Today Leigh abnd I worked with two cardiologists. We spent the morning (10:00am-2:30pm) with Dr. Joshi, a cardiologist at Government Doon Hospital. To get there we took a Vikram which is like an auto rikshaw (tuk tuk) except it seats "8 people"--or sometimes 12. It is a cheap way to get around, costing 4 Rupees one way for a 30 minute ride (40 Rupees= $1).
Dr. Joshi is a very nice man in his mid forties. During the three hour period we saw patients in the OPD (Outpatient Department) he probably saw more than a 100 patients. By his estimations, he sees around 250 patients per day. Talk about a man with multi-tasking skills. All of my knowledge from Dr.Morelli, Kate and John was really put to the test. One of our first patients was a 22 year old female with cardiomyopathy and aortic stenosis that radiated to her carotid artery. It was an incredible case for me to see and hear, as well as for Leigh who is entering her senior year of undergraduate and is an EMT, on our first day. This was one of the many patient who we saw who had cardiomyopathy. Dr. Joshi joked that if we wanted to be heart transplant surgeons, we would never be in need of work in India due to this prevalence of cardiomyopathy. We didn't get much other explanation about why there is such a high incidence in India but I'm sure we will by the end of the week.
It was incredible how much respect the patients had for Dr. Joshi. As we walked the hallways, people would clasp their hands together and bow their heads as he walked by. In addition, on the whole, patients were extremely patient and waited their turn one by one to see the equivalent of the M.A. and then the doctor. This usually looked like about 15 patients all in a room smaller than the room at Aegis waiting and then Dr. Joshi at his desk and Leigh and I sitting next to him. And we thought Aegis was crowded and chaotic! Luckily, patients carry all of their own medical records/charts in plastic bags with them which really cuts down on that whole filling process we seem to get bogged down with in the states. Did I mention HIPAA? It is definitely not in existence here as most of the patients are privy to other patient's encounters with the doctor.
One of the biggest challenges Leigh and I faced were the language barriers: Not only that the patients primarily speak Hindi, but also that Dr. Joshi has a thick accent and the inflection and stress of vowels and consonants is completely different so a lot of the time we would say what we thought we heard, he would shake his head and then say exactly what we said with a different order of words and inflection. In addition, many names for diagnoses in India are different than in the states. For instance, one patient had A.N. or "Anxiety Neurosis". Dr. Joshi explained that this is what they call "depression" because "if you tell a patient they are depressed, they will be depressed. No? Instead you tell them they have a nervous problem in their stomach and they feel better."
Something that did not differ from the US was the prevalence of pharmaceutical reps: They were the same well-dressed, good looking people they tend to be in the US. The difference is they come into the crowded room, flash some fliers at the doctor and then leave samples on his desk. The only problem is, all of the drugs have different brand names and they rarely write down the generic so trying to figure out a patients med list is nearly impossible.
At the end of OPD, at 1:30, we decided to stay and watch Dr. Joshi do echos...yep he does them himself. We saw a patient with dilated cardiomyopathy who had gross aortic dilation on echo. Dr. Joshi said he had never seen such gross dilation of the aorta in his practice. He explained this could be either due to a congenital defect or a symptom of syphilis.
We took a vikram back home and as usual it was an interesting ride. Not only are the number of people on the street incredible, but the sights and smells are definitely like nothing I have ever seen before. These include heaps of garbage with pigs eating it, cows walking along the road, "rivers" full of trash, stores of all kinds--wood working, steel shops, repair shops, fruit stands...talk about sensory overload.
We started with Dr. Gandhi at 5:00pm in the hospital/clinic which he runs. He is also a cardiologist but because he is the only doctor in charge of this 16 bed hospital and clinic he sees a lot more than heart problems. His typical day runs from 8:30am-2:00am. Many people travel more than 10 hours to see him. Our first patient encounter was definitely interesting. A family consisting of a grandmother, two daughters, a son in-law and a grandson came into the office to discuss the health of the grandmother. When this was done, the rest of the family proceeded to have "their" visit with Dr. Gandhi. Dr. Gandhi explained later that this was common practice, often the choice of a doctor is on an entire family basis. In Dr. Gandhi, the cardiologist's own words, "It is difficult to be a specialist here (in Dehradun). Maybe in Delhi you can be one."
We stayed with Dr. Gandhi until 9:00pm. He said he would be seeing patients until 11:30p.m.
When I returned home, I received a phone call from my Mom informing me that a wonderful, kind-hearted, intelligent, talented, Renaissance man, Leonard Prossor passed away. Leonard meant so much not only as the love of my grandmother's life, but also as a grandfather to her grandchildren. He had such a big heart and sharp wit and he was such an incredible writer. My blog is dedicated to you Leonard, I know you are reading it from a much nicer place now. Tell Greaty I say hi.
Dr. Joshi is a very nice man in his mid forties. During the three hour period we saw patients in the OPD (Outpatient Department) he probably saw more than a 100 patients. By his estimations, he sees around 250 patients per day. Talk about a man with multi-tasking skills. All of my knowledge from Dr.Morelli, Kate and John was really put to the test. One of our first patients was a 22 year old female with cardiomyopathy and aortic stenosis that radiated to her carotid artery. It was an incredible case for me to see and hear, as well as for Leigh who is entering her senior year of undergraduate and is an EMT, on our first day. This was one of the many patient who we saw who had cardiomyopathy. Dr. Joshi joked that if we wanted to be heart transplant surgeons, we would never be in need of work in India due to this prevalence of cardiomyopathy. We didn't get much other explanation about why there is such a high incidence in India but I'm sure we will by the end of the week.
It was incredible how much respect the patients had for Dr. Joshi. As we walked the hallways, people would clasp their hands together and bow their heads as he walked by. In addition, on the whole, patients were extremely patient and waited their turn one by one to see the equivalent of the M.A. and then the doctor. This usually looked like about 15 patients all in a room smaller than the room at Aegis waiting and then Dr. Joshi at his desk and Leigh and I sitting next to him. And we thought Aegis was crowded and chaotic! Luckily, patients carry all of their own medical records/charts in plastic bags with them which really cuts down on that whole filling process we seem to get bogged down with in the states. Did I mention HIPAA? It is definitely not in existence here as most of the patients are privy to other patient's encounters with the doctor.
One of the biggest challenges Leigh and I faced were the language barriers: Not only that the patients primarily speak Hindi, but also that Dr. Joshi has a thick accent and the inflection and stress of vowels and consonants is completely different so a lot of the time we would say what we thought we heard, he would shake his head and then say exactly what we said with a different order of words and inflection. In addition, many names for diagnoses in India are different than in the states. For instance, one patient had A.N. or "Anxiety Neurosis". Dr. Joshi explained that this is what they call "depression" because "if you tell a patient they are depressed, they will be depressed. No? Instead you tell them they have a nervous problem in their stomach and they feel better."
Something that did not differ from the US was the prevalence of pharmaceutical reps: They were the same well-dressed, good looking people they tend to be in the US. The difference is they come into the crowded room, flash some fliers at the doctor and then leave samples on his desk. The only problem is, all of the drugs have different brand names and they rarely write down the generic so trying to figure out a patients med list is nearly impossible.
At the end of OPD, at 1:30, we decided to stay and watch Dr. Joshi do echos...yep he does them himself. We saw a patient with dilated cardiomyopathy who had gross aortic dilation on echo. Dr. Joshi said he had never seen such gross dilation of the aorta in his practice. He explained this could be either due to a congenital defect or a symptom of syphilis.
We took a vikram back home and as usual it was an interesting ride. Not only are the number of people on the street incredible, but the sights and smells are definitely like nothing I have ever seen before. These include heaps of garbage with pigs eating it, cows walking along the road, "rivers" full of trash, stores of all kinds--wood working, steel shops, repair shops, fruit stands...talk about sensory overload.
We started with Dr. Gandhi at 5:00pm in the hospital/clinic which he runs. He is also a cardiologist but because he is the only doctor in charge of this 16 bed hospital and clinic he sees a lot more than heart problems. His typical day runs from 8:30am-2:00am. Many people travel more than 10 hours to see him. Our first patient encounter was definitely interesting. A family consisting of a grandmother, two daughters, a son in-law and a grandson came into the office to discuss the health of the grandmother. When this was done, the rest of the family proceeded to have "their" visit with Dr. Gandhi. Dr. Gandhi explained later that this was common practice, often the choice of a doctor is on an entire family basis. In Dr. Gandhi, the cardiologist's own words, "It is difficult to be a specialist here (in Dehradun). Maybe in Delhi you can be one."
We stayed with Dr. Gandhi until 9:00pm. He said he would be seeing patients until 11:30p.m.
When I returned home, I received a phone call from my Mom informing me that a wonderful, kind-hearted, intelligent, talented, Renaissance man, Leonard Prossor passed away. Leonard meant so much not only as the love of my grandmother's life, but also as a grandfather to her grandchildren. He had such a big heart and sharp wit and he was such an incredible writer. My blog is dedicated to you Leonard, I know you are reading it from a much nicer place now. Tell Greaty I say hi.
7 comments:
Hi My Precious,
HAPPY BIRTHDAY!! As always, I am so proud of you. As it so happens, the owners of the radiology company I am working for are both from India. I will have to find out from which area.
We send our love to you!
Cattie
Alexis
Your blog is amazing to read. So glad you are sharing your experiences. My condolences to you on the loss of Leonard. I know it will have a big impact on your grandmother's life. . . I'm glad she had his companionship as long as she did.
My very best to you, Nancy G.
Hi Nini,
Thank you for remembering Leonard's birthday. I'm sure he is reading your blog and appreciating every bit of it. Thank you - that was very sweet of you to dedicate it to him.
Love,
Gram
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