Gautam Viswanathan
Yes...ready, Doctor?
Zarshis Avari
since I was born, Editor
Gautam Viswanathan
So, why did you want to become a
doctor?
Zarshis Avari
that's it?
no intros?
Gautam Viswanathan
You will see that in the final
article
Zarshis Avari
Oh okay cool
Gautam Viswanathan
So, once again
Why did you want to become a doctor?
Zarshis Avari
Becoming a doctor was actually never
on my agenda.
I always wanted to do research and be
on the frontline of Science
Gautam Viswanathan
So what changed?
Zarshis Avari
I pursued that ambition by doing
research for my Honours project
However, I soon realised how
monotonous research can be.
Every experiment needs three repeats
whose results have to match perfectly.
It means days, if not months of
performing the same experiment repeatedly
In the middle of my project, I
started talking about becoming a doctor with a close friend of mine
Gautam Viswanathan
But what about the lifetime
commitment of being a doctor?
Zarshis Avari
You are not letting me finish
Gautam Viswanathan
Go on
Zarshis Avari
Once I had a few talks with her, she
told me that being a Doctor is just as hard, and it is just as monotonous in
the beginning as an intern.
However, you always have the chance
to meet and talk to new people. New people brings new opinions and new
information and you tend to grow as a person even while doing the same tasks
again and again
I then decided to pursue a career in
medicine
Also, the monotony does end once you
become a resident. Doctors working in ED face new challenges every other day.
Gautam Viswanathan
Okay
So, essentially, being a doctor is
like being on the front lines.
Zarshis Avari
It is.
It is the doctors that have to make
the final decision that will affect the well being of the patient
And having that kind of
responsibility is humbling yet exciting
Gautam Viswanathan
Surely that is not an easy decision
to make. What were the thoughts going through your mind when you decided to
alter your career?
Zarshis Avari
At the time I knew I was making the
right decision. I did not have long sleepless nights trying to make the
decision. And I don't regret making it either.
The only thoughts entering my mind
were how I would convince my parents, since making that career change required
me to take an year off.
Which is a big crime, in brown
cultures
Gautam Viswanathan
Haha, I know the feeling. How did you
approach them?
Zarshis Avari
I thought about letting my supervisor
do the dirty work by telling them I was not cut out for research
But my ego would not let me do that.
So I had to suck it up and tell them
I had decided to change my career.
They did not give me a lot of grief though,
since they always wanted me to become a doctor.
Gautam Viswanathan
Oh how come?
Zarshis Avari
My dad hated the fact that I had
"wasted" two years by doing Honours, but I knew that knowledge gained
never goes wasted.
And i was right
My Honours degree will help me gain a
part-time spot on a research team once I've finished my degree
Gautam Viswanathan
You've said that there is monotony
when you're taking your first steps en route to becoming a doctor. Take us
through the monotony
Zarshis Avari
As an intern we are supposed to look
after the so called 'menial' tasks of putting in an IV drip, cannulation,
administering drugs, taking histories and filling in endless amounts of
paperwork.
Gautam Viswanathan
Okay.
Go on, please
Zarshis Avari
That is in addition to the studies we
have to do to pass exams.
Also, most interns do overtime to
gain experience and money, and hence you can see how it can very quickly drain
your energy and enthusiasm for work.
Gautam Viswanathan
Yeah I do
So, take us through a day in your
life
Zarshis Avari
It depends on which day of the week
we are talking about. We have lectures on Tuesday and Friday, lab sessions on
Wednesday, problem based group learning sessions on Thursday and a clinical day
on Monday.
Gautam Viswanathan
I think most people here will be
interested in knowing what interns do at the clinic
Zarshis Avari
You mean med students?
Gautam Viswanathan
Yes...my bad
Zarshis Avari
As medical students we are divided
into small groups. Each group attends clinic at a different hospital. Every
hospital has slightly different methods of teaching. At my hospital, we have
tutored sessions where we learn communication skills such as history taking and
giving bad news to patients, as well as examination skills where we learn how
to perform system exams on patients such as hip exam, knee exam etc.
We also have sessions called SCORPIOS
whereby we meet actual patients who come in to our medical education center and
the students practice those skills on the patients.
In addition to that we are also
taught important procedural skills such as gowning, CPR, taking basic obs,
plastering etc.
In between the tutored sessions,
students are free to make ward rounds and talk to, take histories, and perfomr
exams on patients.
Gautam Viswanathan
Okay
You've used quite a bit of technical
jargon in there...what are basic obs?
Zarshis Avari
Basic observations such as
temperature, heart rate, respiratory rate, blood pressure etc.
Gautam Viswanathan
Right...and what is plastering?
Zarshis Avari
Applying casts/plasters or splints on
fractures.
Gautam Viswanathan
I thought as much. On that note, what
is gowning?
Zarshis Avari
Gowning up is a laborious procedure
that we have to follow in order to gain access to operation theaters. It is
done in order to maintain the sterility of the theater
Gautam Viswanathan
Okay
Zarshis Avari
It mainly involves a lot of
scrubbing, followed by more scrubbing
Gautam Viswanathan
On TV shows such as Scrubs and Grey's
Anatomy, we see medical students being regarded as the lowest rung in the food
chain. How true is this?
Zarshis Avari
Very true
It has its advantages and
disadvantages though.
We are not allowed to perform major
procedures on patients, however in case we do make a mistake during a minor
procedure we are protected against lawsuits
Gautam Viswanathan
Okay
Tell us a little bit about the
paperwork you are expected to fill in
Zarshis Avari
As med students we do not fill out
any perperwork
But as interns we would be expected
to fill out forms required for blood transfusions, samples sent to the
laboratories, patient medical and drug charts etc.
Every procedure that a patient goes
through has a corresponding form/s that needs filling out.
Gautam Viswanathan
Okay
Zarshis Avari
Interns also have to do other tasks
such as following up with the patients GP, calling his/her friends and
relatives if need be
Gautam Viswanathan
Okay. So what sort of work are you
expected to do in the clinic?
Zarshis Avari
All we do as med students is take
histories and perform simplae examinations on patients such as a cardio exam,
respiratory exam, musculoskeletal exams.
It is not work per se
It is still considered study
Gautam Viswanathan
Okay
So how do you feel at the end of a
day?
Once you've exited the clinic?
Zarshis Avari
I feel drained
And most often the first thing I do
upon getting back home is plonking down on the bed and taking a nap.
Followed by a nice long
shower/gym/football training.
Gautam Viswanathan
Okay. What else do you do to unwind?
Zarshis Avari
I watch this comedy show called
Taarak Mehta ka Ultah Chashma :)
It's a daily routine and I'm addicted
Gautam Viswanathan
Hahahaha
Zarshis Avari
The girls like to cook/bake to unwind
They call it procrastibaking
I find it a chore
Gautam Viswanathan
Haha
What about your other friends?
Zarshis Avari
Everyone has a different way of
unwinding. Most of my Aussie friends love going to a bar and having a few beers
or a bbq on a nice hot day. I prefer going to a sports bar and cheering my team
on, but the time difference means that the games are telecast around midnight.
Some of my other friends like to go for walks near the harbour bridge if the
weather suits them. Some others do things I cannot mention here.
Gautam Viswanathan
Yes...those are best left in the
supply closet
Zarshis Avari
Haha..absolutely
Gautam Viswanathan
But I'm sure one of the things that
drains you emotionally is giving bad news to people.
Zarshis Avari
Yes it does. I remember this one
session we had at clinic during our Haematology block where the clinic hired
top notch actors to act out how patients would react upon being told bad news.
The emotions they acted out were grief, denial, anger and confusion. That
session ended with a lot of people feeling completely drained and a few left
with tears in their eyes.
Gautam Viswanathan
Wow
Please continue
Zarshis Avari
That's it..as med students we have
not yet been allowed to give bad news to actual patients.
Gautam Viswanathan
Okay...so take us through the process
of recording a patient's history
Zarshis Avari
Taking a patients history is a lot
like detective work. More often than not we have to tease out pieces of
information that we as doctors think are important but may not be so for the
patient. It involves asking the patient about his current illness and the
symtoms and risk factors assoc. with the illness. We also have to enquire about
their surgical history, past medical history, any history of disease that run
in the family along with a detailed description of their social life which
involves questions on their living status, finances, travel, immunisation,
pets, etc.
Gautam Viswanathan
Surely there are some patients who
would consider these a little too personal. How do you coax it out of them?
Zarshis Avari
We tell them they have to tell us
that if they want to live.
It's pretty easy after that
Gautam Viswanathan
You didn't mince words there!
Zarshis Avari
We put it across to the patients in a
different way, but the message is the same
Gautam Viswanathan
How do you normally convey it to
them?
Zarshis Avari
We tell them that some of the
questions may seem irrelevant or personal but we need to know everything in as
much detail as possible to figure out an accurate diagnosis that will affect
their management.
Ofcourse, as you get experienced you
tailor the questions
You wouldn't ask all of these
questions to a 18 year old man with a sniffle,
Gautam Viswanathan
Most definitely
But there are those who would still
try to shoo you away and clam up. How do you deal with them?
Zarshis Avari
There will always be patients who
will not listen to your advice
In the end, it is their decision and
we have to respect it.
Establishing a rapport with the
patient is an essential part of taking a history
If you have a good rapport it is very
unlikely the patient will be uncooperative
In such cases, we can always ask
their spouse, relatives or friends too.
Gautam Viswanathan
What if they refuse to answer you?
Zarshis Avari
If the patient and their relatives
still refuse to answer questions then we can only help them in the most basic
of ways
Gautam Viswanathan
Okay
Zarshis Avari
Almost every procedure requires
consent, and without that there is nothing left to do but ensure that the
patient does not suffer.
Gautam Viswanathan
So the history is essentially a
checklist that ensures you do what is best for the patient
Zarshis Avari
It is much more than a checklist
It will be different for each patient
It helps us figure out the best mode
of approach
Gautam Viswanathan
Right
Zarshis Avari
For example a persistent fever can be
due to a multitude of causes
With an accurate history, we might
uncover that the patient has travelled to a high risk area and treat him for
appropriate infections
An accurate history also helps the
technicians such as the radiologists and the microbiologists
Gautam Viswanathan
How is dealing with a child different
to dealing with an adult?
Zarshis Avari
Very different.
The medicine is different, the ethics
are different, the approach is different and so is the history,
Gautam Viswanathan
How so?
Zarshis Avari
We were jokingly told by one of our
professors that paediatric and veterinary medicine are quite similar in that
the patient can not talk
We have to rely on what the parents
and other relatives tell us
Also the some of the organ systems of
a newborn child are different to an adult's
For example the bones of an adult are
fused at the tips, whereas they are not in very young kids.
This makes it difficult for a doctor
not experienced in paediatric x-rays to figure out whether the child has a
fracture
Gautam Viswanathan
So what is the ethical conundrum
surrounding a child?
Zarshis Avari
With newborn children there is also
the issue of genetic diseases, some of which are very serious and have to be
dealt with straight away to maximise the quality of life of the child.
A child cannot give consent and hence
it is up to the parents.
Gautam Viswanathan
Ah
Zarshis Avari
Sadly, sometimes the parents do not
have the baby's best interests at heart
Also there are ethical issues
surrounding a 10 eyar old girl who visits you asking for contraceptive pills
Gautam Viswanathan
Ouch
Zarshis Avari
Do you tell the parents or not?
Do you still maintain privacy of the
patient?
In most cases, yes
Gautam Viswanathan
Right
Zarshis Avari
Another ethical conundrum that is not
limited to kids but is seen in kids quite often is abuse10:02
Be it sexual, physical or emotional.
It is the prerogative of the doctor
to report any suspected abuse to the authorities
Gautam Viswanathan
Okay
One last question then, Doctor
At the end of the day, when you hang
up your white lab coat and are done for the day, how do you feel, knowing that
in your hands lie the keys to life and death?
Zarshis Avari
I feel like it is the biggest
responsibility I have ever taken up/ will take up. As doctors, we spend time
with some patients who are at their lowest points in life, and if I can ease
their pain even a little bit then I will be a happy man.
It is definitely humbling,
Gautam Viswanathan
Thank you for your time, doctor
Zarshis Avari
Call me Zarshis
Gautam Viswanathan
Fair enough, Zarshis
Zarshis Avari
Zarshis Avari
If I ever become a paediatric doc I
want to be called Doctor Z
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