Medical Education and Practice - India vs England

One of my Facebook friends has asked me to pen a post on comparing the teaching system in the U.K. with that from India. Frankly, there is no comparison. Firstly, the kind of illnesses we see in India and the ones that we see in the U.K. are quite different. Secondly, our healthcare systems are completely different. In India, we work with limited budgets, whether in government/municipal hospitals or in private clinics/hospitals. 

In the U.K., too, there are some budgetary constraints, but the supplies are all top-class, and there is no shortage of essential as well as non-essential stuff, except for the items which are in the very expensive range. 

Thirdly, and this is the most important difference: the system is driven by evidence - the kind of evidence that comes from research and trials - and is completely based on protocols that are specific to each institution but framed from national and international data that is published by national-level agencies. Such evidence is periodically reviewed so as to be abreast of the current knowledge. This kind of evidence is completely lacking in India. Individual doctors may, from time to time, update their knowledge base and use this to help their own patients. Devising of hospital-wide uniformity of treatment never does occur, so that every doctor treats the same condition differently, based on their own learning, experience, and hearsay from their peers.

Coming to teaching: We have excellent teaching in India as well, but it is fragmented. Doctors learn from their seniors when they are students, but as soon as they start a private practice, they give secondary importance to continuing education. The Medical Council of India and state-level bodies like the Maharashtra Medical Council etc. have recently moved to enforce that every registered practitioner should have a certain number of points to be able to stay registered on the professional register. However, the points can easily be collected by sending the money to the organisers of teaching programs and then receiving the participation certificate in absentia. Many a times, doctors will attend a conference or learning seminar just to get the points, but not use the learning to improve their practice. Occasionally, doctors will, for reasons of expediency, join programs that are not even from their own speciality, just to gather the required points.  

In the U.K., learning is referred to as teaching! Thus, when a student says that they are going for teaching, they are actually going for learning. While I haven't done my formal medical training here and cannot, therefore, comment on how their teachers are, I can definitely say that medical students here are far more experienced than Indian medical students are, in practical, hands-on experience. This is because, from their third year onwards, when they attend the wards (just as we did or do in India), they begin to clerk patients in a proforma, taking the patient's history, examine them, etc. and they will, in their fourth and fifth years, be expected to give a differential diagnosis, and formulate a plan of management for that patient. This allows them to think like practicing doctors years before they actually will practice clinical medicine. 

What really makes the difference in their training, however, is the fact that they have to collect, and later produce, evidence of their learning. This has to be uploaded by them electronically, and I have often had students presenting a medical case to me and then coming back a few minutes later to take my digital signature on their mobile phones to collect the evidence that they did, in fact, present a case to me. They will also sometimes send us a link to give a feedback on how their performance went. This is a requirement for them and not an option. This enables them to advance professionally in a more structured, evidence-led method than the kind of haphazard learning that we have in India.

I hope this answers the question for my friend, and helps others too, to understand how the system works in the U.K.   

Completed a year since leaving Saudi Arabia ... and why NHS is so admirable.

This is a reminder to me that I left the Kingdom of Saudi Arabia on the 3rd of September 2015. Hopefully, it would be my first and only stint of working in the Kingdom. The major takeaways of that stint of nearly 4 years were  the fact that I was able to perform Umrahs and Hajj; that I was able to save some money; that I was able to emancipate my family from being dependent on me; and that I completed the exams that would serve as my stepping stone to enter the United Kingdom (I am talking about the M.R.C.P.C.H.). 

I am unable to say which of these four achievements have led to the maximum benefit to me and my family. I would probably say each of them had their own merits. Spiritually, I came closer to Allah with my Umrahs and Hajj. Mentally, I was able to study further and get qualified with an additional, U.K. approved, post-graduate qualification. My family's "independence" served to liberate me as well. Today, my wife Nishrin and my children, Inas and Hannah have become largely independent and only occasionally have to consult me. Finally, the bank balance has permitted me to take positions in some investments within my country, something that I could not have done earlier.

Since my arrival here in the U.K., I have learned to adjust with the entirely new and unfamiliar system of medical practice. I have realised that I have a long way to go before I will get accepted by my bosses. I am currently learning a lot of skills by working at different trusts in the North Western part of England (and occasionally at other trusts in the U.K.). These skills include communication skills, cannulations, lumbar punctures, planning therapy, child protection, and a lot more.

Over and above this, I am beginning to understand how the English health system (the NHS) functions below the belt. Its underbelly, if you understand what I mean. Initially, I struggled to work, especially when it came to managing the out-patient clinics. Now, don't get me wrong. I have had a clinic for nearly 25 years in India before I went to Saudi Arabia. Nothing prepared me, however, for the kind of patients you see in the U.K. There is acute paediatrics, of course. In the clinics, however, it is all about chronic stuff. Things that can stay in a child's life for years, if not decades. Until 16 years of their life, they are ours to see. In some cases, especially with children having chronic, incurable illnesses, we continue to manage them even when they cross that age. After this, however, they transition to adult medicine. In India, the most we could do was to see them until they turned 13. I did have a few of my old loyal parents who came to me with their 15 and 18-year-olds to have them treated by me, but it was legally untenable. 

However, it is not just about age, or the chronicity of problems. It is about the range of diseases and problems that are totally different from a tropical country like India. Additionally, it is the inherent knowledge patients have about their own illnesses and about their own biological stuff. Finally, it is about how to communicate with them. British sensibilities are completely different from ours. What we discuss with patients openly in India has to be said privately and with much more empathy, for example. The risk of being sued in courts always hangs upon you wherever you work, but it is definitely much more in the U.K. compared to India. 

There is yet another, very crucial difference. In the U.K.. there is a huge infrastructure of community and outreach services that have no comparable example in India. A child with cerebral palsy, for example, has to spend huge amounts to even reach a level of mediocre care in an advanced city like Delhi or Mumbai. Even then, when it comes to successfully rehabilitating that child and integrating him with society, we can hardly do anything. In the U.K.. the system is so advanced that the child gets automatically eligible for a range of rehabilitative services. For example. even his home can be modified at government expense to get him to have a ramp to ride his wheelchair on. If a child with excessive illness related to pollution applies, he and his family can be given an entirely new place to stay by the government. Of course, the family will pay off whatever they can over years and years, but care to the child will not stop because the family does not have the means to fund it.

Child protection is a big thing and abuse of a child sets off a chain of governmental remedial actions that include but are not limited to removing the child from the influence of his abusive relatives, handing him over to an appropriate foster parent, or hand him over to court, which will then place him appropriately, police action that is swift and commensurate with the degree of the abuse, and so on. Social care services will then continue to monitor the whole thing ... until the child can be, if feasible, returned to the family - or be kept away for as long as is needed. 

With such services spread nationally, it is not difficult to understand why the U.K.'s NHS is considered to be one of the best health services in the world. And the services are 90% free to the people - not just British or English citizens, but also legal residents and immigrants after their stay has been legally sanctioned. 

This is all I will be writing about in this post. Do leave your comments below. 

Thanks for visiting, reading and interacting with me.

Medical Professionalism Matters

On the evening of the 12th of July, I had the unique opportunity to attend a workshop on the captioned topic. The venue was the Museum of Science and Industry at Deansgate, Manchester.

This was a joint programme of many organisations led by the UK's top regulating body, the General Medical Council. Other organisers included the British Medical Association, the RCGP, the RCP, and others. The thrust of this event was to interact and formulate a blueprint of what professionalism means to doctors and other healthcare workers in modern times. There were discussions related to several aspects of this; they included talking about proper communication, having compassion in care, being ethical and responsible, being concerned about self-development (professionally and otherwise), being safe and having a paramount concern for safety in healthcare, being a team-worker and being resilient. 

There was a keynote speaker, Prof. Jacky Hayden (@Hayden.Jacky), who spoke on several aspects of qualities of being a good health professional. Her talk was brief but it highlighted all the important issues and set the tone for the next programme - a series of group discussions. During these group discussions, a moderator from the GMC collected thoughts from the participants at each table on a specific aspect of the main theme. Thus, there were tables where, for example, communication was discussed; or, where the discussion related to patient safety, or, to doctors' advancement as scholars and innovators in their field. I enjoyed these group discussions tremendously. There were professionals from all walks of the medical field, right from junior doctors like me, to stalwarts like Pali Hungin, the president of the BMA, sharing ideas freely on all these topics. Each table sat for 20minutes, then we changed to another table, with another topic for brainstorming. 

Supper was served after these discussions, and this was then followed by a panel discussion where the panellists took questions sent by participants. The entire discussion was very illuminating. One of the speakers was Dr Umesh Prabhu, (@DrUmeshPrabhu), a Paediatrician from Wigan. He is a highly innovative person who has made a mark on NHS through his work related to Patient Safety in Healthcare. Do look him up on Twitter.

To read more about this event, and the issues raised therein, do visit www.gooddoctors.co.uk.

Thank you.

P.S. For non-medicos, who are not interested in this post, I apologise sincerely.