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Welcome to the Medical Profession

Congratulations on being admitted to the Medical Profession.

 

This chapter details the basics of medical education you have chosen to be part of. The Medical Council of India (MCI) decides policies on the regulations and curriculum for the medical courses. The present regulation was introduced by the MCI in 1997. The pattern of the course was changed from the previous schedule. This book is based on the detailed syllabus and curriculum for the MBBS course prepared by the Director of Medical Education, Kerala. The Universities of Kerala have adopted this uniform pattern. From the year 2010, all admissions to the medical courses will be under the new Kerala University of Health and Allied Sciences (KUHAS).

 

The schedule of undergraduate medical education has to be completed within the stipulated period of four and a half years. The students can then complete the stipulated internship of one year in time to be able to write the All India Postgraduate Entrance Examination. With predetermined posting and examination schedules, as detailed in the academic calendar, it will also be possible for the students and parents to organise family functions and tours accordingly.

 

 

 

 

 

MEDICAL COLLEGES IN KERALA

 

According to recent reports, there are 314 MCI approved Medical Colleges in India, offering over 31,000 MBBS admissions and around 12,000 post graduate seats. Of these around half are in the Government sector and the rest in the private sector. In Kerala, there are 23 Medical Colleges, 5 in the Government sector and 18 in the private sector. Of these, 22 come under the ambit of the Kerala University of Health and Allied Sciences (KUHAS), whereas, one forms a Deemed University. The Thiruvananthapuram Medical College was the first one to be established in Kerala. Later on the Calicut Medical College, followed by Kottayam, Alleppey and Trichur Medical Colleges were started. Presently newer Medical Colleges have started in the Cooperative and private Sector, including Co-operative Medical College, Pariyaram, Kannoor, Sree Gokulam Medical College & Research Foundation, Trivandrum, Malankara Orthodox & Syrian Church Medical College, Kolencherry, Amrita Institute of Medical Science & Research Centre, Kochi, Amala Institue of Medical Sciences, Thrissur, Co-operative Medical College, Kochi, Dr. Somervel Memorial CSI Hospital & Medical College, Karakonam, Jubilee Mission Medical College & Research Institute, Thrissur, MES Medical College, Perinthalmanna, Karuna Medical College, Palakkad, Pushpagiri Institute of Medical Sciences & Research Centre, Tiruvalla, Kannoor Medical College, Ancharakkandi, Kannoor, SUT Academy of Medical Sciences, Thiruvananthapuram, Azeezia Institute of Medical Sciences, Meeyannoor, Kollam, Travancore Medical College, Kollam, KMCT Medical College, Calicut, SN Institute of Medical Sciences, Paravoor, Ernakulam and Malabar Institute of Medical Sciences, Calicut.

 

 

 

 

 

 

 

 

 

DURATION OF THE COURSE

 

The undergraduate medical education is to be completed in five and a half years including one year of Internship. The course of four and a half years is divided into nine semesters of six months each. The first two semesters constitute first MBBS, when the pre-clinical subjects of Anatomy, Physiology and Biochemistry are taught. The second MBBS for the next three semesters constitutes the para- clinical subjects of Pathology, Microbiology, Pharmacology and Forensic Medicine. The final MBBS lasting for four semesters includes Community Medicine, Ophthalmology, Oto-rhino-laryngology, Medicine, Surgery, Obstetrics and Gynaecology and Paediatrics. Clinical postings in the hospitals will start from the third semester onwards. You have to recognise that at the end of one year from now, you will have to be tackling the actual patients. This requirement will identify the importance of being a real professional in the ethical sense.

 

The first year is going to be the toughest. You are getting into the new world of the medical profession. The subjects are new. The timings are tight. You start the classes at 8.00 a.m. You have to rush in before the door closes. The teaching methodologies are new. The examination patterns are new. You will have regular internal assessments. The class timings are going to be long. The I MBBS examination is just ten months away from the commencement of the course. Don’t get worried about the tight schedules ahead of you. There are ways to tackle them. This is only meant to inform you that there is no time to waste. Start straight away. The mode of teaching and assessment are different from your earlier ones. You will have to adjust your mode of studying and facing examinations accordingly. Recognise that the subjects are too vast, as you will know shortly. Don’t dream that you can mug up every line of standard textbooks from first to last page. “Overall study without leaving the essence” is the line of rescue. Try to use the basic books to learn the essentials. Be oriented practically; all we learn are to be practiced on the living human body! You are welcome to obtain the help of your teachers whenever there is any strain.

 

 

 

REGISTRATION

 

Once you have graduated, you will have to obtain provisional registration with the Travancore Cochin Medical Council. Then there is a training programme for one year called Compulsory Rotating Resident Internship (CRRI), which is basically done in Medicine, Surgery, Obstetrics and Gynaecology and Community Medicine. After this permanent registration with Travancore – Cochin Medical Council will have to be obtained which is the most important document for practicing medicine

 

 

POST GRADUATION

 

At the end of House surgeoncy, you will be independent as a medical professional. You can either perform jobs as medical officer or start your own practice or go for higher studies. There are several fields where you can take post graduation. You can go for three-year postgraduate degree courses in any of the basic medical subjects or specialities, which have been covered in your undergraduate studies. There are also certain post graduate diploma courses of two years duration in some subjects like Obstetrics and Gynaecology, Orthopaedics, Ophthalmology, Anaesthesia, etc.

 

 

 

 

SUPER SPECIALITY COURSES

After PG degree courses, you can study for superspeciality degrees like DM (Cardiology, Neurology, Medical Gastro-enterology, Nephrology etc.) or MCh (Urology, Paediatric Surgery, Neurosurgery, Plastic Surgery, Surgical Gastro-enterology etc.). There are five-year courses leading to MCh. in Neurosurgery directly.

 

 

 

MEDICAL EDUCATION SERVICE

The Medical Council of India now insists on a post graduate degree as a basic need for appointment as Lecturer / Assistant Professor in teaching Departments. People who are not keen to do clinical work can opt for the non-clinical teaching Departments like Anatomy, Physiology and Biochemistry or paraclinical Departments like Pharmacology, Pathology, Microbiology and Forensic Medicine. These Departments give more of teaching jobs.

 

 

 

MODERN TRENDS

Computer informatics has come of age in the medical profession. Try to procure basic knowledge on computers. It will keep you in good stead as you go along in the profession. Try to do one research project during your course. It will stand you in good stead as years pass by. You will learn that you can achieve the heights you are due for. Modern technological advancements are pervading the medical practice in terms of investigations and treatment. The advent of Ultra sound scan, colour Doppler, CT scan, MRI scan, PET scan and the like and the therapeutic modalities like endoscopy and laparoscopy has revolutionized medical learning

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TEACHERS

 

Teachers of today will make you what you will become tomorrow. So they should be seen as role models. They will teach you the art and science of Medicine. Learn to imbibe the knowledge, good professionalism and ethics from them. However, don’t consider teachers as flawless. Some one may reprimand you, another may hurt you, but these are to be taken in the proper perspective. Some body will definitely be there to support you and take you through crisis periods.

 

 

 

 

 

ETHICS AND EMPATHY

 

In the days of Hippocrates, the doyen of medical profession and the Father of Medical Ethics, the doctor was considered as a Demi God. This situation continued to be very true even till very recent times. Unfortunately there is recently a general trend in the society to downgrade the importance of the medical profession, as can be gauged from the number of cases that are being taken up in the consumer protection forums against doctors. This is very unhealthy for the medical profession and more so for the society. We should ask ourselves why this change has occurred.

 

The Medical profession should ponder over this issue and introspectively assess the causes of this malady. We will have to accept that we are responsible for this impasse. This is all because of the deterioration of medical ethics in the profession. Ethics is decided by the right approach in the conscience of the professional. In every thought, action, talk, teaching, diagnosis and decision making of the professional, ethics comes to play a significant role. What is right for the patient and the family should be the motto. In order to achieve high ethical standards, one has to show empathy. Empathy means putting oneself in the shoes of the patient. The doctor should consider how he would feel, if he had been the patient. The doctor has knowledge of the disease whereas the patient may not have the knowledge. Empathy requires emotional understanding of the patient.

 

I would request all the new entrants to our noble profession to consider these very seriously. The parents should also have a strong thinking on these aspects as you also have a great role to play in the development of your child as a professional in the medical fraternity. The most important casualty in recent times is medical ethics. The profession has lost its glory because many in the profession have converted the great vocation into a money spinning business. The patient is considered as an object to be utilised for financial gains. The mushrooming laboratories around the place have started giving big incentives for which the clinicians fall at the expense of the poor patient.

 

The medical students of today and tomorrow are the ones who can bring the situation out of the crisis and hence this appeal. Those who have elected to come into this profession should take an oath that their purpose in life should be service above self. They shall recognise that their position in society is due to the high levels of intimate services that the profession can render to the ills of the body and mind of the society. Wherever you go, the medical profession is sought after. Take the Railway reservation form, you are to note if you are a doctor. You fly in a plane; there is invariably a call for a doctor on board. You are needed every where, you are wanted by every body. Take the highest dignitary on earth; he will also crumble in front of a doctor. You thus find that the pain of mankind, the agony of mankind, the diseases of mankind, the injuries of mankind, the catastrophe of the vagaries of nature all make the doctor big. Should we professionals bloat over this recognition? My dear young friends, we should exhibit humility in this great honour that God has bestowed upon us; that society has bestowed upon us. If we fail to achieve that humility, God shall disown us; society shall ridicule us.

 

 

 

 

 

COMMUNICATION SKILLS

 

One aspect of medical education, which has taken a back seat of the present day medical training is teaching communication skills. Both verbal communication and non verbal communication play a significant part in tackling human emotions. Many an illness is cured by a caring attitude towards the patient and the relatives. This can be corrected only by developing a professional personality. This cannot be read from books. This has to be imbibed by being one with the teacher - an ideal teacher. Here in comes the role of the teacher in developing the professional communication skills of the students.

 

 

 

THE HUMBLE BEGINNING - WHAT CAN BE DONE?

 

Very simple, you can start straight away. Don’t consider that you have reached the pinnacle of your life’s achievements. This is only the beginning of a great saga. Start preparing for that straight away. Develop your personality to fit into the requirements of the professionalism that is to be inculcated into you. You are no more a child. In spite of your young age, the society regards you with respect, for you can cure the ills of the society. Stand up to the expectations of society. Dress well, behave well, show humility, don’t waste time, learn to be a good listener, talk gently to others, work hard, avoid too much of leisure, respect the feeling and emotions of others, consider your patient as a human being with a body and mind and show empathy towards them. Recognise that if you can’t do anything to a patient in terminal illness, you could still console the relatives and do a great service to them. When you are in the hospital, recognise that all patients and bystanders are observing you. Your looks, your movement, your talk, your behaviour, your concern for the patient all will be under scrutiny. Respect your teachers, your senior and colleagues. Treat your nursing colleagues with respect. They can teach you practical medicine a lot. Behavioural aspects of a professional make or destroy his credibility. When you attend the wards, be very careful about your dress, which decides your personality. Men should ideally wear a dark coloured pant and a light coloured shirt, which is tucked into the pants and have ordinary full shoes. Jeans, T-shirts and other casual wear, slippers, sports shoes and the like should not be worn. Ladies should ideally wear light coloured sari with matching blouse. Glamorous and modern dresses should be avoided. The hair should be put up if the length falls below the level of the shoulders. Flowers should not be adorned on the hair. Too many ornaments should be avoided. All should wear overcoats extending up to the knee with half sleeves. Name plate must be worn.

 

 

 

EPILOGUE

 

So dear friends, be prepared for a change. Be prepared to take up the challenges of the profession. With a little care, I am sure you will come unscathed with much better wisdom, intelligence, knowledge, maturity and professionalism to lead a life of a clinician in a way that Hippocrates preached and practiced and would want us all to lead.  The Hippocratic Oath and the other more recent Oaths, which are used to be sworn by all modern medical professionals, are appended for your perusal.

 

 

 

 

 

 

 

 

 

HIPPOCRATIC OATH

 

1. i.                     I swear

ii.                     by Apollo the Physician and by Asclepius and by Health and Panacea and by all the Gods as well as Goddesses, making them judges [witnesses],

iii.                    to bring the following oath and written covenant to fulfillment, in accordance with my power and my judgment.

2.                    i.                      to regard him who has taught me this techne as equal to my parents, and

ii.                     to share, in partnership, my livelihood with him and to give him a share when he is in need of necessities, and

iii.                    to judge the offspring [coming] from him equal to [my] male siblings, and

iv.                    to teach them this techne, should they desire to learn [it], without fee and written covenant, and to give a share both of rules and of lectures, and of all the rest of learning, to my sons and to the [sons] of him who has taught me and to the pupils who have both made a written contract and sworn by a medical convention but to no other.

3. i.                      And I will use regimens for the benefit of the ill in accordance with my ability and my judgment, but from [what is] to their harm or injustice I will keep [them].

4. i.                      And I will not give a drug that is deadly to anyone if asked [for it],

ii.                     nor will I suggest the way to such a counsel. And likewise I will not give a woman a destructive pessary.

5. i.                      And in a pure and holy way

ii.                     I will guard my life and my techne.

6. i.                     I will not cut, and certainly not those suffering from stone, but I will cede [this] to men [who are] practitioners of this activity.

7. i.                     Into as many houses as I may enter, I will go for the benefit of the ill,

ii.                     while being far from all voluntary and destructive injustice, especially from sexual acts both upon women's bodies and upon men's, both of the free and of the slaves.

8. i.                      And about whatever I may see or hear in treatment, or even without treatment, in the life of human beings -- things that should not ever be blurted out outside --, I will remain silent, holding such things to be unutterable [sacred, not to be divulged],

i. a.                 If I render this oath fulfilled, and if I do not blur and confound it [making it to no effect]

b.                 may it be [granted] to me to enjoy the benefits both of life and of techne,

c.                 being held in good repute among all human beings for time eternal.

ii. a.                If, however, I transgress and perjure myself,

b.             the opposite of these.

 

 

 

 

 

 

 

 

 

 

 

HIPPOCRATIC OATH (MODIFIED)

 

I swear by Apollo Physician, by Asclepius, by health, by Heal-all, and by all the Gods and Goddesses. Make them witnesses that I will carry out, according to my ability and judgement, this oath and this indenture.

 

To regard my teacher in this art as equal to my parents; to make him partner in my livelihood, and when he is in need of money to share mine with him; to consider his offspring equal to my brothers; to teach them this art, if they require to learn it, without fee or indenture; and to impart precept, oral instruction, and all the other learning, to my sons, to the sons of my teacher, and to pupils who have signed the indenture and sworn obedience to the physician’s law, but to none other.

 

I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or wrong them, I will not give poison to anyone though asked to do so, nor will I suggest such a plan. Similarly I will not give a pessary to a woman to cause illegal abortion. But in purity and in holiness, I will guard my life and my art. I will not use the knife on sufferers from stone, but I will give place to such as are craftsmen therein.

Into whatsoever houses I enter, I will do so to help the sick, keeping myself from all international wrong-doing and harm, especially from fornication with woman or man, bonded or free.

 

Whatsoever in the course of practice I see or hear (or even outside my practice in social intercourse) that ought never to be published abroad, I will not divulge, but I will consider such things to be holy secrets.

 

Now if I keep this oath and break it not, may I enjoy honor, in my life and art, among all men for all time; but if I transgress and forswear myself may the opposite befall me.

 

 

 

 

 

 

 

 

INTERNATIONAL CODE OF MEDICAL ETHICS

 

Duties of Doctors in General

A Doctor must always maintain the highest standards of professional conduct.

A Doctor must not allow himself to be influenced merely by motives of profit.

The following practices are deemed unethical:

a)                   Any self advertisement except such as is expressly authorized by the national code of medical ethics.

b)                   Taking part in any plan of medical care in which the doctor does not have professional independence.

c)                   To receive any money in connection with services rendered to a patient other than the acceptance of a proper professional fee, or to pay any money in the same circumstances without the knowledge of the patient

Under no circumstances is a doctor permitted to do any thing that would weaken the physical or mental resistance of a human being, except from strictly therapeutic or prophylactic indications imposed in the interest of the patient.

A Doctor is advised to use great caution in publishing discoveries. The same applies to methods of treatment whose value is not recognized by the profession.

When a doctor is called upon to give evidence or a certificate he should only state that which can be verify.

Duties of Doctors to the Sick

A doctor must always bear in mind the importance o preserving human life from the time of conception until death.

A doctor owes to his patient absolute secrecy on all which has been confided to him or which he knows because of the confidence entrusted to him.

A doctor must give the necessary treatment in emergency, unless he is assured that it can and will be given by others.

Duties of Doctors to Each Other

A doctor ought to behave to his colleagues as he would have them behave to him.

A doctor must not entice patients from his colleagues.

A doctor must observe the principles of “The Declaration of Geneva” approved by the World Medical Association.

 

Declaration of Geneva

 

Adopted by the General Assembly of the World Medical Association at Geneva, Switzerland, September 1948

At the time of being admitted as Member of the Medical Profession:

I solemnly pledge myself to consecrate my life to the service of humanity

I will give to my teachers the respect and gratitude which is their due;

I will practice my profession with conscience and dignity;

The health of my patient will be my first consideration;

I will respect the secrets which are confided in me;

I will maintain by all the means in my power, the honor and the noble traditions of the medical profession;

My colleagues will be my brothers;

I will not permit consideration of religion, nationality, race, party politics or social standing to intervene between my duty and my patient;

I will maintain the utmost respect for human life, from the time of conception; even under threat, I will not use my medical knowledge contrary to the laws of humanity;

I make these promises solemnly, freely and upon my honour.

 

 

 

 

 

Dr. A.P.J. ABDUL KALAM’S OATH FOR

MEDICAL PROFESSIONALS

 

(With modifications by Dr. Y.M. Fazil Marickar, MS, MAMS, PhD (Urology), FAMS, FAS, FIMSA, FEMSI, Principal, Azeezia Medical College, Kollam.)

 

  1. I realize that as a medical professional, I am in God’s mission.
  2. I will always give part of my time for treating patients who cannot afford.
  3. As doctor, I will never introduce the diagnostic pain to my patients and I will recommend conduct of minimum need based medical tests.
  4. I will treat at least 20 rural patients a year at minimum cost by going to rural areas.
  5. I will encourage the development of quality indigenous equipment and consumables by making use of them in all our diagnosis and treatment assuring the reliability of the products.
  6. If I get into research in medical science, I will work in directed research for developing vaccine for malaria and HIV and finding a permanent cure for type-I and type-II diabetes.
  7. I will follow the motto “Let my brain remove the pain of the suffering humanity and bring smiles”.
  8. In order to fulfill the above obligations, I shall strive to develop professional integrity by caring for my personality development, honoring my commitments, following time management, adhering to appropriate dress code warranted by the profession, respecting my teachers and parents, loving my colleagues, respecting public opinion and caring for humanity by showing empathy to whomsoever comes to me for support and help.

 

 

 

AT THE END OF 40 YEARS FROM NOW,

YOU SHOULD ANSWER THESE 8 QUESTIONS

 

1.             Have I received a single rupee as corruption from any patient?

2.             Have I received a single rupee as commission from any Laboratory for having sent patients for any investigation?

3.             Have I received any sponsorship from any firm for attending any conference?

4.             Have I decided to do a Surgery on any patient with the intent of obtaining personal gains?

5.             Have I asked for a single investigation with intent of getting illegal gratification?

6.             Have I worked in a private hospital while I was not permitted by rule of law?

7.             Have I discriminated any patient on the basis of religion, sex, nationality or political affiliation?

8.             Have I done to any of my colleagues, what I would not have liked to be done to myself?

 

If the answer is “YES” to any one question, then the oath taken now will become invalid.

May God bless you.