Wednesday, February 25, 2009


FREE FLOW… No, I am not talking about iodized salt to prevent goiter!! Free-Flow, that’s how I describe residency in US.

I was, like all my peers in medical college, very curious to know how It’s different! I had my own assumptions….may be they see more interesting cases… COPD, CAD, CVA, CRF, CLL…. (voh, yenn idella naav noDde irodaa??). Of course, we have seen it all (bejaan times) during our medical school years back home, and perhaps even more! The amount of clinical exposure we received in medical school was enormous, it was a boot camp! It is a foundation we built on, and I will be ever grateful for that. Yet, if I were to take sides, I would lean towards the US’ system of learning.

I recount one of my earliest cultural shocks during my interview season for residency. It was the morning rounds and one of the interns was ‘presenting a case’ to an Attending (equivalent of a ‘Professor’) and was chewing gum!! Rounds and Chewing gum, they just did not seem to fit into a single frame in my mind. I felt so unsettled, and was seconded by this other Indian co-interviewee with whom I kept exchanging flabbergasted stares. Imagine a scenario of ‘getting caught’ chewing gum in classroom during one of the lectures in medical college… well, you may as well imagine spending the rest of the afternoon outside the lecture-hall preparing your apology speech.

The next shocking episode came during the very first monthly-birthday-celebrations in residency (which included ‘My birthday! My birthday!’), when our Program Director (I might equate him to the Department head- HOD) cut the cake and served it to us. I was stunned….wha…. That’s the camaraderie that exists when you let the reins of your authority go, treat all like colleagues and work as a Team.

Casual- is how things function here, and it is good. Infact it is great, because it allows ‘free-flow’ of discussions, and knowledge. Everything in medicine is so relative, and so dynamic. You tell me what you think, I tell you what I think, and we learn. I cannot recall a single casual conversation with any of my medical college professors, and I never had a great rapport with them. Well, there was never a chance to! I recall our rounds during internship as this one-way conversation by the boss, while the minions just listened. By the way, do you have a point to make? Well good, then keep it to yourself! Don’t even try to ‘act smart’ with your addendum to the big-boss discussions. And if you ever dared to ask a question, awww….bad move….you are either melted under the lava of the volcano that you just unscrewed, or you get this little sermon of, ‘why don’t you tell me? Go and read up!’

Some of the things were FIRSTs for me in US. For the first time, I heard a resident being nonchalant about NOT knowing something about a patient’s history or blood work… an Attending being ok with accepting he learnt something from the minion… history and progress notes dint have to look like Presidential speech (Attending notes can look like this, “I underestimated the patient, he looks awesome!" "Today, the patient really tried to die on us")… and yes the big relief of dropping the ‘Sir’ before referring to a senior doctor. During my first year medical school, my Anatomy professor threw me out of exam hall for being disrespectful, because I didn’t begin the answer with a “Ma’am”. But how do I explain to her that I really had a huge respect for her, until that day.

Going by the case-load (that’s the magnitude of patients we saw back home) and clinical knowledge (=number of readings of Harrison’s / year), there is a huge difference in the way we train in India and US during a PG 's life. I can never compare with quality of the medicine PGs I worked with in B’lore, they were geniuses. So, what is it that makes medical training in US different? Well, it’s not the books, not the patients, not the rare diseases, not even those hi-fi investigations you do…. As I see it, it’s the learning, and the way it happens. You learn as you do, and you learn as you discuss. And the freedom of expression wins the gold medal!

We went out for a team-dinner last month, after finishing one busy month of floors (wards). Needless to say, it was fun! The Attending narrated the story of how (many years ago) he met his future wife on one of the hospital floors as a medical student. We laughed over the times in the past month when we had success stories, near-misses and goof-ups. Just then, I was reminded of a showdown incident from my second year medical school, when a psycho Professor had passed an uncalled-for vulgar comment for walking alongside a boy “roaming around in college shamelessly instead of going home and studying”. Well, ‘Sir’, that was a great display of manners from you right there!!

To “Freedom of expression and Freedom of knowledge” I told myself as we raised a toast and my glass clinked with my Attending’s….. “CHEERS….. to the Team”!!