient should always be treated with the same care and compassion, no matter what the disease is or how he/she contracted it.
The medical school I studied in is a charitable institution as well, catering to the needs of underprivileged sections of the society, so I was always close to the cradle of the basic human needs and emotions. I was a part of numerous camps that our Internal Medicine department had conducted which encompassed giving free medications and further follow up in our hospital; by doing this we were able to reach our medical care to all the sections of society, notably the tribal population in our state. The health condition is the tribal areas were far worse than I had imagined-poor sanitation facilities, malnourished children, symptomatic but un-discovered cardiac problems in children and adults alike, various forms of oral cancers, pregnant women not seeking medical care, high maternal and infant mortality rate, neonatal tetanus and so on. With our constant individual counseling, health education sessions and poster campaigns we were able to instill the importance of medical care in their minds. A primary health center was established in the tribal area in which I had the opportunity to participate and slowly, but steadily we were able to gain the trust of the local people there and provide health care for the community thereby improving the quality of their lives. It was during the internship period that I found there is a teacher inside me. I had the opportunity to go to different schools and communities to give health education classes on substance abuse, STDs and so on. I found the art of providing health education and interacting with various people from all walks of the society a fulfilling experience.
To speak to patients and families when they are helpless the most, is a challenge that the medicine has provided. We all know that people become vulnerable when they are sick. To help people take decision regarding the different treatment modalities: which is best for which patient, to have help people take end of life decision, comfort the immediate relatives and ease the passing of terminally ill patients, to hold their hands and comfort them, to wipe a tear from their eyes and an occasional hug for an old patient who has been abandoned by her children and tell her that we are all here to take care of you, has all given me a certain amount of satisfaction. My interpersonal and communication skills were polished and developed during this period of time. I was able to establish a good relationship with many patients who were under our care during internship. They all touched my life as much as I was able to touch theirs.
Internal Medicine is a dynamic branch as the internal medicine doctor not only treats the disease, but the patient as a whole. I want to achieve better training as a doctor; make meaningful contributions to the society and I believe that research opportunities are one of the best to achieve that goal. The internal medicine residency program will foster my interest in academics, offer the best clinical training and provide research opportunities. I would like to nurture the ‘teacher’ within me through patient education and involvement in student training. My personal reason for liking internal medicine is that it uniquely combines hard work, service, compassion, empathy and strong communication skills. In addition to the traditional education, a physician studying abroad will obtain a general global perspective on various health issues and hence encourage broad mindedness. I expect a challenging environment in which to practice and learn the enormous volume and life experiences that encompass internal medicine. I am sure that Internal Medicine residency will be a fulfilling experience helping me to develop a strong foundation for the future years in this field.
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