16th August 2014
"Today I made a new friend that I hope to keep for a long time coming. For now, I'll call her Priya. Priya is an intern at Osmania General Hospital, a government hospital in the heart of Hyderabad, and she is in the process of completing her fifth and final year of her MBBS degree (Bachelor of Medicine, Bachelor of Surgery). A very intelligent young woman, her angst and emotion towards the Indian healthcare system are such that she no longer wants to work here, nor does she feel prepared to start practicing as a GP if she doesn't pursue her MD next year. [To provide some context, an MBBS degree in India is the first level of training required to become a licensed general physician, and the MD program provides the next level of specialization in Internal Medicine].
Priya dreams of doing her MD residency in a place like the US. She has a passion for oncology - pancreatic cancer in particular - but over coffee today she explained that the chances available for distinction students like her to make it to specialist level are slim when they have to compete against a large population, with limited infrastructure, and politics disrupting the system. She attributes this solely to the way medical education programs are structured in India, and this was with her background of studying at a private facility. For me this conversation exemplified why education and healthcare now go hand-in-hand as two of India's highest focus areas for development. It spoke to me about the underlying systemic changes that need to be achieved in order to increase awareness about bradycardia and its symptoms, amongst patients and the general physician population. This is especially true in areas where there may be limited contact with practitioners, or in facilities where there may not be the infrastructure to allow for accurate differential diagnosis.
For GPs, training and education can become limiting factors for two reasons. Firstly, the immense competition faced by thousands of students for admission into MD programs after completing their MBBS degree means that many GPs are practicing straight after their MBBS final year internship, with a breadth of knowledge but not much depth into the area of cardiology. Priya explained that her only experience in cardiology throughout her MBBS degree was in her fourth year, where her class studied one chapter of a textbook on cardiac conditions. She is highly motivated, so a lot of her extra knowledge about bradycardia diagnosis and treatment methods came from self-learning, but for those who may not be as inquisitive as her, the same knowledge may not be reached, or could be misinterpreted. She learned how to read an ECG under senior guidance during her internship, but this wasn't taught to her; she had to seek this knowledge by driving her own interests.
Secondly, there are few programs in place to maintain up-to-date dissemination of medical knowledge at the MBBS level, at least in the parts of Hyderabad that we spoke about (there are various programs around the country that are available in some areas but not others). This means outdated practices are commonly used and diagnosis is often based on clinical symptoms, or it is assisted with suboptimal tools. This has been confirmed by a variety of healthcare professionals, and seems to be one of the contributing factors towards unwell but asymptomatic patients being missed or misdiagnosed. However, GP awareness is not the only reason for this; accessing adequate care also relies on the patient being aware of their health and choosing to seek treatment in the first place. A sense of complacency is often seen due to age, financial constraints or both, which means the importance of regular check-ups for screening is undermined.
After two hours of eye-opening and humbling conversation, I left the café feeling very grateful to have met Priya and heard her story. It is connections like this that I feel can make a difference, whether it be on a personal level or on a larger scale, and I look forward to being a part of that change."
- Maddie.
"Today I made a new friend that I hope to keep for a long time coming. For now, I'll call her Priya. Priya is an intern at Osmania General Hospital, a government hospital in the heart of Hyderabad, and she is in the process of completing her fifth and final year of her MBBS degree (Bachelor of Medicine, Bachelor of Surgery). A very intelligent young woman, her angst and emotion towards the Indian healthcare system are such that she no longer wants to work here, nor does she feel prepared to start practicing as a GP if she doesn't pursue her MD next year. [To provide some context, an MBBS degree in India is the first level of training required to become a licensed general physician, and the MD program provides the next level of specialization in Internal Medicine].
Priya dreams of doing her MD residency in a place like the US. She has a passion for oncology - pancreatic cancer in particular - but over coffee today she explained that the chances available for distinction students like her to make it to specialist level are slim when they have to compete against a large population, with limited infrastructure, and politics disrupting the system. She attributes this solely to the way medical education programs are structured in India, and this was with her background of studying at a private facility. For me this conversation exemplified why education and healthcare now go hand-in-hand as two of India's highest focus areas for development. It spoke to me about the underlying systemic changes that need to be achieved in order to increase awareness about bradycardia and its symptoms, amongst patients and the general physician population. This is especially true in areas where there may be limited contact with practitioners, or in facilities where there may not be the infrastructure to allow for accurate differential diagnosis.
For GPs, training and education can become limiting factors for two reasons. Firstly, the immense competition faced by thousands of students for admission into MD programs after completing their MBBS degree means that many GPs are practicing straight after their MBBS final year internship, with a breadth of knowledge but not much depth into the area of cardiology. Priya explained that her only experience in cardiology throughout her MBBS degree was in her fourth year, where her class studied one chapter of a textbook on cardiac conditions. She is highly motivated, so a lot of her extra knowledge about bradycardia diagnosis and treatment methods came from self-learning, but for those who may not be as inquisitive as her, the same knowledge may not be reached, or could be misinterpreted. She learned how to read an ECG under senior guidance during her internship, but this wasn't taught to her; she had to seek this knowledge by driving her own interests.
Secondly, there are few programs in place to maintain up-to-date dissemination of medical knowledge at the MBBS level, at least in the parts of Hyderabad that we spoke about (there are various programs around the country that are available in some areas but not others). This means outdated practices are commonly used and diagnosis is often based on clinical symptoms, or it is assisted with suboptimal tools. This has been confirmed by a variety of healthcare professionals, and seems to be one of the contributing factors towards unwell but asymptomatic patients being missed or misdiagnosed. However, GP awareness is not the only reason for this; accessing adequate care also relies on the patient being aware of their health and choosing to seek treatment in the first place. A sense of complacency is often seen due to age, financial constraints or both, which means the importance of regular check-ups for screening is undermined.
After two hours of eye-opening and humbling conversation, I left the café feeling very grateful to have met Priya and heard her story. It is connections like this that I feel can make a difference, whether it be on a personal level or on a larger scale, and I look forward to being a part of that change."
- Maddie.
.JPG) |
| Patients and families at the entrance of the OGH Outpatient Center |
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