Stress in Medical Colleges....

ORIGINAL ARTICLE
Year : 1998 | Volume : 44 | Issue : 1 | Page : 1-6

A study of stress in medical students at Seth G.S. Medical College.

Supe AN
Department of Surgery, Seth G.S. Medical College, Mumbai.,

Correspondence Address:
Supe A N
Department of Surgery, Seth G.S. Medical College, Mumbai.

:: Abstract

BACKGROUND: It is usually observed that medical students undergo tremendous stress during various stages of the MBBS course. There is a high rate of suicide among them. METHODS: To determine incidence of stress and factors controlling stress in medical students at various stages of MBBS course at Seth G S Medical college, 238 students (First year 98, Second 76, Third 64) were asked to complete a questionnaire on personal data (gender, stay at hostel, mode of travel, time spent in travel every day, medium of study in school, place of school education.), Stress inducing factors, Zung's depression scale, ways of coping, stress relievers, perceived social support and personality type. Statistical tests used were ANOVA, critical ratio and Student's 't' test. RESULTS: Majority of medical students (175/238--73%) perceived stress. Stress was found to be significantly more in Second and Third MBBS students rather than First MBBS levels (p < p =" NS).">

Keywords: Adaptation, Psychological, Female, Human, Incidence, India, epidemiology,Male, Social Support, Stress, Psychological, epidemiology,Students, Medical, psychology,statistics &numerical data,Suicide,

How to cite this article: Supe AN. A study of stress in medical students at Seth G.S. Medical College. J Postgrad Med 1998;44:1-6

How to cite this URL: Supe AN. A study of stress in medical students at Seth G.S. Medical College. J Postgrad Med [serial online] 1998 [cited 2007 Nov 1];44:1-6. Available from: http://www.jpgmonline.com/text.asp?1998/44/1/1/389

The present curriculum of the MBBS course is vast. As a large syllabus is fitted in a short period, the MBBS course is extremely demanding in terms of students’ effort. The study aimed at examining the stress in medical students at Seth GS Medical college and various factors that cause and relieve stress. It also aimed at studying the various other related factors such as ways of coping and social support in medical students.

:: Methods

The descriptive method of the comparative type was used in order to compare the stress in medical students. Stratified random sampling technique was used to collect data from the three different levels of MBBS students. Systematic random sampling was used for the selection of sample at each level of MBBS. (Total 238, First MBBS 48 M, 50 F; Second MBBS 42 M, 34 F; Third MBBS 38 M, 26F).

:: Tools of research

In the present study following tools were used:

1. Personal data :

This section includes general information and specific information regarding Stay in hostel, Mode of travel to college, Time spent in travel every day, Medium of study at school education, Mother tongue, Marks obtained at 12th Standard at the time of medical admission, Place of school education, Place of Education in junior college.

2. Stress Inducing factors:

To determine the stress inducing factors perceived as stressors (Stress inducing factors) were divided in to 4 groups

a) Academic: academic achievements, examination & competition amongst students.

b) Physical factors: hostel and canteen facilities, environmental situations, noise in classroom and library etc.

c) Emotional factors: emotional comfort of student and other associated factors such as love affairs, jealousy and fights etc.

d) Social factors: Social aspects in the college, parental influence & socio-economic support.

These were then subjected to construction validity by the experts in education and others. There were total 28 items.{ 7 in each group) Each item was scaled as 1(Little or no stress), 2 (Moderate stress), 3 (Considerable stress) and 4 (Great stress). A total score was obtained from summing up of scores for each sub group. Average scores for each subgroup of individual were compared for further analysis.

3. Stress Reducing factors:

To determine the stress relievers, various factors perceived as stress relievers (Stress reducing factors) were divided in to 6 groups

a) Friends,

b) Gymkhana

c) Physical factors

d) Co-curricular activities:

These include “Shidori” (A three-tier course of co-curricular activities) and student - teacher preceptor programme. The programme has been envisaged to be conducted for a student at 3 time points in his/her UG career. To test this idea we implemented the programme for 3 separate batches of students: at entering medical college, at the beginning of clinical terms and during internship. Three aspects were covered in Shidori-1 : Group dynamics, study skills and communication skills in a workshop manner. Shidori-2 is conducted for 2nd MBBS students and includes Bedside manners, Communication skills and Coping skills. Shidori-3 is for interns and included following topics: Relationship between medical representative and doctor, Rational drug prescribing, Rational diagnostics use, Doctor-patient communication, and time management and assertive behaviour training.

e) Teacher's behaviour

f) Personal hobbies.

These were then subjected to construction validity.

Each item was scaled as 1(Little), 2(Somewhat), 3 (Considerable) and 4 (Very much). A total score was obtained from summing up of scores for each subgroup. The average score for each factor was calculated by dividing the total score for that factor by number of items. Average scores for each subgroup of individuals were compared for further analysis.

4. Zung’s self rating scale for depression[1].

This scale was preferred to others as this tool evaluates depression in normal non-psychotic individuals and has been time tested. This scale assesses the perceived feelings of the students regarding their emotional status.

The test form was labelled as “section three” as it is important that respondents be unaware that it is a depression scale. The tool consists of 20 items with scale ranging from 1 to 4. The total score was summation of all scores. The value ranges from 20 to 80. Stress was considered as a continuous variable ranging from low to moderate to high degree of experienced feeling. A high degree of stress was reflected in high scores on the Zung’s scale and a low degree was reflected in low scores on this scale. Score more than or equal to 40 was considered as stress.

5. Way-of-coping scales by Folkman and Lazarus[2]

Coping is defined as the person’s constantly changing cognitive and behavioural efforts to manage specific external and/ or internal demands that are appraised as taxing or exceeding the person’s resources.

Folkman and Lazarus developed “Way of coping scales” to study coping styles of any individual. This scale was used for present study. The scale consists of 50 items. The coping scale has eight sub scales. These were developed from factor analytic procedures using alpha and principal factoring. The eight sub scales are as follows

a) Confrontive coping ( ? = 0.70) Total number of items = 6: This describes aggressive efforts to alter the situation. It also suggests a degree of hostility and risk taking.

b) Distancing (? = 0.61) Total number of items = 6. This describes efforts to detach oneself. It also concerns creating a positive outlook.

c) Self- Control ((? = 0.70) Total number of items = 7: This describes efforts to regulate one’s own feelings and actions.

d) Seeking social support (? = 0.76) Total number of items = 6: This describes efforts to seek informational and emotional support.

e) Accepting responsibility (? = 0.66) Total number of items = 4: This acknowledges one’s own role in the problem with concomitant theme of trying to put things right.

f) Escape-avoidance (?=0.72) Total number of items=8: This describes wishful thinking and behavioural efforts to escape or avoid. These are different from distancing as these items suggest escape and avoidance, in contrast with the items on the distancing scale, which suggest detachment.

g) Planful Problem solving (? = 0.68) Total number of items = 6: This describes deliberate problem-focused efforts to alter the situation coupled with an analytic approach to solving the problem.

h) Positive reappraisal (? = 0.79) Total number of items= 7: This describes efforts to create positive meaning by focusing on personal growth.

Scores (1 to 4) were calculated by summing up the ratings for each sub scale. The scores are calculated for each way of coping and average score for each coping strategy was calculated. Average scores for every strategy were compared and dominant strategy of every individual was determined for further analysis.

6. The Multidimensional Scale of Perceived Social Support(PSS) by Zimet[3]

Social support involves some kind of relationship transaction between individuals. It provides “Coping assistance” to an individual. It is also a positive factor that aids in the maintenance of health as well as in disease recovery.

Multidimensional Scale of Perceived Social Support was used in the present study. It assessed perceptions from three specific sources: Family, Friends and Significant other(Special person)”. The inventory consists of 12 items divided into three groups ( 4 items each). Each item is rated on a five point scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). The value for total scale ranges from 12 to 60. The value for each group (4 items each) will range from 4 to 20.

7. Stress Quiz to determine type of behavioural pattern of an individual[4]:

The stress quiz determines the behaviour pattern of an individual. Type A Behaviour: There are two main characteristics of the type A person- Time-urgency and Hostility. Type A behaviour produces more stress and has more cardiac risk. Type B Behaviour: Type B pattern has absence of all habits and traits that harass the severely affected type A person. Type B person is not afraid to admit mistakes and co-operates with others. He/ she takes break when fatigued and is not devastated by criticism.

For the purpose of this study, the scores obtained on the ‘Stress Quiz” were used. The inventory contains 30 items. Each item was scaled as 1 (never), 2 (Seldom), 3 (Sometimes), 4 (Frequently) and 5 (Always). Maximum score for each item is 5. Therefore 150 would be the maximum score. Any score more than 90 indicated the presence of personality factor (Type A) contributing to the stress.

Statistical tests used were ANOVA, critical ratio and Student’s ‘t’ test.

:: Results

Majority of medical students (175/238 -73%) at Seth G S Medical college perceived stress. Stress was found more in Second and Third MBBS students than First MBBS levels.

There was no difference in the perceived stress on the basis of level of MBBS. [Table - 1]

There was no difference in the perceived stress on the basis of sex of the medical students. (M 95/128, F 80/110, critical ratio, p=NS).

There was no difference in the perceived stress on the basis of Place of stay (Hostel or Non- Hostel). (Hostel 61/91, Non -hostel 114/147, critical ratio, p=NS).

There was no difference in the perceived stress on the basis of Mode of travel to college and Time spent in travel every day. (Mode of travel: Foot- 59/88, car/ taxi 7/7, Bus 37/45, Train- 58/81, Bus and Train 14/17. ANOVA- p =NS; Time spent in travel - < 1hr- 56/80, 1-2 hr- 55/74, more than 2 hrs- 64/84, ANOVA, p=NS).

There was no difference in the perceived stress on the basis of medium of study at school education. (English-141/186, non-English 34/52. Critical ratio, p=NS).

There was no difference in the perceived stress on the basis of Mother tongue. (Marathi- 88/121, Hindi 26/34, Gujarati - 30/41, Others - 35/42, ANOVA, p =NS).

There was difference in the perceived stress on the basis of Marks obtained at 12th Standard.( > 95%- 77/93, 90-95%- 54/80, <90% 44/65, ANOVA, p= Significant at 0.05, Students t test between First and Second, First and Third group significant at 0.05 and 0.01 level respectively).

There was no difference in the perceived stress on the basis of Place of school and Junior college education. (Metro city -141/188, Small town 32/45, Rural 2/5; ANOVA- p= NS).

There was difference in the various stressors (Stress inducing factors such as Academic, Physical, Social And Emotional) on the basis of different levels MBBS and of the total sample.

a) Academic factors were greater perceived than all other factors as cause of stress. Physical and Social factors were greater perceived than emotional factors as cause of stress (Dominant stressor- Academic 159, Physical 31, Emotional 10, Social 38)

b) There was no difference in the students at different levels of MBBS regarding academic factors and social factors as a stress inducing factors.(ANOVA, p =NS)

c) Physical factors were found to be significantly more in second and third MBBS students as compared to First MBBS students.(student’s t test, p<0.05)

d) Emotional factors is found to be significantly more in First MBBS students as compared to second & Third MBBS students.(student’s t test, p<0.05)

There was no difference in the perceived stress on the basis of their individual dominant stressor. (Academic -114/159, Physical 21/31, Emotional 8/10, Social 32/38, ANOVA, p=NS).

There was difference in the perceived stress on the basis of their individual dominant coping strategy.

a) Stress is more common in medical students who have dominant strategy of coping as positive reappraisal, accepting responsibility and planful problem solving.

b) Stress is less common in students who have dominant strategy of coping as escaping and distancing from difficult situation.

c) Stress is more in medical students who have dominant strategy of coping as planful problem solving as compared to accepting responsibility, self control and seeking social support. ANOVA, p= Significant at 0.05

d) Stress is more in medical students who have dominant strategy of coping as positive reappraisal as compared to accepting responsibility, and escaping.

There was no difference in the perceived stress on the basis of individual’s preferred institutional stress relieving factor. (Physical-19/ 26, Friends 20/25, Gymkhana 8/10, Teachers behaviour 40/51, Shidori 6/7, Hobbies 82/119, ANOVA, p=NS).

There is no difference in special person as perceived social support system at different levels of in medical students. Family as perceived social support is more in Second MBBS than First MBBS medical students. Friend as perceived social support was more in Second MBBS than other level medical students. (ANOVA, p= Significant at 0.05). There was no difference in perceived stress in the medical students on the basis of various levels of PSS such as family and friend in total sample and at different levels MBBS (ANOVA, p=NS).

There was no difference in perceived stress in the medical students on the basis of various levels of PSS such as special person at different levels MBBS. There was difference in perceived stress in the medical students on the basis of various levels of PSS such as special person in total sample. Students having high scores on special person as PSS have more stress compared with students having mod scores.( ANOVA, p= Significant at 0.05).

There was no difference in the perceived stress in medical students on the basis of their personality.(i.e. Personality factor contributing to stress) (Type A -52/67, Type B- 123/171) (Students “t” test - t = 0.18 p = NS).

:: Discussion

This study confirmed the general impressions that there is considerable amount of stress in medical students at Seth GS Medical College. This is similar to other studies elsewhere which have reported such findings[5]. However the incidence of 73.5% (175/238) in this series is much higher than that reported by others.

Stress was found to be more in Second and Third MBBS students rather than First MBBS levels. This was surprising as Second MBBS is generally thought to be a year where there was less stress. However Kumarswamy[6] also found that stress was more in Second MBBS and this may be due to greater fear of not attaining their goal of being a doctor. The other reason may be due to excessive load of both para-clinical and clinical subjects as compared to only clinical subjects in third year. The high stress in Third MBBS may be due to competition for the postgraduate seats.

There was no difference in the stress on the basis of gender, stay in hostel, stressors, mode of travel and time spent in travel every day, place of school and junior college education indicating that academic achievement is more important than other factors in inducing stress in medical students.

Stress was more in students having more than 95% of marks at 12th Standard at the time of medical admission as compared to all others. This confirms that students who are high achievers are more under stress. This may be due to higher parental, peer and self expectations on academic performances.

Academic factors were greater perceived causes of stress in medical students at Seth GS medical college. This was similar to the findings reported by others[7],[8]. Final examinations and large amount of information were recognised as most important factors causing stress. There was no difference in stress on the basis of dominant stressor of an individual indicating that the stress is not stressor specific.

There was no difference in the students at different levels of MBBS regarding Academic factors and Social factors as stress inducing factors. However, Physical factors were found to be significantly more in Second and Third MBBS students as compared to First MBBS students. Emotional factors were found to be significantly more in First MBBS students as compared to second & Third MBBS students. This may be due to entry into a large professional college which makes students feel insecure in the initial period.

The distribution of the coping strategies was similar to what was found by Folkman and Lazarus[2]. Stress was more common in medical students at Seth GS medical college who have dominant strategy of coping as positive reappraisal, accepting responsibility and planful problem solving. This may be due to student’s realisation of self mistakes and struggle to fight it out. Stress was less common in students who have dominant strategy of coping as escaping and distancing from difficult situation. Stress was significantly more in medical students who have dominant strategy of coping as positive reappraisal as compared to accepting responsibility, and escaping.

Stress was more in students who have dominant strategy of coping as planful problem solving as compared to accepting responsibility, self control and seeking social support.

Stress was not found to differ significantly in medical students on the basis of preferred institutional stress relieving factor. This suggests that each institutional stress relieving factor has its contribution in relieving stress. Hobbies was the most common stress relieving factor in medical students.

There was no difference in special person as perceived social support system at different levels. However, surprisingly Family as perceived social support is more in Second MBBS than First MBBS students. Friend as perceived social support is more in Second MBBS than other level. This may be due to students spending more time in medical colleges than at home. Friend as a perceived social support decreases in Third MBBS due to competition amongst students.

There is no difference in perceived stress in the medical students at Seth GS Medical college on the basis of various levels of PSS such as Family and Friend in total sample and as Special person, Family and Friend at different levels MBBS. However there is significant difference in perceived stress on the basis of various levels of PSS such as Special person in total sample. Students having high scores on special person as PSS have more stress compared with students having moderate scores. This is contradictory to what has been described by others.[9] This may be due to Special person or Friend making more efforts to help the highly stressed students.

Stress is not found to be significantly more in students having their personality factor contributing to stress (Type A) as compared to others (Type B). This indicates that the stress in Seth GS Medical college is due to the process and not due to personality traits of the students.

:: Conclusion

Study concluded that stress in medical students is common and is process oriented. Academic factors are greater perceived cause of stress in students at Seth GS medical college. Emotional factors are found to be significantly more in First MBBS. However stress is not stressor or trait specific. It is also dependent on personal ways of coping strategy and social support. It also suggested need for measures to reduce such stress and future research.

:: Acknowledgments

The researcher is extremely thankful to Dr. G. Kerawalla, Department of education, University of Mumbai for all the guidance and help.

:: References

1.	Zung WWK. Self rating depression scale. Arch Gen Psychiatry 1965; 12:63-70.
2.	Folkman S, Lazarus RS, Dunkel-Schetter C, Delongis A, Gruen R. “Dynamics of stressful encounter: Cognitive appraisal, coping and encounter outcomes.” Journal Personality Social Psych 1986; 50:992-1003.
3.	Zimet G, Dahlem NW, Zimet SG, Farley G. “The Multidimensional Scale of Perceived Social Support.” Journal Personality Assess. 1988; 52:30-41.
4.	Srivastava CM. “Stress Management”. In GJ Kerawalla (Ed.). Institutional Development: Human Process Techniques. Department of Education, Mumbai: University of Bombay; 1994, pp 44-52.
5.	Boyle BP, Coombs R H. “Personality profiles related to emotional stress in the initial year of medical school.” J Med Edu. 1971; 46:882-888.
6.	Kumarswamy N, Ebigbo PO. “Stress among second year medical students - A comparative study” Indian J Clin Psychol. 1989; 16:21-23.
7.	Indrayan A, Rao S, Grover V, Agrawal K, Gupta A. “Freshers perception of problems in medical education.” Indian J Med Edu 1985; 24:85-94.
8.	Coburn DR, Jovaisas AV. “ Perceived sources of stress among first year medical students” J Med Edu. 1975; 50:589-595.
9.	Thoits PA. “Social support as a coping assistance.” J Consulting Clin Psychol 1986; 54:416-423.

HOW TO SURVIVE A HEART ATTACK WHEN ALONE

HOW TO SURVIVE A HEART ATTACK WHEN ALONE


Since many people r alone whn they suffer a heart attack, without help,the person whose heart is beatin

improperly and who begins to feel faint, has only about 10 seconds left b4 losing consciousness.

However,these victims can help demselves by coughing repeatedly n very vigorously. A deep breath should

b taken b4 each cough, n d cough mst be deep n prolongd, as wen producing sputum 4m deep inside the chest.


A breath and a cough must be repeatd about every 2 seconds without let-up until help arrives, or until the heart is felt to b beating normally again.

Deep breaths gt oxygen into d lungs n coughin movements squeeze d heart n keep d blood circulating. The squeezing pressure on the heart also

helps it regain normal rhythm. In this way, heart attack victims can get to a hospital. Tell as many other people as possible bout this. It could save their lives!!

The story of a doc....Livin A Dream??

It is essential to dream.Only those who dream can hope to realise their dreams.BUT Some dreams can be fatal....There was a boy named Umeed who dreamt of becoming a surgeon.He came from a financially poor background but his parents managed to put him into an English Medium school. Umeed was an intelligent boy and hardworking too.He used to top in his exams and do well at sports.By the time he got to 8th standard ,he was earning some pocket money by tutoring some of his affluent classmates after school hours.

One such student was Vaibhav.Vaibhav hated studies but only due to Umeed's efforts he passed each year.The two became close buddies. In the same school,2 years junior ,was a pretty and studious girl called Kaamana.She was a huge fan of Umeed and also went to him whenever in difficulty. In the 10th standard and then in the 12th ,Umeed was a merit rank holder.In the medical entrance exam ,he got a good rank and entered medical school.At this conjecture,his mother and father were most overjoyed."Our troubles are over now",they thought.

Little did they know that this was just the beginning...... Four and a half years of toil and finally Umeed passed final MBBS in flying colours.His aim in life seemed very near now.He had developed a keen interest in Neurosurgery and was determined to accomplish his ambition. "One year of internship,"he thought,"Then PG entrance."
Umeed knew the importance of clinical work.He decided to do his internship sincerely.He divided his day -12 hours ward work,6 hours study and six hours rest.He followed this rigorous schedule for 365 days and completed his internship.He was nominated as best intern of the year. He was also well-prepared for his entrance exam.

BUT ALAS!! A directive from the university disbarred him from sitting for the exam.'One year compulsory rural service or pay 5 lakhs.' 5 lakhs was a huge amount.Umeed could not make such a big demand from his parents.He chose to go.He was dispatched to a remote adivasi village.Umeed worked dilligently for a year.He returned and gave the entrance exam.

He got through by the skin of his teeth.He had not found time to study but his old acquired knowledge helped him. As a surgery resident,Umeed was a ray of hope for all patients.He was a model doctor alleviating the suffering of people around him.However,he unfortunately got entangled in political rivalry and failed in his first attempt.Studying hard ,he cleared MS after 6 months.He was now almost 29 years old.

Umeed decided to study for superspeciality entrance. BUT ALAS!!! Another directive from the university said" 3 years compulsory rural post or pay 15 lakhs to be eligible!" Umeed was stunned."15 lakhs!!??"It was impossible for him to pay.His father had just retired from post office.There was not much income.Dejected,he left for the rural post.It was in a god forsaken place with poor living conditions.Umeed spent 3 years in a living hell.He thrice came down with malaria,once with leptospirosis and once with typhoid. He lost 10 kg weight and was emaciated by the time he completed.

At 33,after studying,he gave his first attempt at the MCh entrance.He failed.A year later on the second attempt,he missed a seat by 5 ranks.Grey,depressed and broken,Umeed,now a 35 year old unemployed surgeon walked down the street.A few people who knew him smiled or spoke a few words of consolation.But Umeed was impervious to the world.

Just then a sports Mercedez Benz stopped in front of him.A smart looking gentleman in a suit got down and smiled at Umeed."Hey ,don't you recognise me man?Its me,Vaibhav!" Umeed was happy to meet his chldhood friend."What are you doing nowadays ,Vaibhav?'',he queried. "O,I am a consulting neurosurgeon at Bombay Hospital",Vaibhav replied. Shocked,Umeed asked him how he had achieved this feat. "Nothing diifficult.My dad paid 15 lakhs and got me a MBBS seat in a pvt Medical college.I cleared MBBS quite easily.Then I took a six years MCh Neurosurgery course .Cost a bomb .About 55 lacs.But its worth it now.Am earning 15 lacs a month."

Dumbfounded,Umeed heard out this tale of arrogance and power of money.Just then,a beautiful woman in a sari walked up to them.She was fair and adorned with expensive jewellry and diamonds.Vaibhav turned to her and said,"Hey Kaamu,look who is here!"Umeed turned to look into the smiling face of Kaamana,his childhood friend! "She is Mrs.Kamanaa Vaibhav Sehgal now",he said. Some 2 hours later,Umeed returned home.He had done some deep thinking in a nearby park.He was tired of it all.He had dinner with his parents and then went to bed.

Next morning,he was found lifeless with an empty syringe and a vial of morphine on the bed. 13 days later,as Umeed's mother sat quietly struggling to comprehend what had happened,the doorbell rang.It was a letter from the university.She opened it.It read"Reverification of the marks of DR.Umeed has revealed an error in assessment.He has stood not 30th but 3rd in the MCh entrance." "3 seats".She could hear Umeed's voice in her head.He had said that there were 3 seats for MCh Neurosurgery. Tears welled up in her eyes.He had done it.He had achieved his goal.He had kept the promise he had made to her 20 years ago.But now it was too late. Mechanically ,she switched on the TV.The news was showing the interview of the health minister."Our new rule regarding rural posting is a novel and innovative idea.It will help the rural population and also give some wonderful experience to young doctors.I have a FEEDBACK that many doctors are actually benefitting.........................................."..THE END.

Why Are the Doctors and Patients Rivals?

Ever since medical profession came into place, the relationship between the healers and the healed was a pious one... the healer was considered above all- whether he be a holy man/witch doctor, a priest or a doctor. The patient placed him/herself in front of the healer trusting what ever he does is for the patients benefit and he did trusted his doctor to the extreme. Times have changed... so has the doctor patient relationship. The patient got to know that even the doctors are imperfect, that he too also make mistakes, they also heard that the divine status of a medical man can be bought by any ordinary person by money or power, also he heard of stories of doctors taking commissions or sending for unnecessary investigations. Again adding to the worry. He lost his trust finally in the previously god-like doctors. Well! On the other side of the coin! The doctors started to wonder where we went wrong.

The sincere ones were hurt while the other group didn’t care or bother! But both the groups felt they were targeted by a pseudo enemy! This only worsened the situation! So to job here is not for the patient! But the doctors to earn that long lost trust! By words, action and compassion ... To regain what we lost sometime ago. Also it is up to us doctors to treat our fellow doctors with that respect that they too deserve. Only thru sincere effort shall each one of us regain that respect.Maybe the whole doctor community shall never regain that old name. Because flaws still exist among us, but each doctor who took sincere efforts in healing minds and relationships along with the bodies he treats may prevail above all... Just reminding you that oath we take when we take our first step!

Let us stick to that [read the classical and modern versions carefully and our questions will be answered.] Hippocratic Oath?
Modern version I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of over treatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death? If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at god.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sounds of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. Written in 1964 by Louis lasagna, academic dean of the school of medicine at Tufts University and used in many medical schools today.

Hippocratic oath -- classical version I swear by Apollo physician and Asclepius and Hygeia and panacea and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant: to hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves. What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

i learnt a few lessons...

Never try to shout out your problems it wont help...especially arnd ur girlfriend...
Never think about your problems offduty..especially in front of your girlfriend...
Never try to remember your problems....especially in front of your girlfriend...
Coz your girlfriend is there to make you forget them...
Thts wht we men are made for right!!!

Unless of course..ur girlfriend becomes your problem!!!!! :-))

cao
Zin

well sometimes i think about things that really do not have any role in the current scenario that i am in. i start day dreaming about being big and powerful. A wise guy once said one should not day dream....live in the reality he said. i ask isnt reality an illusion....a manifestation of what we have done in the past. i ask that if we would have given a thought then things could have been different. the scenerio could have changed

But then as a doctor..we learn that we do not make or break scenerios..we are not directors....the Almighty god is the one pulling all the strings...we are mere reactors and actors....

so to dream or not to isnt the question we should be asking...what we should be asking is
What Next God???

Some Funny Things We Do!!!!!!

1. a man comes into the ER and yells, "My wife's going to have her baby in the cab!" I grabbed my stuff, rushed out to the cab, lifted the woman's dress, and began to take off her underwear. Suddenly I noticed that there were several cabs -and I was in the wrong one. Submitted by Dr. Mark, MacDonald, St. Antonio, TX.

2. at the beginning of my shift, I placed a stethoscope on an elderly and slightly deaf female patient's anterior chest wall. "Big breaths," I instructed. "Yes, they used to be," replied the patient. Submitted by Dr. Richard Byrnes, Seattle, WA

3. One day I had to be the bearer of bad news when I told a wife that her husband had died of a massive myocardial infarct. Not more than five minutes later, I heard her reporting to the rest of the family that he had died of a "massive internal fart." Submitted by Dr Susan Steinberg, Manitoba, Canada

4. during a patient's two-week follow-up appointment with his cardiologist, he informed me, his doctor, that he was having trouble with one of his medications. "Which one?" I asked. "The patch. The nurse told me to put on a new one every six hours and now I'm running out of places to put it!" I had him quickly undress and discovered what I hoped I wouldn't see. Yes, the man had over fifty patches on his body! Now, the instructions include removal of the old patch before applying a new one. Submitted by Dr. Rebecca St. Clair, Norfolk, VA

5. While acquainting myself with a new elderly patient, I asked, "How long have you been bedridden?" After a look of complete confusion she answered..."Why, not for about twenty years - when my husband was alive." Submitted by Dr. Steven Swanson, Corvallis, OR

6. I was caring for a woman and asked, "So how's your breakfast this morning?" "It's very good, except for the Kentucky Jelly. I can't seem to get used to the taste" the patient replied. I then asked to see the jelly and the woman produced a foil packet labeled "KY Jelly." Submitted by Dr. Leonard Kransdorf, Detroit, MI

7. A nurse was on duty in the Emergency Room, when a young woman with purple hair styled into a punk rocker Mohawk, sporting a variety of tattoos, and wearing strange clothing, entered. It was quickly determined that the patient had acute appendicitis, so she was scheduled for immediate surgery. When she was completely disrobed on the operating table, the staff noticed that her pubic hair had been dyed green, and above it there was a tattoo that read, "Keep off the grass." Once the surgery was completed, the surgeon wrote a short note on the patient's dressing, which said, "Sorry, had to mow the lawn." Submitted by RN no name

AND FINALLY!!!................

8. As a new, young MD doing his residency in OB, I was quite embarrassed when performing female pelvic exams. To cover my embarrassment I had unconsciously formed a habit of whistling softly. The middle-aged woman upon whom I was performing this exam suddenly burst out laughing and further embarrassing me. I looked up from my work and sheepishly said, "I'm sorry. Was I tickling you?" She replied, "No doctor, but the song you were whistling was, "I wish I was an Oscar Meyer Wiener". Dr. would not submit his name

A Psychiatrist's Song!!!

a psychiatrist's song..
Normal people and DoctorDoctor saab!

kyon chalti hai pawan ?there is no pawan, its ur paraesthesia man

kyon jhoome hai gagan ?most likely labrinth disorder

kyon machalta hai mann ?because of anxiety neurosis or hyertension.

na tum janno na hum ?i know that, ur insight has lost --> psychosis

kyon aati hai bahar ?because of change in season

kyon lutata hai kaarar ?becuase of depressin

kyon hota hai pyaar ?because of hippocampus, amygdala and prefrontal lobe (limbic system)

na tum janno na hum ?like i said these are all medical phenomena

kyon gum hai har disha ?because of sensory ataxia, cerebellar disorders etc.

kyon hota hai nasha ?because of addiction centre nucleus acumben

kyon aata hai maza?because of increase MPTP in VTA area in brain.

na tum janno na hum?I think u r multiple neurogic disorders ,get investigated today

cao......DR ZIN

a full circle...
everything we do..we seem to move in circles...
recently i just got to know about a few break ups among my friends who were in love for long time
well first i was just shocked...but then i realized a few things
it is i guess eventually a right thing...what is the point in adjusting and compromising when there can always be the possibility of that perfect man or woman who can be your life partner
it is in search of that perfect being that we begin our search at the very place we thought we had ended.
we again go through that circle of falling in love again and breaking in love again..only for that perfect one
what we do not realize is no one is perfect..even god is not perfect..if he was perfect there would not have been suffering in this world..
so lets realize the importance of being together with some one while we can coz we dont know when we have to move out for the next circle of life..

chao...

So what is the BIG deal????

so whts the big deal??..this sentence has more than the literal meaning for us..medical students!!
you know we ponder over books, ponder over ourselves, ponder over others, ponder over dead bodies, ponder over live bodies and ponder over any imaginable shit thinking and asking ourselves whats the big deal?

1.4 million kids die in the first month of their life in south asia alone..whts the big deal?
2.2 million die before their first birthday..whts the big deal?
2.5 million HIV positive in india..Whats the big deal?

wht does all this have to do wid us.?
we are desensitized humans u know...these things are part and parcel of our lives
death is a misnomer for us.....

so wht if two of my batchmates have died during MBBS...we continue ahead..still putting their proxies in the class..WHTS THE BIG DEAL!!!

Laughter is the best medicin !!...yup surely for us!

You know it is very difficult in remain sane in the enviorment that we live in..... projects are patients conferences are case dicussions deadlines are simply dead people! so its a whole lot of different world out here...a world that is easy for who want be in it but difficult for those who have a slightest of doubts... We laugh a lot..crack jokes that other seem incomprehensible....its not that we have a real bad sense of humour!! its just that the laughter is our oxygen....it gives us an escape route to forget the pain for a moment....a pain that haunts every doctor!! we can never treat every patient we see....we cannot give life everytime we want sometime or the other we are bound to kill a person who could have been potentially saved just if we would have slept well the previous night.....scary right...yes i guess so It is knowledge of the fact that we cannot live upto the expectations of all haunts us to our graves and perhaps leads us to more and more laughter...... The laughter that rids us of our pains Laughter is the best medicine..yup baby bring it on!!!

Laughter is the best medicin !!...yup surely for us!

You know it is very difficult in remain sane in the enviorment that we live in.....
projects are patients
conferences are case dicussions
deadlines are simply dead people!

so its a whole lot of different world out here...a world that is easy for who want be in it but difficult for those who have a slightest of doubts...

We laugh a lot..crack jokes that other seem incomprehensible....its not that we have a real bad sense of humour!!
its just that the laughter is our oxygen....it gives us an escape route to forget the pain for a moment....a pain that haunts every doctor!!
we can never treat every patient we see....we cannot give life everytime we want
sometime or the other we are bound to kill a person who could have been potentially saved just if we would have slept well the previous night.....scary right...yes i guess so
It is knowledge of the fact that we cannot live upto the expectations of all haunts us to our graves and perhaps leads us to more and more laughter......
The laughter that rids us of our pains
Laughter is the best medicine..yup baby bring it on!!!

Masters of Death....The greatest teacher

life isnt simple anymore.....it has its ways to teach people
just few years back i was an arrogant man tryin to prove to the world that i am the best in this world.....i am the best undergraduate that there would be...More importanly i was tryin to prove to my family and myself..
But 5 years of this medicine has changed me..life isnt what it used to be
Patients are wonderful teachers. They withstand so much..just to teach us a few tricks of the trade so that we can earn money and fame when we earn our degrees...
How many of doctors really remember that old man they saw as a 'MAST CASE' who was suffering from esophageal carcinoma....how many of us really remember that one day old baby on which we practised Moro's reflex.....how many of us realll thought what eventually happened with that mentally retarded child whose mother was not feeding him breast milk coz he would become a liability...
probably another part of me will say that it is not possible to remember those...they are just clinical materials for us( for the lack of which, we always complain of!)....
But whatever maybe the reason...eventually it turns out that life teaches us..the medical students to toughen up...to see pain just as a clinical sign....to put it in words one of my professors used to say that doctors seek pleasure in pain...for it fills up their deep pockets!!
ironical isnt it....we just forget that we can die.........
Surrounded by death....we just decide to overlook the dead...
Perhaps that is life and that is what it expects us to be...us the masters of death...

livin and lovin hell.....

you know it is just getting crazy as hell. I am being warned, scared, shouted at, threatened and every imaginable thing to make me against reading Harrison's Textbook of internal Medicine( The God of medicine)...but i am hell bent on doing that...they say its impossible to finish this..crazy to even think about it but i am ready to go crazy this time...
ab aar ya paar.. ths it......either i fail grandly or i create history..thts it..no other way arnd
and as 50 cents put it---Get Rich or die tryin!!!!!!!