Doctor diaries. Counselling for parenting??

 

n-PARENTING-628x314

This week, I had a rather unusual request. I have worked with new parents who are flustered over post partum issues, or parents who bring their children for sorting of behavioral problems. Contrary to what I was expecting, the client I spoke to had none of the above. Instead, she had come to enquire whether she was “fit” to be a mother! She wanted to know whether she was making the right decision at this point of time and needed someone to validate it. This was so new and so unexpected, that it got me thinking and back to my books.

In the Indian setting, one of the main reasons behind a marriage happens to be to have children. Within a year of the marriage, the couple tends to answer stray questions about “good news”, which become insistent as the years pass. Though the scenario seems to be changing (for the good) in many cities across the country, a large amount of the population still seems to be stuck on the fact that the most important goal of a marriage is to have 2.2 children and hence a complete family!

Children (even the ones yet to be born) are considered the messiahs to a number of problems which exist in the family. If the couple are fighting- “Have kids, it’ll be ok”, would be the sage advice. Relationship issues with the in laws- a grandchild would solve all the problems. Irresponsible husband- “Hand over a child and see him change over to a new leaf!”. Though repeated examples prove that in issues such as these, the problems seem to complicate further with a child, the urban legend still seems to go strong.

Hence, this client of mine, made me wonder at her maturity.

A parent child relationship is central to a child’s moral development, social behavior and ultimate attainment of adult independence. In the age of joint families, children would have the additional advantage of knowing how to deal with a lot of people at a young age. Also, the amount of input they used to receive would be more. But in today’s scenario of a nuclear family, with one or both working parents and part time availability of grandparents, bringing up a child and remaining relatively stress free seems to be a tall order. Coming to think of it, planning parenting seems to be necessary for every couple. But most of the time, the planning would involve financial issues, and little else.

We live in a time where stress is a part and parcel of everyone’s life. Unfortunately, stressed out parents are not good for the healthy development of the child. Though advertisements show hoardings of happy roly-poly babies and their benevolently smiling, content mothers, most post partum experiences do not behave like it. Painful episiotomies, worries about adequate milk, sleepless nights and post vaccination fevers do take a toll on the mother’s mental health. Hence, planning a stress free parenting experience would be advisable.

  1. Knowing what happens.

Traditional thinking puts the onus of pregnancy and baby care completely on the mother. This puts a lot of burden on the mother, especially if she is working. A working woman handling a pregnancy and child care has not been without conflict, as they feel the pressure to stay at home as well as to return to work. Employed women feel guilt above leaving their child behind and worry about the competence of the child care that they have painstakingly chosen. Those who stay at home feel a loss of independence and social standing.

Societal predispositions do not help much. If Cheryl Sanders (the COO of Face book) was trolled for going back to work within the first few weeks of her delivery, many other work places, make maternity leave as short as three months, causing much distress to the feeding mother. There are only few workplaces which have child friendly services which the mother can avail.

Therefore, before becoming pregnant, plan the pregnancy and post partum period with an almost clinical precision. Discussing  each partners’ share of child care responsibilities beforehand makes life easier. Talking to the employer about how to manage post partum work period would also help.

  1. Prepare sensibly.

There is a lot of literature out there regarding pregnancy and the post partum period. Pick the ones which are written by qualified doctors or specialists. Make sure not to believe everything that is put out on the internet. Listen to the voice of experience (which includes grandmothers, mothers and well meaning aunts), but also learn to sort the myths from the truth. Talk to your Ob Gyn regarding the doubts that you have regarding your diet, precautions and work pattern. Keeping fit and eating healthy makes a huge difference too. The traditional “eating for two” concept probably needs to be discarded asap.

  1. Life changes. Learn to accept it with grace.

Child birth is a life changing experience. You suddenly become responsible for a very helpless person, who depends totally on you for his/her well being. For the next so many years, the parents have to automatically think about the baby before making ANY decision, be it as simple as going to the movies or making a move from one city to the other.

First time mothers also need to understand that babies are whimsical creatures who dance to their own tunes. They come loaded with personalities which take time to understand and accept. Be prepared for change and accept it as the norm. Only then, can the post partum blues be kept at bay.

  1. Recognize post partum depression.

Sleeplessness, decreased appetite, irritability, extreme frustration, sadness, fatigue, inability to feel happiness and any such symptoms during pregnancy or post delivery should not be considered as normal. Mothers need to consult their obstetrician or a counselor to rule out post partum depression, which happens to be quite common, though poorly recognized.

Having children can be an invigorating experience. Watching them grow and growing with them is definitely fun. But it does not discount the fact the first few months(or years) can be taxing for the mother.  Going by the idiom “Well begun is half done”, it would be sensible to prepare for parenting than to take it as it comes!

As Benjamin Franklin famously said “ By failing to prepare, you are preparing to fail”, the client who came to me made me wiser and better prepared for the next one!

 

 

Advertisements

A little bit of empathy- Doctor diaries.

 

Monotony brings in boredom. I believe that this happens to the best of us, in whichever profession we happen to be involved in, and so medicine is no exception. Though we start of as idealistic, bright eyed, young doctors, over the years, we get jaded due to tiredness and the sheer numbers that we treat. There is hardly any time to think. Rather, we work more by force of habit, than the passion that we started of with.

Prof. B.M. Hegde, the former Vice Chancellor of MAHE University was often known to quote, that as doctors, we need to cure rarely, care often and comfort always.  But in the mad juggle of life, responsibilities and work, we sometimes lose out on the sensitivity which we need to show the patient, rather than just treating him.

As a mental health professional, the number of times that I have had to diagnose a life threatening illness is less as compared to many other branches of medicine. Rather, most of the illnesses in my bag, fall in the category of life altering. Nothing remains the same after the diagnosis is made. Both for the patient and the family. A lot of times, this causes morbidity in ways which are unseen, but cause a lot of suffering. Decisions that fall outside realm of medicine, like long term medications to be given to patients who are not so willing to swallow them, the crashing of dreams which the parents would have built for their children, the change in roles and responsibilities when the bread winner of the family falls sick, the insecurity of a relapse, the frustrations of the family which work adversely on patient outcome and the societal shaming – all of which are invisible to us, but very much a part and parcel of the illness. And as it is invisible, it often becomes easy to brush off conveniently under the carpet.

It was on one of such days when I diagnosed schizophrenia in a seventeen year old boy. The mother  broke down and started crying copiously. After customarily consoling her, I happened to remark that there were others who had worse forms of the disease, and so should consider herself lucky. To which she replied that maybe it was so, but she was crying not only for her son, but also for breakdown of her life which was painstakingly constructed for the past so many years. She told me that she had to cry so that she could grieve the loss, the burden and her son, and only then she could accept it. She asked for permission to cry, because she could not do it in front of her son or family. Once done, she walked away quietly, only to return for the next visit with a set of questions regarding how her son and family could cope better.

This small incident made me rethink my qualities as an effective counselor. As a doctor, I had thought it important to treat the disease, but forgot about the patient and his family. I could have consoled myself saying that the lack of time was the cause of this heartlessness, but it somehow seemed unforgivable. There are many instances that I have seen, where there are doctors with no super specialty degrees or  swanky clinics, but where the Que for visiting the doctor is serpentine. What they call “Kai guna” in kannada, must be the magic of sharp observation, unhurried questioning and a profound sense of empathy used together as treatment. This combination must be more potent than all the medications and hi fi equipment put together.

From then on, I resolved to spend a little more time with my patients than just enough to spot the diagnosis. And the results have been nothing short of remarkable. Now I have extended families in my patients. The caretakers know that they have a shoulder to cry on and are hence more comfortable. Each milestone they have achieved becomes partly mine. And when the seventeen year old passed his class twelve with a first class, I got home a huge box of yummy mysurpak. There seems to be no monotony anymore.

How bad is it, doc?

doctors There are many cliches associated with being doctors. The near dictum that doctors are next to Gods. That practicing medicine is a noble, respectable, ideal profession. In the nineties, most children in India, I would safely say, grew up with an idea that their life would be made if they became doctors, or engineers. It was the rare parent that would allow his child to choose a profession apart from these two.

According to a recent study by the WHO, despite medical schools mushrooming all over India, we still are short of doctors.  The state of a patient in rural India, who needs some form of emergency medicine is still abysmally bad. So,yes,we do need doctors.

But suddenly, it almost feels like doctors are everyone’s favorite punching bag. It is as if we are a group of individuals with dubious reputations, unscrupulous, unethical and those trying to make a buck out of the poor patient’s pocket.

It is therefore probably the right time to remind ourselves that medicine is, basically, just another profession. Yes, compassion is important, as well as a sense of responsibility. But then, those with an aptitude for both should not have difficulty in finding their way into this field, just as someone with good computing skills takes up computer engineering. To deglamorise, doctors study five and a half years for a degree which tells them how tackle certain ills in a scientific manner. We do not claim to be Gods, nor are we the devil reincarnate.

I do agree that there is a lot going wrong with the practice of medicine in India. But these wrongs mainly stem from a flawed, aged, system rather than the individual doctor.

Children as young as seventeen, I believe, rarely have the maturity to realize the seriousness of a profession like medicine. In the west, medical school would be an option to only those with an undergraduate degree under their belt. I personally know of kids who take up medicine because of the glamour associated with it or because of parental pressure. When you choose a profession for the wrong reasons, the outcome seems near obviously bad.

The presence of corruption in a system which deals with life itself. In conversation with one of vice chancellors of a medical school, I get to understand that the seat matrix in any medical school across India is decided by how many palms are greased rather than, how good the patient student ratio in the teaching hospital is. We see around us a number of med schools where professors exist only on office papers, and the teaching hospital needs to be filled with fake patients who are hired during MCI inspections. We PRACTICE MEDICINE. And where the practice of teaching is poor, the confidence of a doctor to handle a patient is obviously poor.

The weird attitude that once we choose to become doctors, we, as individuals, need to give up on material gains. The salaries of doctors in rural service is pathetically low for the amount of risk that they take. To quote Atul Gawande in his book, “Better” ,doctors in rural India are the most innovative and efficient. They need to work with patchy electricity, minus specialist help, have to work against unhealthy  but traditional practices to the convince the family to get the patient treated. Hence, they learn to work with enormous amount of common sense. But, the rewards materialistically or otherwise are poor. They have poor roads, horrible infrastructure, no legal aid, their children have no good schools, due to which they would have to be sent away for their education. All the while, when media glaringly shows them, that their counterparts, with half the years of education, are earning fat sums, driving the newest eye candy, spending time in malls, living in penthouses, working in centrally air conditioned offices and sending their children to international schools. Who in their right mind would choose rural service?

As doctors we ultimately deal with lives. And people. And people with a million different personalities. And these personalities, when they are under stress of illness. But nowhere in medical schools are we taught the importance of good communication, on dealing with grief, on being calm during periods of stress or emergency. It is as if we are expected to magically source this information from some place in the universe and imbibe it. The art of counseling, is not hereditary. It needs to be taught. And as my dean in med school, Prof. Dr.B.M.Hegde would quote, doctors, needed to be trained to “cure rarely, care often and comfort always”. Poor counseling skills, automatically translates to poor patient care.

Law concerning self protection, medical insurance and negligence are alien subjects when we study medicine. We only get to hear these terms when we land, slap bang in the middle of a controversy. We do make mistakes. We are human. But, mostly the health of our egos and our bank balance depend on the good health of our patients. The pleasure we get when we see a critically ill patient walk back home with a smile on his face, is probably what keeps most of my fellow doctors in the profession, despite the grueling hours and non existant social life. Hence, if we were to be taught what to do when we err, we would definitely tread with more caution, rather be caught on tv appearing like a petty criminal.

If we are a society concerned with health, then we have to understand that we have an individual responsibility towards our health. Poor lifestyle habits, not following the doctor’s advice and skipping doses, and then blaming the doctor for poor health despite taking expensive medicines is simply playing the blame game. Not acceptable.

To summarize, we need a multi pronged approach to start a change in most of these areas. Able law makers,thinkers, senior doctors and the public at large who should first understand the flawed but totteringly functional system completely. And then attempt change. Only then, we can hope for the health of the country as well as its doctors.  Till then, still happy to be a doctor and enjoying it despite the hurdles!