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Sunday, October 13, 2013

The Family doctor

The days of the family doctor concept is slowly disappearing with the advent of multispecialty corporate hospitals .all the shine and sheen of such a place can never reclaim the warmth of a known family physician ,
I know , because I still remember some of the doctors I knew in childhood , and many patients still remember me in my two decades of being a family doctor in Cochin .
My early memories in Madras during childhood is of Dr Rajagopal an ENT surgeon who served in the army for some time and later had a roaring practice in Mylapore ,
he used to even do tonsillectomies in his four roomed clinic .
I remember going to him for sore throat and cough all by myself  and him  inserting a pharynx touch and also peeping into me with his head light ,his bald head would be shiningly close ,
"so young man just take this mixture shall send the bill to your dad later " and I would walk home with a smile .
Later Dr Mohan kumaresh who was also our neighbour was our family doctor ,he was not at all like Rajagopal sir , he was smart handsome and dashing and I never knew later I would be his student in my III MBBs at Royapettah hospital when he would call me
" Hari you tell me now  " ,to a blushing me in front of the others .
Dr Mohan was an ideal for me those days and still is on how a doctor should dress and carry himself .
Generally doctors are known to be quite shabby in their dress this  includes  me ,but Dr Mohan was well dressed  with the latest model shoes which he would exhibit by placing his foot on a bedstead and raising his pant hem with his pen !so that we all see it .

 Dr. Ahmed Ali to whom I had gone for many minor ailments in high school  turned out to be my surgical professor at Kilpauk medical college and to this day he is someone I consider and respect as my mentor ,
I would learn the ropes of family medicine sitting in his hallowed  chair in his clinic during his absence  though I never thought I would do that when I sat as a patient in front of him some years back .
read my post on him

After completing my post graduation in Radiotherapy at Madras Medical College in 1986  I turned down a not very promising offer from Adayar Cancer institute ( maybe my  career would have been different if I had accepted it then academically but no regrets at all  )
we moved to Kerala and Cochin and slowly started a private family practice ,
with no oncology set up in cochin at that time there was no way I could pursue my speciality .

Cochin west was a highly populated area with people living very closely and  many of the places were accessible only by small lanes and in the rainy season these were mud clogged and waterlogged  .

Our house and clinic of course was in the main highway and we had a reasonably busy practice ,

house visits were part of the practice ,relatives would come with a car or an Auto rickshaw and off I would go with a small bag and sometimes a nurse but mostly alone .
Most of them when asked about the distance to the house would say
" just close by Dr  sit we can reach in a jiffy  "with time I used to take such statements with a pinch of salt ,
the place where the vehicle would go would be reached in a jiffy of course but one still had to plod through by lanes and along canals gazing at Chinese fishing nets plunging into the water for their slippery catches .
on the way there would be other patients houses too and they would call out Dr Hari you are here come home for a cup of tea .These were loaded invitations as one would end up drinking a cup of luke warm tea and  seeing a  whole family with their multitudes of ailments and the family would be happy to save a trip to the clinic !with just a cold tea for that doctor !!
of course invitations were plenty for marriages childbirth functions and even funerals which we would attend as far as possible because the formula in private practice is to be accessible to people .
almost being local celebrities they would give us a lot of weight and seat us importantly with the local priest police inspector etc
I even once got an award for good service to the populace at large phew
local community clubs would call me for a speech  and I would put my best act of a politician in a not so good Malayalam as the sleepy audience would confirm later
but many remembered us ,any office we went for any work there would be somebody whom we knew and he or she would do the work for us in a jiffy ,avoid queues as doctors were deemed to be eternally busy though in real life it was nothing like that !we too had our time as couch potatoes .
Even after coming to UAE a couple of my former patients who had come to as  children when I was practising in cochin  would call me up from Dubai and Abudhabi for any health doubts for their family  .
I still remember for a church function where we were invited for the celebratory   lunch on the main day and asked  to come straight to the meda ,having been brought up in Madras to me meda meant stage so I prepared myself  for an elegant speech ready to address the devotee multitudes waiting to hear the golden words of the doctor ,it was an anti-climax when they led us to the main priests quarters which is called the Meda and made me sit for lunch with many others .
Only consolation was I had a talkative police inspector sitting next to me and  who was full of foreboding happenings to doctors !during lonely house visits .
Another menace we had those days were the  local politicians  who  felt doctors made lot of money squeezing their poor constituents and hence  were prime targets to collect money for their needs  ,so they would walk in unannounced while we were seeing  patients and  deliver an impromptus speech on their coming conference for which they needed a big fat cheque for the big fat doctor and how doctors should give back to the society for all the money they grabbed !
of course without the  adjective big fat  added ,
any small amounts would bring a frown to their threating faces and they would counter that's is unexpected from an educated doctor and it   would be remembered at the wrong time   and would leave thunderingly with that threat hanging in the air like the Damocles sword
,this was one problem faced by all the doctors who had clinics ,strangely we were all good friends and so decided to start a local doctors forum and named it PDF or Palluruthy doctors forum ,this name  very much resembled the other DF s of Kerala politics that sounded ominous enough for our purpose ,nothing to beat  a malayalee with than a political outfit .
so next time anyone came  for donations we would speak with a straight face
well you see dear man our rules needs us to present any such requests of donations or subscriptions in in next board meeting of PDF and it has to be approved by the executive committee and later the general body after much debate according to our byelaws and  you may get a fraction of what I want to give now after an year or even later ,this was the language they knew well  and so would sheepishly take what they were offered ......the beggars
incidentally the one other  problem I faced was my amnesia .this was anathema to a GP .
I hardly could  remember my patients names and details when they seemed to know all about me ,
this issue was solved by one of my young patients Ren who was an IT guy ,he suggested me to go for a software built specific for my clinic ,in the nineties it was too early for all this and our clinic was one of the earliest in that area to go for a computerised clinic
 we had a LAN network with monitors for the  reception and for the nurses
I would have a list of my waiting patients and all his details, In fact I was able to group my diabetics hypertensives and the areas from which my patients came and even do a little research
I would surprise my patients with my excellent memory the long power cuts alone were my Achilles heel when the computer would go blonk
today Ren is a top IT man somewhere in the US
thanks Ren .
and thus till I moved back to oncology by joining lakeshore hospitals the family clinic was my livelihood and my enjoyment too ,it has helped me a lot in terms of communications to patients and also in terms of general medical management both of which are lacking in todays specially tuned specialists ,today I am in a specialised field with the background of a general physician which I still hold dear .


Sunday, October 06, 2013

Bicycle Thief review

The legendary Bicycle thief  Ladri di biciclette by director Vittoria de silva is a textbook for movie makers falling in the classic mode of Satyajith Rays Pather Panchali and such greats .
 This Italian Black and white film was in my list to be seen movies for a long time ,at last I did see it today and it left an indelible impression in  my mind .
The script is very simple ,the protagonist living in the hard times in post world war Rome  is able to acquire  a job of sticking posters which was something to be proud of but unfortunately his bicycle which is needed for the job is pawned ,his wife decides to pawn her dowry bed sheets which are valuable heirlooms for any women and thus he gets his bicycle in return
on the very first day of his job the bicycle  gets stolen .
 The rest of the movie is all about the search for his stolen bicycle in the dreary city accompanied by his small son Bruno  as he was bound to lose his job without a bicycle .
The son and father travel to a market where one could possibly find stolen items but though they almost find a similar bicycle its serial number is different ,then Antonio suddenly sees the thief talking to an old man but as soon as he is chasen thief gets away  ,then the father son get hold of the old man in a church with a lot of confusion and try to trace the thief who escapes into a brothel from where Antonio extricates him but a crowd gathers and the thief suddenly develops seizures and there is a lot of sympathy for him .
while the hostile crowd narrow upon Antonio clever Bruno somehow brings a police officer and he tries to check the thief's house but finds no proof of any stolen cycle .
In this stressful time Antonio even hits his son once and then to condone his act takes him to an expensive restaurant to buy him food which he could ill afford ,there is a scene when he loses his son and fears of his being drowned in a river but luckily it turns out to be someone else
finally Antonio is frustrated at his plight and sees everyone moving around with cycles ,he tries to send off his son in a tram and tries to steal another bicycle in desperation but is caught by the crowd and trashed ,his son comes to his aid and seeing the small boy the owner lets them go ,the final scene is a weeping father led by his small son walking into the horizon
this movie which got so many awards including the Academy awards is one of neorealism where untrained actors where all actors were non professionals
Antonio was really a factory worker and young Bruno was just a small boy who galked at the shooting
to make such untrained people act in locations shoots shows the skill of the director
A movie that makes you feel sad and happy in turns with such a simple story
not to be missed at all

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