May 24, 2015

Home at last!

“Home is where you go to find solace from the ever changing chaos, to find love within the confines of a heartless world, and to be reminded that no matter how far you wander, there will always be something waiting when you return.” – Kendal Rob

​Well the semester is finally over! I’ve packed my things, put them away in storage and locked up my dorm room for the summer. I realised that I’m somewhat of a pack rat- who else would save old, used up pens because they’re reminders of courses completed? As the plane lifted off from the Piarco runway last Tuesday night and I saw the lights of Port-of-Spain spread out below me, I felt like I had finally snapped shut a new chapter- my second year of Med School. It was a relief, to be honest. As the plane climbed higher and higher, I felt like all of my worries and anxieties of the past semester were falling away as I was being whisked away towards home.
At every level it feels like that exam is the hardest exam I’ll ever have to write- that’s how I felt writing SSEE, writing CSEC and then CAPE. And invariably I’ll look back and think, “Why was I complaining back then? I’d definitely prefer to take back CAPE Unit 2 Pure Math and Physics on the same day again than these 2nd year final exams!”
But as my dad likes to remind me, “This too shall pass.” And it does, and I end up surviving another exam and can return home for the holidays.
And it’s been amazing being home, reunited with my family! It’s nice settling into old routines and waking up in my own bed. There really is no place quite like home!
And now I’m home, it seems like the May-June rains are here. Ordinarily I would have to be making the journey to QC and the rains usually make that quite a damp, dreary, smelly and quite miserable ordeal that would have me shaking my fist and railing against the stormy sky. But this time around, safely ensconced in bed, I can borrow a line from Frozen and say, “The cold never bothered my anyway.”
But my return home hasn’t completely been the restful and relaxing lazy-days I was looking forward to. I had been scheduled to return to vote – and looking forward to exercising my franchise in what I’d already figured was a critical one. But then fate, in the form of Caribbean Airlines, intervened when they arbitrarily switched me to the day after.
The past couple of days has been focused more on our elections that I had anticipated. I had (naively) expected that the votes would soon be tallied, a result announced and a Government sworn in relatively soon, not the long, drawn-out saga that has played out. I would’ve hoped that after all the drama with past elections, systems would be in placed to speed up a more transparent process.
The GECOM press conferences proved to be pure theatre…complete with dramatic tension and conflicts. Hopefully today there will be a denouement today that’ll allow Guyanese – including me – to get back to our everyday routine. As I finish this piece I’ve been staring at the TV screen for the last hour – waiting for the final announcement to be made as to who’ll form the next government. My deadline’s past…so I’ll just say: Good luck to the next administration. Life goes on…

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Happy Mother’s Day!

“Mama was my greatest teacher, a teacher of compassion, love and fearlessness. If love is sweet as a flower, then my mother is that sweet flower of love” – Stevie Wonder
Today, the second Sunday of May, has been set aside as Mothers’ Day. Children of all ages, all over the world, will try to do whatever they can to make their mothers feel special. Some will give their mother flowers or cards. Some might even prepare a home-cooked meal, or take their mom out for dinner.
My Dad’s going to call his Mother – my Ajee – in New York…and thank goodness for Skype, we can see her as well. My Mom usually has her Mom over – my Nanie – who’s still in Guyana and we usually have a great sit-down meal. The family that “saa-nays” together sticks together!!
When Mothers’ Day became a recognized holiday in the US in 1914, it quickly spread to the rest of the world. And just as quickly, by the 1920’s it had become as commercialized as any other holiday. Unfortunately.
But why should you only honour your mother on the second Sunday of May? It’s just a date chosen arbitrarily. It could’ve been any other date or better yet, it doesn’t just have to be one date. Why can’t people show their love for their mother every day? Or rather, why don’t they?
Your mother should be important enough to you that you would have no problem with showing her that you love her every day- whether you want to show your love by just saying ‘I love you’ or by showering her with gifts, it’s your prerogative. Be spontaneous; show your love every day in all of the little ways that count much, much more.
You wouldn’t even exist if it weren’t for your mother. With it becoming more accepted for females to have abortions or to be on birth control, your mother could’ve decided that she didn’t want to have to deal with a noisy, complaining, whiningbrat.
She could’ve decided she wanted to be some high-powered executive, completely focused on her career, caring about nothing but her job. But she didn’t. She decided to have you.
So let’s hear it for those wonderful women who had to put up with our wailing in the middle of the night as babies, our whining about going to school, our teenage angst, and everything else.
The women who all too often are our shoulders to cry on, the persons we share our hopes and fears with, the persons who worry about us more than we ever worry about ourselves.
And when we become mothers, we often pattern our behaviour after our own mothers. And my mom has certainly set the bar pretty high – a bit down the road, I’ll have somepretty big shoes to fill.
But the good thing is that your mom would be there to help you get through your own journey through motherhood. She’ll teach you how to hold your new-born child and of course she’ll spoil your kids rotten so they’re always more excited to see their grandmother than you.
And this Mothers’ Day isn’t just limited to celebrating your biological mother. It’s a time to honour all of those great women who were mothers to you, who at some point treated you like you were their own child.
Hey… we can even honour our country that has given birth to us!! Tomorrow is E-Day, when we get a chance to select those leaders who will take care of this sacred land that’s given so much to all of us. And let’s be honest, it has, hasn’t it?
And even though you should be showing your love every day, it is a nice gesture to go that extra mile on Mothers’ Day. And on E-Day!
Happy Mothers’ Day!

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A momentous occasion

“Can a man still be brave if he’s afraid? That is the only time a man can be brave.” ― George RR Martin

On Tuesday, the nation will celebrate the 177th anniversary of East Indians arriving in Guyana.  One hundred and seventy-seven years since the first batches of East Indians arrived on the shores of Guyana aboard the Whitby and the Hesperus.
And in Grade Two, around this time, our project was to make a model of either the Whitby or the Hesperus. I remember those days (not so very long ago) when my Dad and I would painstakingly glue on sails to the masts and paint on tiny portholes onto the sides of the ships.
For me, building that ship was one of the things I liked the most about Indian Arrival Day.  We put a lot of effort into building that ship. We didn’t just build some generic ship – we built the Whitby. We did research to try to build the ship as accurately as possible. It made me reflect that this ship was something important. So as far as school projects go, that one was pretty thorough.
And for the other grades when we didn’t have to build ships, there was always a special effort by the teacher to teach something specific concerning the arrival of East Indians in Guyana.
But somehow, in secondary school, interest in the arrival of East Indians to Guyana waned. The holiday came and went relatively unremarked. The CXC even set exams on this day (as they have done again this year). There were no more assignments to build the Whitby or the Hesperus. Or even to reflect on why their “arrival” was necessary. We should think about those reasons for the neglect.
In history textbooks, there was probably only a single chapter dedicated to Indian arrival and heritage. You could blink and literally miss the entire topic of Indian Indentureship to the Caribbean. And yet about half-a-million souls arrived in the West Indies and the vast majority (almost 75 per cent) remained. Indians have contributed so much to our society and culture. Right off the top there is so much diversity presented to the Region in our dances and songs and music and food. Isn’t curried goat the national dish of Jamaica?? And how about the “ganja” that is now legalised in Jamaica – for “medicinal purposes” of course. And I’m not even going to delve into their contributions with regards to religions and philosophy. They deserve to be celebrated even more widely.
I’m Guyanese, I’m a Caribbean person – I’ve never even stepped foot in India. I’ll always support the West Indian cricket team over the Indian team without question. But the cultural practices, philosophy and beliefs that my ancestors brought and preserved from India, have shaped me, my ideas and my ideals. I am an Indian Guyanese. India may be my “Mother Land” but Guyana is my “Sacred Land”.
So for me, May 5 is an important day. It’s a momentous occasion. It’s the day that the first set of East Indians crossed the Kala Pani (Black Waters) and  arrived on our shores. It’s the day when they disembarked on an entirely different continent. It’s the day that everything changed for them – and for us in Guyana.
It’s the day that their old life ended and a new life began. For better or for worse, they were here, in Guyana, a whole ocean away from their old lives. And most of them left behind family members, and most of them, like my great-great-grandfather, never saw those family members again.
It must have been so traumatic to be transplanted from everything that was familiar to this completely alien land. But they pushed on, they survived and they prevailed. They made a home away from home. Let us not risk that home being destroyed.
They forged a new identity to cope with everything that they had to deal with. They showed courage and fortitude in the face of hardship. They pushed aside their fears to bravely make a better life for themselves and their descendants.
Happy Indian Arrival Day!

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A momentous occasion

“Can a man still be brave if he’s afraid?
That is the only time a man can be brave.”
― George RR Martin

On Tuesday, the nation will celebrate the 177th anniversary of East Indians arriving in Guyana.  One hundred and seventy-seven years since the first batches of East Indians arrived on the shores of Guyana aboard the Whitby and the Hesperus.
And in Grade Two, around this time, our project was to make a model of either the Whitby or the Hesperus. I remember those days (not so very long ago) when my Dad and I would painstakingly glue on sails to the masts and paint on tiny portholes onto the sides of the ships.
For me, building that ship was one of the things I liked the most about Indian Arrival Day.  We put a lot of effort into building that ship. We didn’t just build some generic ship – we built the Whitby. We did research to try to build the ship as accurately as possible. It made me reflect that this ship was something important. So as far as school projects go, that one was pretty thorough.
And for the other grades when we didn’t have to build ships, there was always a special effort by the teacher to teach something specific concerning the arrival of East Indians in Guyana.
But somehow, in secondary school, interest in the arrival of East Indians to Guyana waned. The holiday came and went relatively unremarked. The CXC even set exams on this day (as they have done again this year). There were no more assignments to build the Whitby or the Hesperus. Or even to reflect on why their “arrival” was necessary. We should think about those reasons for the neglect.
In history textbooks, there was probably only a single chapter dedicated to Indian arrival and heritage. You could blink and literally miss the entire topic of Indian Indentureship to the Caribbean. And yet about half-a-million souls arrived in the West Indies and the vast majority (almost 75 per cent) remained. Indians have contributed so much to our society and culture. Right off the top there is so much diversity presented to the Region in our dances and songs and music and food. Isn’t curried goat the national dish of Jamaica?? And how about the “ganja” that is now legalised in Jamaica – for “medicinal purposes” of course. And I’m not even going to delve into their contributions with regards to religions and philosophy. They deserve to be celebrated even more widely.
I’m Guyanese, I’m a Caribbean person – I’ve never even stepped foot in India. I’ll always support the West Indian cricket team over the Indian team without question. But the cultural practices, philosophy and beliefs that my ancestors brought and preserved from India, have shaped me, my ideas and my ideals. I am an Indian Guyanese. India may be my “Mother Land” but Guyana is my “Sacred Land”.
So for me, May 5 is an important day. It’s a momentous occasion. It’s the day that the first set of East Indians crossed the Kala Pani (Black Waters) and  arrived on our shores. It’s the day when they disembarked on an entirely different continent. It’s the day that everything changed for them – and for us in Guyana.
It’s the day that their old life ended and a new life began. For better or for worse, they were here, in Guyana, a whole ocean away from their old lives. And most of them left behind family members, and most of them, like my great-great-grandfather, never saw those family members again.
It must have been so traumatic to be transplanted from everything that was familiar to this completely alien land. But they pushed on, they survived and they prevailed. They made a home away from home. Let us not risk that home being destroyed.
They forged a new identity to cope with everything that they had to deal with. They showed courage and fortitude in the face of hardship. They pushed aside their fears to bravely make a better life for themselves and their descendants.
Happy Indian Arrival Day!

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Elections in the air

“Just because you do not take an interest in politics doesn’t mean politics won’t take an interest in you.” – Pericles, Greek statesman and General (495-529 BC).

Even though over here in Trinidad I’m grappling with finals (and wondering, “Why do we have so many muscles, bones and joints? And why do I need to learn everything about all of them??”), news of our elections keeps wafting over.
Exams or not, I still aimlessly scroll through my Facebook newsfeed (some might call that procrastination, I call it ‘taking time to keep up with the rest of the world’) and I’ve been noticing an ever-increasing number of posts regarding our upcoming elections. And from what I can gather, things are really heating up.
Fingers crossed, this year might be the first election I get to have my finger stained. I’m done with exams on May 7, and hopefully I get done with packing and all those things by May 11.
From my now-going-on-two-years sojourn in Carnival Land, I’ve felt a little better that we’re not the only country where one’s ethnicity/race has such a dominant effect in politics.
You read about these matters and patterns in books – look what’s happening in Iraq – but it really hits home when you experience it “in the flesh”, so to speak. Trinidad has pretty much the same ethnic breakdown as we do – “Indians” and “Africans/Mixed” almost balanced – and with the notable exception of the “French Creole” substituting for our Amerindian 10 per cent.
As a Guyanese, and as a stranger in a strange land, with the chance allusions to politics in “ole talk” and the even more occasional perusal of the local papers, you begin to get a feel for the lay of the land.
The fact that Trinidad will also have elections this year has quickened the discourse. But what have I learnt from my Trini experience? Firstly that by and large they also vote along ethnic lines. By and large.
Unlike us, however, they do seem to have a larger set of folks who may vote along issues outside their ethnic camps – and this adds some fluidity to their voting. They’ve changed Governments several times since the 1980s.
It would appear that unlike what has happened over in Guyana, while there is a recognition that the claims of both big ethnic blocs are to be taken with a grain of salt (or more!), the preferences on who to vote for still appear to be sorting themselves along the old ethnic lines.
While I studied West Indian history, my writing piece was the introduction of new labour into the West Indies – especially Guyana and Trinidad – after the abolition of slavery. The freed Africans and the Portuguese, Indians and Chinese, were moved by the British like chess pieces on a board that they always controlled for their benefit.
And because it was the bargaining power of the Africans that were being undermined by the newcomers, it is not surprising that there was scant interest that the latter were “objects” in all of this, not “subjects”. The British “divide and rule” tactic worked to a “T” – for them.
But today we are masters of our own fate and captains of our destiny, as they say, and we should be moving on beyond the old divisions. But from the little I know divisions and identities are very heavily influenced by pressures and oppression as much as internal belief systems.
The cliché, if I remember correctly, was that “we are constituted as much as we are constitutive”. (Whew!!) At a minimum, I think, our Governments ought to focus on removing social, cultural and economic disparities among our peoples that can be explained and resented by: “it’s because of my race”. I’ll be looking at the parties’ manifestoes from this perspective.
Very sadly though, I don’t think this kind of closeted thinking will disappear overnight. Some folks say that increased standards of living will solve matters. But Trinidad is so much richer than us and yet is so heavily influenced by ethnicity in voting.
But their big block of “swing votes” does suggest that progress is possible. Let’s work on it as we go into the final lap of the elections.
Can we discuss the issues, please?

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The world of books

“There are perhaps no days of our childhood we lived so fully as those we spent with a favourite book” – Marcel Proust

Later this week – Thursday, to be exact – will be World Book Day – a day to show one’s appreciation for books. I can’t think of a better way to show appreciation for books than by reading one.

And therein lies a problem nowadays – with so much to study and so little time, it’s been a while since I’ve had a chance to prop open a book that wasn’t a textbook.

But whenever I think of “books”, a warm feeling of nostalgia sweeps over me. My earliest memories have to do with my father reading to me…and later to my brother and me. He would re-enact the stories with the various “voices” so that the characters almost literally came alive!

It was a great motivator for me to read so that I too, could enter into so many other worlds. The physical books were in themselves objects of awe, only partly occasioned by my father’s caution that one should not “mistreat” books.

I once asked him about this outlook and he reminded me that we come from a tradition in which books are literally “worshipped”. In all the Hindu religious ceremonies the texts are ceremoniously paid reverence.

I also love the smell of books – especially the smell of new books. The smell is a harbinger of what is to come: a whole new world unfolding in ones mind as the words are filtered through the eyes.

But to return from whence I began, even though medical school is supposed to be one long slog through dozens of thick, esoteric tomes, I have yet to touch a traditional “book” – even though I am about to finish second year.

All my “books” have been downloaded onto an iPad that I can take with me wherever I go. So I still read books, but I am yet to turn a page or breathe in that musty smell deeply. And so I guess I am only participating in an inevitable evolution of what a “book” actually is.

For thousands of years before writing, information was transmitted orally – and had to be memorised through intense effort. I grew up hearing about how the Vedas- which would amount to a good size library – were memorised and passed on for thousands of years by specific families.

After the invention of writing, we’ve passed through papyrus, palm leaves and parchments. These would have been written and copied individually – and so they were certainly not very common.

It was only after the German Johannes Gutenberg invented the moving press that books gradually became common. Now five centuries later, my “books” are buried in the electrons of my hard drive in my IPad.

I must confess that it is a completely different experience from reading a book made from paper. And it’s not only the physical object. Somehow the information seems to be more transitory.

What I have found myself doing as part of my study regimen is to make laboriously detailed notes – with diagrams and drawings – of what I’ve read on the iPad. In a sense, I have gone back to the manuscript stage of books – even as I use the quintessential 21st century artifact – the computer.

But I tell you what: I still look forward to a “real” book and one of the things that I’m looking forward to, is to loll around in bed (preferably with the rain pattering on my roof in Guyana) with a good novel.

The novel has helped to develop our modern sensibilities – and Book Day began as a celebration of the first western novelist Cervantes, creator of Don Quixote in the 17th century.

I enjoy the fact that several female writers did more than their bit in the 19th century – especially the Bronte sisters and Jane Austin. Marcel Proust who’s quoted above, wrote what is probably the longest novel ever, translated from French into English as “Remembrance of things past”.

Some 3000 pages, taking a quarter of a century to write at the beginning of the 20th century. Maybe I’ll get the entire edition and plough through it.

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Empathy and being human

“If you could stand in someone else’s shoes… hear what they hear. See what they see. Feel what they feel. Would you treat them differently?” – Empathy: The Human Connection to Patient Care

I saw a video recently that gave me a lot to think about and mull over. It was titled “Empathy: The Human Connection”. Now right up front lets distinguish between “sympathy” and “empathy” – which both concern peoples’ feelings. You feel empathy when you’ve “been there” and sympathy when you haven’t. You feel compassion but not necessarily feel their feelings.
The video took viewers  through a hospital, showing patients, doctors and family members. It used text to nonverbally show what might be going on with that particular person during that particular time, what might be on their mind. It really brought home to me that as a future doctor, what my future patients might be like. They’ll be persons from across the broad spectrum of society. They’ll come from widely different backgrounds, cultures and have different social pressures. They might, as the video mentions, be terminally ill, visiting their Dad for the last time, or been recently divorced. One will have to – for the duration – enter into the world of the “other” to really feel as they do.
We’ve had classes about “empathy” and what it means to be empathetic and the “neuroscience” behind empathy. They also really caused my mind to churn. They made me wonder about whether in my everyday life, how much time I actually take to put myself in other people’s shoes. They made me think back to the times that the people around me were empathetic to the things I was going through. And made me wonder about why even though we’re all wired with empathy, why so many of us really don’t take enough time to be empathetic. It’s supposed to be in our nature, so why then do we find it so easy to just tune out the people around us and just not listen to the things they have to say?
The video really hit home the idea that we really don’t know what’s going on with the people around us. Most of the people in the video, I wouldn’t have had any idea about what they were going through if not for the text above their heads. As a doctor, I probably won’t know many of my patients for an extended period of time. But if I take the time, I can get at least some inkling about the patient’s life other than the fact that they have cancer. And by putting myself into their shoes, I can be more sensitive about how I inform them of their diagnosis and treatment options.
I usually get really anxious when visiting the doctor of dentist. Fear is one of the strongest emotions I feel. I’m usually more comfortable with the doctors that communicate with me. I appreciate it when the doctor reassures me that, “The injection will feel like just a tiny prick”- even if that’s a little white lie. I guess those are the doctors that actually took the time to empathize with me. Like Dr. Clive Jagan who took time to chat with me and distract me while he extracted FOUR of my baby teeth – without me even noticing! And in my experiences the empathetic  doctors were the ones I genuinely liked and trusted.
All individuals are different – a cliche…but not often put into practice. We react differently to triumphs, to tragedies. How as a doctor I might feel about a particular disease mightn’t be exactly how the patient who was just diagnosed with the disease might feel, but I’ll have to do my best to relate to the patient for that at least that little while. Most persons have so much more going on under the surface than they’ll initially let on. Some people might never let on what’s going on their personal life unless someone is concerned enough to take an interest in finding out the root of the problem.
We could all do with being a bit more empathetic in our everyday life. A little care and concern goes a long way

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Happy Easter

“We are all in the gutter, but some of us are looking at the stars” – Oscar Wilde

Normally, because school used to be already closed for a two-week holiday, I’ve never really fully appreciated glorious wonder that is the four-day Easter weekend. The Americans, of course, have taken this four-day weekend civilizational innovation to new levels which alone justify their War of Independence against the Brits!
But since med-school is still in full swing for me now, the long weekend is a welcome reprieve from sitting in a lecture hall, keeping my eyelids open while listening to the droning of names, functions, origins and insertions of 100’s of muscles. You never miss the water till the well runs dry, eh??
I was lucky enough to pop home to Guyana last weekend. Over here in Trinidad, there was a holiday last Monday, Spiritual Baptist Liberation Day, so I took advantage of that long weekend and came home.
Maybe Guyana can follow suit and acknowledge the Rastafarian religion and also give them a holiday?? I have an exam later this week, so I couldn’t return home for the Easter weekend and last weekend was the next best thing.
While I was home, I heard a buzzing sound, and it took me a couple of minutes to register what I was hearing – kites! Normally, the incessant ‘singing’ of kites far in advance of Easter would eventually start grating on my nerves. Especially the ones that are designed with short “tails” to “dance” – careening madly up and down – while continuously varying the pitch of the annoying sound. But this time, it got me thinking about Easter when I was younger.
My dad used to make our kites from scratch. Half of the fun of Easter is assembling your kite and choosing the coolest colours of kite-paper and adding stars and sparkles to make your kite look better than your brother’s!
I never got to experience the paste from “gamma cherries” that my dad used as a boy to stick on the kite paper to the frame – which he would also eat even though he’d been warned his “belly would stick together”!!
The other half of the fun was trying to add as much kite-paper as possible to the “frills” of the kite to make it the most colourful kite ever. As babies we were all always attracted to shiny or colourful objects and we clearly haven’t gotten over that as yet!
Then there would be the careful tying of the “bull” that sang and the “loop” that balanced the kite. The latter needed geometric precision!
My grandparents used to take me and my brother up to the seawall to fly our kites. We have pictures of the four of us, all packed up with snacks in picnic baskets and our kites, ready and raring to go. And it used to be so much fun! The whole process of raising a kite, seeing it dancing in the wind, putting your ear to the thread to hear it sing, it’s all extremely exhilarating.
Like most childhood memories, my memories of Easter are bathed in that warm, golden nostalgic glow, so it’s nice to reminisce over those carefree childhood days.
(If you’re wondering about the childhood memories not bathed in nostalgia, those would be my memories of the hundreds of math problems we had to do in Sixth Grade. Maybe in time, when I’m in my hundreds, I’ll be able to look back on that homework fondly, but I highly doubt it.) My dad advises that there are no “warm” memories unless there are “cold” ones. No “up” without “down” I guess.
But I hope everyone has enjoyed and is enjoying what’s left of the long weekend! It’ll be an “up” memory!!
Have a Happy Easter everyone! And go fly a kite!!

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Doctor-patient confidentiality

“Whatever, in connection with my professional practice or not in connection with it, I see or hear in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret” – Hippocratic Oath

Nowadays, it’s so much easier to get yourself heard across the globe, thanks to the Internet. You can post something on some social media site and within minutes or hours it can be seen by people millions of miles away.
It’s easy to post things without pausing to consider exactly how many people could potentially see what you’re about to share. Confidentiality isn’t such a big deal any more.
It’s not unusual for most people to wake up, roll over in bed, grab their phone (which they fell asleep using) and start scrolling through Twitter or Facebook. We share so much about ourselves on the Internet – what we’re having for lunch, what we’re wearing today, our current location, our political views, complaints about any and everything, and details about our jobs.
And it’s become so normal to share everything that people don’t really think twice before sharing something. And while for most things, the biggest danger of oversharing is annoying your friends with yet another picture of your healthy lunch, sometimes it can have much bigger ramifications.
But for doctors they have an actual duty to maintain confidentiality – there are exceptions – but there is that duty. So if a doctor decides to take a selfie while in the OR with their patient open on the table behind them, with the caption “Ugh #Mondays”, it’s not just how desensitised she is to think that it’s a good idea to post that, she’s breaking the rule of confidentiality with her patient – which is part of that principle of the patient’s autonomy, I spoke about earlier.
Patient confidentiality is a vital part of the doctor-patient relationship, and as indicated above it’s actually part of the Hippocratic Oath every doctor takes. In order for the doctor to be able to make a sound diagnosis of the patient’s condition, the doctor must get all of the necessary information from the patient. The patient therefore, has to trust the doctor to not spill all of their private medical details, in order to speak freely.
Doctors have to be able to balance their lives as individuals with their duty as a doctor to their patients. They’ll have to set boundaries. They’ll have to remember doctor-patient confidentiality at all times.
They’ll have to always keep at the forefront of my mind that the cases they’ll be dealing with are actual people who not only have a desire for privacy but a right. They really wouldn’t want the details of their ailment to be bandied about on the Internet for the entire world to see.
It’s about respecting the patient, it’s about having some empathy and placing yourself into the shoes of the patient to think about whether you’d like it if someone was spilling the beans about your health.
Some of the exceptions are pretty straightforward. For instance the law may require a doctor to inform the authorities of say, a particular communicable disease that presents a public health challenge.
Right now if your doctor suspects that you may have contracted Ebola, she should inform the authorities – while also informing the patient of the diagnosis and also of passing on the info.
While this is a tricky one, doctors many also disclose confidential info if they believe it’s in the patients best interest. But here again, the patient must be informed.
Finally, the last and trickiest exception is if in deciding that a patient’s condition presents a threat to the public, which outweighs the patient’s interest in keeping the information confidential, she must pass on the info.
What I have gained from this issue of confidentiality is that all patients must be considered as subjects with rights and not objects to be manipulated. And patients ought to know about these responsibilities of doctors towards them.
Forewarned is forearmed.

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Medicine and social justice

“One of the fundamental reasons why so many doctors become cynical and disillusioned is precisely because the abstract idealism is worn thin, they are uncertain about the value of the actual lives of the patients they are treating. This is not because they are callous or personally inhuman: it is because they live in and accept a society which is incapable of knowing what a human life is worth” – John Berger.

In school, we’ve covered the fundamental principles of medical professionalism and ethics and last week, I touched on one of them – the principle of patient autonomy. Basically this means that physicians should be honest with their patients and empower them to make informed decisions about their treatment. People aren’t objects to be prodded and probed at the doctor’s will.

I had quite a discussion with some friends as to whether patients will ever be in a position to be “really informed”- not only in our Caribbean locales, but ANYWHERE – since the public’s knowledge of human anatomy and physiology is generally very rudimentary.

But, we agree that the attempt must still be made. It was noted that “informed consent” is more widespread in the US primarily because of doctors fearing medical malpractice suits!

Today I’d like to share a few thoughts on “the principle of social justice”. Now I know that some of you might be saying (with bitter memories of you or some close relative not being not able to secure vitally needed medical care).”Say what?? Doctors and social justice in the same sentence?!”

But there it is. We’re taught that the medical profession must promote justice in the health care system – including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.

The way I see this is that as doctors, we’ll be practising in health care systems at various levels of development. In Guyana, while my dad tells me that things have improved tremendously since he returned in 1990, it is still much below Trinidad.

But with whatever resource set we have at our disposal, we must be fair in our treatment to one and all. It does seem to me that our people are conditioned to defer to the “big ones” in society – and I suspect that doctors also do this – as the John Berger quote above cautions.

One troublesome area is that we’re cautioned about the physician’s professional responsibility for appropriate allocation of always limited resources – both of the institutions, especially governmental and of the patients’ finances.

Doctors, then, should practice a scrupulous avoidance of superfluous tests and procedures, shouldn’t we? After all, the provision of unnecessary services not only exposes one’s patients to avoidable harm and expense but also diminishes the resources available for others.

But from what I already have seen – both during my visits and readings about the U.S. Health system and even in my native Guyana in a couple of private hospitals – there is a lot of over prescription of tests.

In the States, doctors may be doing this because of an overabundance of caution from fear of being sued? But what’s the local excuse?? Making big bucks? While it may be a judgement call to assist in a better diagnosis, I do believe that a doctor should be aware of the social circumstances of the patient and be prudent.

Overall, returning to a previous discussion I had about our more “socialised medicine” than that of the U.S. I am firmly committed to our system. And based on what we’ve been taught, doctors also have a duty to work towards a medical system that is based on social justice.

While I happen to believe in free enterprise, I believe that medical care falls into “public goods” that must be guaranteed by the state. And I am happy that in Guyana we spend such a large portion of our Budget on health. The private medical care should supplement and augment the private system.

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