Interview with senior physician – Dr Menon

Dr MN MENON

Q- How long have you been in practice and what changes have you seen in recent times including Covid-19 period?

My journey began from Government Medical College, Kottayam in 1969 in my teens, like most of us of our times, my focus turned to modern medicine and public health, and my professional practice began in 1975. As we all can see, scientific updates, inventions, discoveries and technical innovations are happening globally at a fast pace. So much so, I have witnessed tremendous changes in modern medicine and health care delivery system in our country since my undergraduate days. In my long innings in the field of modern medicine, I have seen and imbibed many important changes that have happened in the profession. In those days our practice was strongly based on clinical history and examination findings as compared to investigations. Investigations were rather few compared to the manifold and lengthy list of near perfect sophisticated tests we have now. With more chances of lab errors in those days, we relied more on our clinical acumen and we checked the slides to the counts ourselves on many occasions.

I have been managing a 25 bedded nursing home over a few decades that was recently converted into a daycare center.

General practice or family medicine concept was very popular in our times, the health expert’s world over accept the concept even in these advanced times. There were fewer doctors in our state with just three government and one private medical college in those days. Doctors had meagre salaries and in government or private sector monetary gains was not a major factor and consultation fees was never a three-digit figure. The family doctor knew everything about each member and the family of his locality and people had real trust in those doctors and vice versa.

A family doctor tries to provide comprehensive health care, including preventive measures, treatments, counseling, end-of-life care, as needed and directs patients to specialist care as deemed. Many of us keep in touch with the specialist, which is an added advantage to the patients as well. The trend of people directly going to the neurosurgeon with an MRI scan of the brain for a sinus problem is much common nowadays. This should change, by consulting a local family physician or a GP, you can save unnecessary costly investigations and expenses.

Now the patients are seen more as consumers by the judiciary and litigations are rampant now. Assaults and attacks on doctors, health care institutions, which was unseen in early decades or so in our career has become a common scene now. Changes definitely are the only constant things in the universe. Inevitably we also accept the positive developments in the medical field for effective professional practice and to benefit the ailing humans. Medical ethics was not a subject in our curriculum, but as most of our teachers were role models, we never needed any special session on medical ethics.

Things have changed in the last few decades from the times when doctors were considered demigods. There has been regular erosion in the mutual trust between the patient and doctors, even though doctors try to save human lives and intent no harm to their patients. People want total cure and are not ready to accept death even in serious or terminal conditions.

The recently implemented Hospital Protection Act takes care of the attackers but cannot prevent attacks. Hospitals and clinics should be declared protected zones. Untoward incidents can be prevented by improving our communication skills, patient hearing, clear instructions, informed consent and timely advice.

Now coming to these Covid-19 times, the pandemic has really affected our consultation and practices since almost a year. We are constantly updating ourselves on infection control measures and other protocols. I too have restricted patients to bare minimum in order to check the virus spread and for the safety of the staff and other patients coming to my center. Staffs are also given special training and updates to follow the Covid-19 protocols.

Q-From your viewpoint, is telemedicine a boon or a bane for general practitioners?

Telemedicine has been legalized recently in the background of the pandemic. It has its real use as to extend treatment to patients without troubling them to attend the clinics, especially those with chronic conditions. Telemedicine has its great use in expert consultation for remote areas by seeing the patient and reports online along with briefing by the attending local doctor.

Once again, the irrelevant and rampant use by patients and doctors may detrimentally affect this service. Might affect old time practitioners unless they too are part of it. Judicious use of telemedicine could be helpful in many situations, but whether everyone should get used to it routinely is debatable as of now. It is definitely unethical to treat any patient on a long-term basis, especially without ever seeing or examining him.

Q- As a leader for IMA and many medical organizations including AFPI, how would you convey the importance of organizations among medical professionals?

Coming to the importance of organizations, ethical guidelines direct registered practitioners of modern medicine to be part of professional organizations, especially for updating the clinical knowledge. Sad to say though we were asked to procure credit hours to stay registered with the medical council or the new National Medical Commission, the government is not thinking of updating the medical graduates except those in service. Even private practitioners are not trained by the government.

It is a great commitment by organizations like the Indian Medical Association (IMA), Academy of Family Physicians of India (AFPI) that they are updating their members periodically. Moreover, they help by providing security to our family and help us in case of litigation through excellent schemes. It should be a matter of pride and honour for us to be part of such great organizations.

Q-From your years of experience what advice would you give on dealing with "a difficult patient"?

When you are not sure on how to tackle a tough patient or complicated disease in spite of your best efforts, it is better to gently advise and refer the patient to an expert. Invest in good security systems for a peaceful and safe environment at work. Keep cool and try to react with empathy when you face aggressive and abusive patients, and their emotionally upset relatives. Keep good relations with your professional colleagues too.

Q- Can you brief the young practitioners about maintaining a healthy lifestyle during their busy practice?

Healthy lifestyle is very important especially for young doctors. Studies have revealed that doctors in India are not taking care of their own health properly. Stress, strain and the indifference shown by us towards the exercise, healthy diet and sleep contribute to our ill health. Many doctors die at a younger age, due to conditions resulting from lifestyle disorders. So, it is important that young doctors find time to relax and enjoy life by indulging in healthy hobbies, finding good time to spend with family and friends and have good sleep.

Q-What tips would you suggest from your experience as an organizational expert to young doctors of Spice Route India movement?

Really happy to note all the excellent academic activities organized through spice route. It caters to the postgraduate students also and the members and helps in refreshing and updating them. But I have a few more points regarding how to go ahead with your practice. Empathy and ethics are some essential factors much needed in our professional life which shall help in healthy practice. Priority should always be for the well-being of our patients. Stay updated too.

Dr MN MENON
Chairman State action committee, IMA Kerala
Vice chairman, INTEC
Central working committee member, National IMA
Member standing committee on medical ethics, National IMA
IMA Kerala state vice president 2017-18
LIFE MEMBER: IMA, IMACGP, AFPI, All India AARO, GPA, WONCA