Indian Journal of Vascular and Endovascular Surgery

: 2021  |  Volume : 8  |  Issue : 2  |  Page : 117--118

What they forgot to teach us at M school…

Ilayakumar Paramasivam 
 Senior Assistant Professor, Institute of Vascular Surgery, Madras Medical College, Chennai-3, Tamil Nadu, India

Correspondence Address:
Ilayakumar Paramasivam
Senior Assistant Professor, Institute of Vascular Surgery, Madras Medical College, Chennai-3, Tamil Nadu

How to cite this article:
Paramasivam I. What they forgot to teach us at M school….Indian J Vasc Endovasc Surg 2021;8:117-118

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Paramasivam I. What they forgot to teach us at M school…. Indian J Vasc Endovasc Surg [serial online] 2021 [cited 2021 Jun 24 ];8:117-118
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Don't you have any sense? Shouted the resident, venting his frustration at a noncompliant patient. True, if the patient had any sense, why should he undergo treatment with us. Scenes like these get enacted within our wards and outpatient departments of our hospitals on a regular basis; only their situation and intensity may vary. Why does this happen? The medical curriculum trains a student in clinical skills such as percussion and auscultation but leaves huge lacunae when it comes to communication skills. We tend to forget the fact that effective communication skills are the key determinant in good patient care and patient satisfaction.

If we remember our very 1st day at medical school, when we were introduced to human cadavers in the anatomy dissection hall, probably that day, we transformed ourselves into cold, noncommunicative, detached personalities, which has stuck on to us even after entering the clinical side.[1] Except for a few physicians like my teacher Prof. T. S. Subbiah, Retired Professor of Surgery, MMC, I did my MS (General Surgery under him) who insisted that we address our patients as Mr. or Mrs. when presenting their case history or like Dr. S. Sridar (late), MMC, who advised us to treat each and every patient like how we treat our own relatives, we had very little guidance on this.

A smile, a greeting, gentle touch, well-groomed appearance, listening to our patients with empathy and above all compassion will go a long way in comforting if not curing these poor patients. In this age of sophisticated gadgets and advanced technologies, if we can improve our communication skills, it will help us diagnose and treat our patients better and increase patient satisfaction. For the physician, it gives greater job satisfaction, prevents burnouts, increases referrals, and faces less mal-practice suits. Since the most important issue in most malpractice suits is mainly lack of communication with the patient and attenders.

“Do not be arrogant because of your knowledge. Take counsel with the unlearned as with the learned. For the limit of a craft is not fixed and there is no craftsman whose work is perfect.”

– The Maxims of Ptahhotep, 2500BCE.

The choice is ours, whether we be allowed to be manipulated and made a willful scapegoat to the exploitation happening within and outside the system or redeem our solemn pledge from our hoary past, tradition, and lineage according to Barry Bub[2] (Radcliffe Publishing, UK).

It is our choice:

To see an examination room as just a room or realize that room is sacred spaceTo be called a healthcare provider or physician and skillful healerTo regard medical practice as a chore or as holy workTo see our work as meaningless or part of the great unfolding.

The choices we make may not necessarily be perfect, but they may alter people's lives, says Gawande;[3] further, he says,

We should ask an unscripted question to our patients, for example, ask about where they grew up. It helps him/her to relax and communicate with you better; sometimes, you may be surprised that such a simple looking man would have been a retired government school teacher or an headmaster from your home town!Don't complain about your work, surroundings, co-workers, etc., but try to improve what best you can with what little you have, so when you leave, you leave behind a better place and sometimes a lasting legacy of ethical work, dedication, and a commitment to excellence, true leaders create leaders not followers, mentoring young people is a tough job but worth it on the long run, they are the future and in all probability going to treat you in the future as well!Count something, document, collect data, present, publish, what is not documented, vanishes for everWrite something in our diaries, blogs about our work, our patients, etc., so you create an interest in your own work.

Prof. C. M. K. Reddy, Retired Honorary Professor of Surgery, Stanley Medical College, Chennai, Senior General and Vascular Surgeon, in his recent book, “The consultation room” (Tyme books, India) focuses on the importance of developing soft skills and public relations to medical practitioners in addition to their academia; in one of its chapters, he mentions about “The twelve commandments” for a “healthy and litigation-free medical practice.”[4]

A tidy appearance and warm receptionEncourage free communication and clearing the patient's doubtsExplain all therapeutic options and involve them in decision-making to the extent possibleOutline the risks involved, obtain informed consent, and never guarantee cureBe punctual and available for emergencies (at least on phone)Maintain proper records and prompt correspondenceBe considerate, noncommercial, and avoid advertisingJoin professional organizations, read literature, attend CMEs, update yourself, and practice evidence-based medicineRespect co-practitioners and be willing to get a second opinionObserve ethics, know the statutes, and act judiciouslyDo some free service and involve in community service activitiesDon't forget your family and children.

Although the above “commandments” were compiled by him in the 1990s, they are very much relevant for today as well as for the future practice as well.

 Clinical Research

Another aspect of medicine that is not dealt with in medical colleges is the need and conduct of clinical research in medicine; apart from the need to publish certain number of articles in indexed journals as a prerequisite for promotion for the faculty, there is a real dearth for genuine research and a question mark regarding the quality of the papers and the often predatory journals they are published in.[5] True, islands of excellence do exist in a sea of mediocrity, but much of the blame for failing to empower the students to do research and set standards for the country lies with the senior faculty who preside over impoverished academic environments, says Dr. K. S. Jacob, from CMC, Vellore;[6] he further outlines certain steps to improve this situation like raising the academic bar by appointing both clinical and research professors, the former, who are mostly experts in the art and science of medical practice and will focus mainly on teaching practical matters rather than theoretical and research aspects, while the research professors focus mainly on theoretical and research aspects, promotion of whom will be based on the standard of their publications and the nature of grants and funding they have received along with innovations and contribution to science. “He concludes by saying that medical schools should focus on clinical and teaching skill among the faculty members, measuring their clinical and teaching performance, which should translate into a meaningful recognition for those achieving excellence such that outstanding clinicians and teachers may feel valued and decide to stay in academia,” and he also feels that “research and academics in India need to focus on the many health, illness and disease challenges facing us and theorize medical practice suitable for its context.”[ 7]

To conclude, since change is the only constant thing in this world, we need to adapt ourselves to this ever-changing world, and we need to change our ways, our ideas, our old concepts, acquire new skills, cultivate leadership qualities, develop a passion driven by ethics, improve the quality of care, and make a commitment to excellence and thus help strive to bring glory to our noble profession and to “the temples of knowledge,” which are our institutions we work for.


1Melissa Piasecki MD. Clinical Communication Book. USA: Wiley-Blackwell Publishing; 2008.
2Barry Bub MD. Communication Skills that Heal: A Practical Approach to a New Professionalism in Medicine. U K: Radcliff Publishing; 2006.
3Gawande A. Better: A Surgeon's Notes on Performance. India: Penguin Books; 2007.
4Prof Reddy CM. The Consulting Room. India: Tyme Books; 2021. p. 128.
5Laine C, Winker M. Identifying Predatory or Pseudo-journals. Natl Med J India 2017;30:1-6.
6Jacob KS. The cultures of academic medicine in India. Natl Med J India 2019;32:308-10.
7Jacob KS. Theorizing medical practice for India. Natl Med J India 2017;30:183-6.