If you want to do something, don't be a fool and say it aloud. Ten people will jump and try to oppose you. Twenty people will rope in and challenge if you really want to do good to other people. And you will be lucky if anyone at all will believe that you have no self interest in it. I learnt my first lesson in management here. That people do not choose to concern themselves with clinical diagnosis and dispensing the best cure to the most needed. A triage method is required. I am firmly convinced that 100 percent treatment to even 40 percent people is far superior than 20 percent treatment to all the patients. Benefits outweigh the guilt. But it needs grit, and a tremendous amount of knowledge, and an even bigger amount of guts. To say no.
As a tertiary center, if we treat pateints with geriatric debility and UTI, for every unstable angina that turns out to be an ischiorectal abscess, for a LBBB 2 years old, for a patient with CVA 7 days back who comes walking to the emergency, for a liver abscess whose size is decreasing, I fail to understand where kindness is involved, especially when the people who admit these patients do not come to see the patient even once. If we had 5 first years to deal with this, it would be okay, if we had 60 beds instead of 30, it would be welcome, trouble is we have 30 beds with 20 patients anytime, and post emergency if 20 odd patients are discharged without a single work up ( wait, the reports are sent the morning itself, no workup has been done from the emergency despite the card saying so...), there is something to think about...Especially...
When we cannot save a patient with Nephrotic syndrome who is having seizures, a patient of septicaemia who could not be saved...A CKD patient who could not be dialysed on time, whose Dialysis Disequilibrium could not be diagnosed, or if diagnosed, could not be treated.
I am not against hard work. I have my left ankle swollen twice its normal size and no one but my SR knows about this. I have promised myself not to touch books but to spend every time possible to finish the work up of my patients. From posture change, to Ryle's tube feeding to Physiotherapy to Fundus, they get it all. And my Co-PG works hard as well. But I dont want to run for a open Koch's patient with hemoptysis while my Nephrotic Syndrome dies. I cannot adjust to this fact that her death can be dispensible. That a CVT patient should die. I do not want to waste my time on these people who have a different ward to be admitted, different set of doctors looking after them, and different level of isolation that cannot be practised in my ward.
I am not sure if people share the same views. I am not sure if I have the back up. Here people are so engrossed in the status quo for several reasons that it is difficult to convince them that even as an outsider you think about their good only. And they would take it as an excuse for inaction. Forget the fact that I exist in a vacuum personal life, do not socialize, do not take leaves, and do not loaf around.
This and a number of other incidents have only confirmed my belief that instead of pointing fingers at others, the best thing that you can do is to get to a position where people will listen to you, and then do what you believe in. Its a waste, to write about it.
Acquiring the feathers has already begun. The wings will take shape in some time. At least my Juniors will not have patients coughing Mycobacterium tuberculosis into their mouths, or worry about the diagnosis. This is a promise.
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