Wish I had known- Dont forget to document!

While I was going through the ups and downs of the final years of MBBS at Government medical college, Thrissur, one thing became clear. I wanted to be a surgeon. I remember my close friend (now my husband) casually asking me what I wanted to do for postgraduation. I immediately replied that I would be doing MS in ENT at Maulana Azad Medical college, New Delhi. Rather specific, he thought back then. You see, I had already decided I wanted to be a surgeon, and my time in the ENT department was enjoyable during clinical postings and internship. I also did not want to study for the next 6-7 years of my life. Thus, an ‘end-speciality’ is what I wanted. I was ecstatic when I got the placement I wanted.

                     The first wake-up call was probably on the first day of my post-grad training when I realized we were pampered princes and princesses as MBBS house surgeons. Postgraduate life was a raw prelude for things to come. As anyone who has gone through the experience in a busy place like Delhi will tell you, there were some days that I wish I were dead. However, working in a place like Delhi allows you to have so much experience that you will be a confident doctor at the end of those 3 years, able to work independently.

               I did a couple of years as a senior resident before finally settling down as a consultant in a private tertiary care medical college in my hometown. Having a child also puts things into perspective and you then realize that you have to tone down on the number and types of surgeries you do. The times of doing a tracheostomy on a tetanus patient under local anaesthesia were firmly behind me. Those times when your senior kept droning about proper record-keeping started to make sense. It all came to head when a patient came in with advanced laryngeal cancer and airway obstruction at 2:00 pm. The bystander was quite insistent that I had seen the same gentleman a year back and had advised no treatment. There was the undercurrent of ‘this is all your fault’ to add to the stress of doing a high-risk procedure in the middle of the night. After the patient was out of the woods temporarily, I got the old records out and the Gods were looking down on me because though the lesion back then was small, I had advised further procedures. The patient had chosen not to come back. And most importantly, all this was documented in the patient notes. I guess that’s when my hair first started to turn grey. The experience also left a very bad taste in my mouth.

                                      At the insistence of a couple of my students, I wrote the MRCS exam and passed it. When I wrote the exam, I just thought a new qualification would look rather nice on my name board. It turned out to be a lifesaver because one thing led to another, and within a year I was in the UK starting a job as a Specialty doctor.  There was a period of adjustment because practice in the UK is quite different from India. It was always cold and it felt like I was starting from scratch. I often think of all the procedural experience I have accumulated over the years and wish I had kept records. My logbook from my training days probably ended up being used to wrap peanuts in the street. Even when one is thinking of applying for the training pathway in the UK, the system usually allows you to show the last 5 years of experience. Working in the UK also opened my eyes to concepts like ‘work-life balance and perusing other interests (to preserve your mental health because medicine is a tough master). So, Medlogbook is the dreamchild of a discussion a friend and I had about the vast experience we gather in India and our lack of initiative to document that. It is an online logbook which we had designed specifically for the Indian curriculum. It helps doctors record their procedural skills, data for research purposes and interesting case discussions without bringing patient-identifying data into it. This is in the interest of patient confidentiality. It also has the facility to get your seniors to verify the data online through a few clicks. At present we are planning to test-run it for feedback. The basic intent is to encourage junior and mid-career doctors to document their skills and experience. As a doctor, I never planned to leave India. But circumstances and ideology change with time. In retrospect, it would have helped me if I had records of my experience signed off by my senior colleagues to show my experience and competencies as there are alternate routes other than training to become a consultant in the UK. I can see my old friends rolling their eyes and thinking ’why bother?’. It is strange because I had the same thought about 6 years ago and have had to change my mind since. With the number of doctors graduating every year in India, anything that gives you an edge is worth adopting.

Author info:Dr.Sridevi Karuthedath,Speciality doctor ,ENT, Ysbyty Gwynedd,Betsi Cadwaladr University Health Board,Wales, Uk

MBBS(Government Medical college,Thrissur),MS ENT(Maulana Azad medical college,New Delhi),DNB Otorhinolaryngology(NBE,New Delhi),MRCS ENT(Royal College of Surgeons, England),Former Assistant prof. ENT( Amala Institute of Medical Sciences)