The first day at the hospital was quite a culture shock. After navigating the streets--which I should mention, although filled with haphazardly moving objects are surprisingly well-paved--this time in the CMC student shuttle, we made it to the CMC hospital. It's a compound with tons of buildings and people... patients laying all over the ground in front of the "casualty" area (aka emergency room) and rushing between buildings around security guards blowing their whistles and trying, unsuccessfully, to do crowd and traffic control.
Thousands of patients and their families were mulling around in and out of the buildings. Of note, this is the equivalent of a tertiary referral hospital and gets patients sent to it from all over India and some neighboring countries. CMC is a 2700-bed hospital receiving 1.9 million outpatients and 120,000 inpatients annually, to give you a reference, Tufts in downtown Boston is a 400 bed hospital, so CMC has about 7 times the capacity.
My first clinical rotation is on the internal medicine and infectious disease service. As you may or may not know, I'm somewhat of a germaphobe so this is kind of diving in head first to some serious infectious disease, for you budding psychologists out there-- this is extreme exposure therapy. The first day wasn't as bad as future days in this regard though since it was in outpatient clinic.
And man, I have never seen an outpatient clinic quite like this one! It was like an assembly line! They have so many patients that the resident I sat with sees 50-70 patients PER DAY, again for perspective to non-medicine people - a typical clinic day for a resident in the US is 8 in the morning and 8 in the afternoon if they're pushing it AND they're a senior resident or attending. It was insane. I was sitting in a room observing a senior resident go through patient after patient, calling them into the room via a microphone like a bank teller.
They had 2 doctors per room each seeing 2 separate patients simultaneously (no divider between them), and, of course, every patient brings at least 1 family member for support, if not more. That meant a minimum of 7 people in the room at all times, so it was nice and cramped. In addition to that, patients from earlier would barge back in to show a slip of paper or ask another question while the next patient was being seen. Patients waiting would also peak in the doorway uninvited, I assume just to make sure the doctors were doing their work.
There was also the constant background noise of the hundreds of waiting people chatting, as there are no roofs to the patient rooms. There's also no doors on one side, and there were windows between the patient rooms -- which was good for me since me and my friend Tim were in neighboring rooms and pretty bored by hour number 8 of patients we couldn't understand.... but definitely bad for patient confidentiality, I have a feeling HIPPA doesn't exist here.
The patient encounters themselves were very regulated and rushed too. I got out of it what I could, mostly through body language though, as I don't speak Tamil or Hindi or any of the other languages the patients were speaking. There was no handshake (although I don't think there ever is in southern India) then are you the correct person? Yes? Here's a list of yes/no questions regarding your complaint. Okay, now we have a diagnosis, here is the treatment plan, take this receipt with you. There's no discussion of the disease, the treatment options, or anything--it's very paternalistic and all business. There were hardly any physical exams either except for an occasional pound on the back. Blood pressure was always taken though, with this ancient machine shared between the 2 doctors.
The diseases that came in weren't too exciting in the outpatient clinic (from what I was able to understand) -- more diabetes and hypertension than I expected, and of course everyone has tuberculosis.. but I'll get more into that later. The differences were interesting though, like how they use a different blood pressure medication than we do because of poor follow up or how the female doctor had to come in to do the breast exam for a male doctor's patient.
By the way, this is me at lunch in a tunic eating my veggie fried rice with creamy curry sauce with my (right) hand in a hospital. I gotta find me some spoons for next time though because this was less than sanitary.
Thousands of patients and their families were mulling around in and out of the buildings. Of note, this is the equivalent of a tertiary referral hospital and gets patients sent to it from all over India and some neighboring countries. CMC is a 2700-bed hospital receiving 1.9 million outpatients and 120,000 inpatients annually, to give you a reference, Tufts in downtown Boston is a 400 bed hospital, so CMC has about 7 times the capacity.
My first clinical rotation is on the internal medicine and infectious disease service. As you may or may not know, I'm somewhat of a germaphobe so this is kind of diving in head first to some serious infectious disease, for you budding psychologists out there-- this is extreme exposure therapy. The first day wasn't as bad as future days in this regard though since it was in outpatient clinic.
And man, I have never seen an outpatient clinic quite like this one! It was like an assembly line! They have so many patients that the resident I sat with sees 50-70 patients PER DAY, again for perspective to non-medicine people - a typical clinic day for a resident in the US is 8 in the morning and 8 in the afternoon if they're pushing it AND they're a senior resident or attending. It was insane. I was sitting in a room observing a senior resident go through patient after patient, calling them into the room via a microphone like a bank teller.
They had 2 doctors per room each seeing 2 separate patients simultaneously (no divider between them), and, of course, every patient brings at least 1 family member for support, if not more. That meant a minimum of 7 people in the room at all times, so it was nice and cramped. In addition to that, patients from earlier would barge back in to show a slip of paper or ask another question while the next patient was being seen. Patients waiting would also peak in the doorway uninvited, I assume just to make sure the doctors were doing their work.
There was also the constant background noise of the hundreds of waiting people chatting, as there are no roofs to the patient rooms. There's also no doors on one side, and there were windows between the patient rooms -- which was good for me since me and my friend Tim were in neighboring rooms and pretty bored by hour number 8 of patients we couldn't understand.... but definitely bad for patient confidentiality, I have a feeling HIPPA doesn't exist here.
The patient encounters themselves were very regulated and rushed too. I got out of it what I could, mostly through body language though, as I don't speak Tamil or Hindi or any of the other languages the patients were speaking. There was no handshake (although I don't think there ever is in southern India) then are you the correct person? Yes? Here's a list of yes/no questions regarding your complaint. Okay, now we have a diagnosis, here is the treatment plan, take this receipt with you. There's no discussion of the disease, the treatment options, or anything--it's very paternalistic and all business. There were hardly any physical exams either except for an occasional pound on the back. Blood pressure was always taken though, with this ancient machine shared between the 2 doctors.
By the way, this is me at lunch in a tunic eating my veggie fried rice with creamy curry sauce with my (right) hand in a hospital. I gotta find me some spoons for next time though because this was less than sanitary.
Unlike hospitals in the states where doctors and medical students wear white coats, dress clothes or scrubs, and closed toed shoes, the dress code here is saris or tunics for women and open toed sandals for all. The nurses wear all white saris too. I feel like the scarf of a sari is even more likely to spread disease between patients than a neck tie does in the states, but I could be wrong. It's also harder to tell who is an employee and who is a patient!
Later that night, I squeezed into a rickshaw -- which is kind of a 3 wheeled electric bike taxi of death with a shell exterior, with 2 other students I hadn't yet met to go out to dinner with about 30 people for someone from the previous rotation's last night in town. We squeezed 6 long tables together on a rooftop, and put in orders--some of which weren't filled for over 2 hours. They had alcohol though, which is a pretty rare find in India.
I'm excited (but way too tired) to tell you about infectious disease on the inpatient side, so there's your cliff hanger for my next post!
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