HOW TO BECOME A SUCCESSFUL PRACTITIONER AND A TEACHER
Dr L Mahadevan, MD(Ay),PhD-,Director, Sri Sharada Ayurveda Hospital &Research center
Doctor Patient Relationship must include, Maitri (Committed friendly approach), Ārteşu Kāruņyam (Soulful compassion), Śakye prītihi (Satisfaction in therapeutic output incurable cases with concern. )Prakrutistheşu Bhūteşu Upekşaņam(Committed treatment with non-attachment to result in incurable cases )(Ref. Ca. Su. Khuddaka Catuşpādam)
Professional and Personal Life of Doctors
• While medicine can be a very fulfilling profession, many doctors are dissatisfied and have a very little time for them and their families.
• Doctors suffer from depression four times as often as the general population.
Management Plan for Doctors
• What doctors need to learn is to work smarter, more efficiently, more productively and with more satisfaction. The problem is that certain skills – especially Time management, Knowledge management And Relationship management – are not taught in medical schools. The education of the doctor which goes on after he has his degree is, after all, the most important part of his education.( John Shaw Billings (1838-1913))If you don’t know where you are going, you will probably end up somewhere else!(Lawrence Peter) .Therapy becomes healing only when the healer is involved.
What I learnt
Fate of Āyurveda is different from the fate of Āyurvedic doctors who intend to practice it.The aim of study, the purpose of medical curriculum is to help the suffering humanity.A theory which is not useful in relieving the suffering by any means should humbly be discarded. The Āma produced by unused theory usually doesn’t respond to Lańghana, Lańghana- pācana or Śodhana. Experience in treatment alone eradicates it.1 Palam of Āyurvedic Practice is greater than 100 Prasthās of Theory.(1 Palam = 50 Gms ),(100 Prasthās = 80 Kilos ) Ref: Āyurvedic Pharmacopoeia .You become wiser once you treat.The starting point of all achievement is desire. Keep this constantly in mind. Weak desires bring weak results, just as a small amount of fire makes a small amount of heat.(Napoleon Hill)
References about Practice and Ethics in Āyurveda
– Śīşyopanayanīya Adhyāya (A.S.Su – 2)
– Śīşyopanayanīya Adhyāya Upakrama (Su. Su – 2)
– Yogya Sutriyam Adhyāya Upakrama (Su.Su – 9)
– Vişikhānupraveşanīya Adhyāya Upakrama (Su. Su – 10)
– Tistraişaņīya Adhyāya (Ca. Su-11)
– Daşaprāņāyatanīya Adhyāya (Ca. Su – 29)
– Āyurveda Samutthānīya Rasāyana Pāda Adhyāya (Ca. Chi. – 1/4)
– Khuddaka Catuşpāda Adhyāya (Ca. Su –9)
Vedāntic Principles in Medical Practice–
Dharma ( Righteousness) ,Seva(Service),Loka Sańgraham (Public Welfare),Nişkāmya Karma (Unattached Action),Stithapragňya( Steadfast),Samatvam (Equanimity,) Sreşţa (Leadership) ,Kauśalam (Excellence) ,Ātma Samyam (Self-Management) , Anuśāsan(Administration) ,Ānanda ( Joy ),Sreşţa ( Leadership),Kauśalam (Excellence) ,Ātma Samyam (Self-Management) ,Anuśāsan ( Administration) ,Ānanda (Joy )
INDIAN SPIRITUALITY FOR MODERN MANAGEMENT AND ADMINISTRATION
• Anuśāsan – Administration.Cāņakya, also called Kauţilya and his Artha Śāstra is a treatise on economics and administration, with much contemporary relevance
- Prabhandan – Management .Rişīs were great managers. He was an incredible organiser, communicator and change agents.
- Ātma Samyam – Self-Management–Literature, in all Indian languages, such as Tirukkural in Tamil, echo this value. A comprehensive model for self-understanding, development and mastery is available in Sage Patanjali’s Aşāţāńga yoga, eight stages of union. It enables conscious, aware, deliberate mastery over one’s body, breathing, mind, will, intellect and life.
- Loka Sańgraham – Public Good-For whom do hospitals exist? This is a basic question. In practice the answer is often not clear; or edifying.
- Seva – Service,Such public good is achieved through service, and not oppression, neglect or exploitation. The duty of doctors, staff and workers is to serve the patients
- Dharma – Righteousness.Dhāryanti iti dharma. That which upholds the social fabric is dharma Samatvam – Equanimity,A second definition of yoga is Samatvam yoga uchyate. Yoga is a state of equanimity, coping with ups and downs; gains and losses; praise and criticism, etc.
- Ānanda – Joy–This goes beyond trupti, satisfaction; and sukham, comfort. For this, he himself should stay in a state of ānanda, recognising that this is the true nature of beings and God.
- ‘He who regards kindness to humanity as his supreme religion and treats his patients accordingly, succeeds best in achieving his aims of life and obtains the greatest pleasures.- Ācārya Caraka
Duties and responsibilities of physician in general
• Doctors Vs Doctors—Respect them,Provide feedback. Educate them ,Refer the patient back to them
- Maintenance of Medical records
- Maintain the medical records pertaining to his / her indoor patients for a period of 3 years.
- Records to be given within 72 hrs (if requested by patients/legal authorities).
- Maintain a Register of Medical Certificates giving full details of certificates issued.
- Display of registration numbers.
- Use of Generic names of drugs.
- Highest Quality Assurance in patient care
- Exposure of Unethical Conduct
- Payment of Professional Services
- Evasion of Legal Restrictions
§ Physician shall observe the laws of the country in regulating the practice of medicine
- Prognosis-Neither exaggerate or minimize gravity of patient’s condition
- A physician shall not give, or receive, any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment
Diagnosis has four components to disease management
- Bhişak (Physician ),Dravya (Drug ) ,Upastha (Attender),Rogi (Patient)
Qualities of Bhişak (Physician
- Dakşa – an expert,Tīrtāttha Sāstatto – Academically qualified,Druşţa karma – Experienced,Śuci – Hygienic (Ref – Ashtanga Hridaya Sutra Sthanam 1/27-29)
Qualities of Dravya (Drug)
• Bahu kalpam – (Capable for using various pharmaceutical and dosage forms),Bahu guņam – (Broad spectrum),Sampannam – (Readily available),Yogyam –( Applicable to the patient ) (Ashtanga Hridaya Sutra Sthanam 1/27-29
Qualities of Upastha (Attender)
• Anurakta –( Loving,)Śuchi –(Hyigenic),Daksha- (Skilled),Buddhimaan -( Intelligent)(Ref – Ashtanga Hridaya Sutra Sthanam 1/27-29)
Qualities of Rogi (Patient)
• Aadhyo rogi –( Rich enough to afford treatment),bhishak vashyao –( Obedient to the patient),gnaapakaha –(Communicative),Satvavaan –( Courage )(Ref – Ashtanga Hridaya Sutra Sthanam 1/27-29)
Three Types of Physicians
• Chadhmacara (Pseudo Physician)
– Quacks (Growth only by Advertisement but not by clinical skill)
• Siddhasādhita (Feigned Physician)
– Talks like a great achiever but not really so
• Vaidyaguna Yukta (Genuine Physician)
– Ethical, really knowledgeable and practically successful (Ref. Ca. Su – 11)
• Expertise in Śāstra.Excellent Practical skill.,Has the will power to face clinical challenges.Applies his knowledge to save the life of the patient. (Ref – Ca. Su – 9 & 29)
Who is Dvija?
• One who completes Āyurvedic curriculum and enters into medical practice is called Dvija (Reborn / Twice born) Ref: Āyurveda Samutthānīya Rasāyana Pāda Adhyāya
Need of a Guru
• Try to create life time relationship with a true Guru who should haveEthics and Dharma.,Good Ayurvedic knowledge.,Good practical knowledge.,Willingness to teach.,Open mindedness.,Modern awareness.
What is success?
All doctors have a different definition of success.For some, it may mean having lots of patients.,For others it may mean a new car every year. Others may find it in presenting high quality papers in academic journals.While still others find happiness in teaching students. Others do nothing and get happiness in that.
Who will succeed?
• A clinician, who has polished medical skills, a reassuring bedside manner, and a high personal standard of medical ethics and professionalism.
• An academician, who is a constant learner, and keeps up-to-date.
• A manager, who understands the business aspects of running a profitable clinic, and is knowledgeable about networking.
- Decide Your objective in life ,Your driving force,Your strengths,Your weaknessesBehavioural style, Your approach towards the problems, people, rules,Strategic Planning
• Establish your goal.–Improve the patient number by improving Quality of Diagnosis,Patient friendly approach,Cost effective prescriptions ,Monitoring success periodically inIncome.Patient visit,Procedures
Analyze your Practice and Environment at the following heads
– Patient: His expectation and satisfaction.
– Services: Providing more services.
– Competition: –Keep in pace with the competing Physicians.
– Regulation: Awareness about recent legislations and rules
Starting An Establishment
• Entry to start the practice.
• Establish and create regularity.
• Explore and get into interventional procedures, face challenges.
• Specialize and concentrate on specific area.
• Master over speciality.
Key Points in Practice(NETWORK)
Names – they are important, remember them, Eye contact – is the key, Talk – talk less and listen more, Write – write follow-up notes, Open – be open and ask open-ended questions. Resource – become a resource to others Knowledge – know the people and their works.
Clinical Procedures must include proper knowledge and documentation of
Admission. Presenting complaint. Past History, Personal History, Allergies, Drug HistoryAgni, Āma, Nidra, Mala, Kosta Diagnosis, Diet, Lab TestsRadiological findings, Observe patient history deeply.
Prescription Format-Maintain Case Sheets, Write with care and responsibility, Write Name, age, and date and other important points, It should be readable, Always sign the prescription, Minimum drugs to Children, See that medicines are available, Explain how to take the medicines to illiterate patients, Think about affordability, Give samples to poor patients, Write occupation, Advice to teach drugs side effects, Tell time of administration and medium of administration.
Requirements of General Practice
• Āyurvedic emergency kit can include, Kastūri Gulika ,Dhānvantara Gulika ,Dasamūlarishta Siddha makaradhvaja ,Kastūrikalpa Rasāyana , NavasāraJeerakarishtam ,Rasnadi churnam Ashta churnam ,Vilwadi gulika ,SudarsanamImportant
• Points for Clinics– Give importance to Prayer because God alone is the healer, Create a balance between theory and practice. Do not fix diagnosis immediately – Think of Differential Diagnosis,Proceed step by step,Ask whether the trouble is significant or not for the patient,Do not neglect the casual symptoms of the patient,Exclude treatable causes first,Correlate lab and clinical findings,Do not depend much on investigations.,Remember side effect of the drugs and interactions.Consider mental stress / strain, psychogenic causes,insist on review and to what extent the disease can be cured.Tell the truth and limitations,Don’t be so conservative,Don’t try to prove Sastraall the time.,Accept limitation of your knowledge and practice,Understand that the cases you have seen in the Ayurvedic curriculum is limited. There are a lot of conditions in which you need more exposure. E.g Pancreatic conditions, Intestinal TB, Various carcinomas, Uncommon infections, Mesentric occlusions, Parkinson plus, etc., Don’t criticize other Doctors.Understand that 4 things are common for every practitioner.(Adverse reaction,Hypersensitivity,Bad prognosisPercentage of error),Don’t Over believe the quality of medicine by seeing the label and attractive sentences told by Representatives.,Be conscious about patent drugs and be open to good products.,Don’t buy Rasa Oushadhās from unknown companies.,Develop sense of humour also,Don’t use unaffiliated fellowship and degrees,There is no shortcut to Clinical success. Even if it happens it won’t last long.
Important of prayers in Practice
• Let us be silent, that we may hear, the whispers of God(Ralph waldo emerson )
• My patient taught me that there is more to medicine than pills and incisions Remember that one generation’s miracle may be another’s scientific fact. Neuroscientist Andrew Newberg of the University of Pennsylvania school of Medicine has used several imaging systems to observe the brains of subjects as they meditate or pray. He found that the deeper people descend into meditation Or prayer, the more active the frontal lobe and the limbic system gets. .The frontal lobe is the scat of concentration and attention; the limbic system is where positive feelings, including ecstasy, art processed. It has been recently proved by several studies by functional MRI that the thickness of the cerebral cortex increases in people who meditate regularly. This is an indication that one can develop the brain and, thus intelligence. My comprehension of God comes from the deeply felt conviction of a superior intelligence that reveals itself in the knowable of world (Albert Einstein). Knowledge comes, But wisdom lingers – Lord alfred Tennyson
Dissatisfaction with the way medicine is practiced today
• The callous attitude of the medical fraternity, probably due to their busy schedules.Doctors spend less time with patients and more time with administrative and paper work, investigative reports and research Waiting time OPD is increasing and most people feel that going to the hospital means losing a full day, especially in government-run hospitals,Cleanliness levels are not upto hygenic standards in most government – run and some corporate hospitals,The spiralling cost of medical care. The nursing staff does not display kindness or compassion,Nowadays, medicine has also turned into a market commodity, Everything revolves round finance and this gives a bad impression of the medical profession,As worldwide research proves, 50 per cent of coronary artery bypass grafts were not required. Technology has advanced but not our human approach to the patient. We don’t feel other’s pain.
Ten commandments of beat stress
• Set a realistic goal for yourself, Don’t remember failure or disappointments,Learn to say No, Exercise regularly and play games of your liking,Sleep for a full 6-7 hours,Follow a low fat vegetarian diet. A diet rich in fibre, fruit and fresh vegetables relaxes the mind and body,Be happy and enjoy life,Be positive in your thoughts,Practice a few minutes of meditation, yoga and deep abdominal breathing daily ,Open your heart to your partner – discuss every problem,Ask and it shall be given to you; seek and ye shall find, knock and it shall be opened unto you ( Mathew VII),The compassionate mind is like an dixir, it is capable of transforming bad situations into beneficial comes (His holiness Dalai Lama )
• Meditate-It provides rest and relief to the body and mind,It reduces heart rate and blood pressure, thus preventing hypertension,Meditation can stop the advancement of atherosclerosis. blocked arteres can be opened up without surgery with regular meditation, yoga, diet and aerobic exercises,It relives physical and mental stress and strain. To heal our egos, we seed to believe in something much greater than ourselves, We realize that the Divine mystery is willing to offer us great abundence, yet we often cut off the very source that can supply us with the things that we so desperately want in our lives, It balance the activities of the two brain hemisphere, which brings coordination, calm, relaxation and equilibrium in life.Meditation increases the level of tolerance, which helps people who suffer from chronic pain.
• Type of personality associated with stress-Type C personality is at higher risk of cancer as type A is of heart disease,type B personality is less likely to develop illness,Type A individuals are emotional and sensitive,Type B are balanced individuals and Type C are depressed, introverted and foster negative feelings and attitude,Type – A personality is prone to stress. Such people are Very sensitive, Impatient, Ambitious, Emotional, Aggressive and take up several things at a time.They are hard-working and tend to multitask.Type – B personality is Balanced, Calm, Less competitive, Easy-going and Less prone to stress.
• Appointments-Try to be on time,Allow additional time for elderly and disabled patients.Patients attending for the first time will take longer as their history must be recorded, and needs assessment.
• Medical Ethics– -Be ethical,Be straightforward,Follow the basic medical ethics of Autonomy – Svatantra / Ātmaja pratyā satti,Beneficence – Bahujana sukhāya Bahujana hitāya ca,Non-maleficence – Abhayam Sarvabhūtheşu
Application of Karma Yoga Principles in Practice
• Working with the patient is a Pooja, not an interruption ,Remember that the patients pays your salary – treat him like your boss.,Establish a good rapport with the patient,Express empathy. Let patients know that you understand their problem and are concerned about their feelings.,Do not go on the defensive. You are certain to lose the patient if you become confrontational,Choose the best time of the day to deal with a difficult patient,Don’t downplay the seriousness of the patient’s complaint,Let the patient tell you his or her side of the story without interruption,Never argue with a patient. The patient is always right (in his own eyes),Be a good listener, agree with him where ever you can,Always choose positive words when speaking to a patient,Brighten every patient’s day. Do something that brings a little sunshine into each patient’s life, and soon you’ll discover that your own life is happier and brighter,Always to the extra mile, and do just a little more than the patient expects you to do. For example, make it a habit to phone the patient after discharge from hospital, to ensure he is doing well.
• Your Working EnvironmentWith Co-Workers-Respect your employees,Be fair to them. Then you will be a good employer,Know what is expected of them,Provide the materials and equipments they need,Give the opportunity to do,If something goes wrong, don’t punish. Point the mistake out,Recognize, reward and praise for doing good work.,Make them feel important by counting their opinions,Befriend them.
• Dealing with Mistakes-Accept responsibility for the mistake,Discuss it with colleagues,Disclose and apologise to the patient,Conduct an error analysis,Make changes in your practice to reduce similar errors in the future.
Books on General Practice
• Ashtānga Hŗdayam ,Vaidya yoga Ratnavali (Impcops),Kapoor’s Guide for General Practitioners (Parts I to IV). Now available as Textbook of Medicine in 2 volumes.,Author: Dr. O.P. Kapoor ,Publishers: S.S. Publishers, 16, Rajat, Mount Pleasant Road, Mumbai –06.,General Practice – A Practical Manual, Author: Dr. Ghanashyam Vaidya Publishers: Bhalani Publishing House, 11, Mavawala Building, Opp. K.E.M. Hospital, Parel, Mumbai – 12.The merck manual of patient and symptoms author: Robert.S. Porter, Publisher : Merck Research Laboratories,Publisher: Wotters kluwer (India) Pvt Ltd, New DelhiManagement of symptoms in general practice, Author: Prakash mahajan, Publisher – Divyesh Arvind KothariBate’s guide to physical examination and history taking. Author: Lym S. Bickley Publisher: Wotters kluwer (India) Pvt Ltd, New Delhi,Memorizing medicine faster and better , Author: Rifat Naghmi, Publisher – Hitesh A. Kothari and Atul. A. Kothari,Clinical Medicine – A Handbook of Clinical Methods,Author: Dr. K. V. Krishnadas .Publishers: Jaypee Brothers Medical Publishers (P) Ltd, B-3, EMCA House, 2323B, Ansari raod, Daryaganj, Post box –7193, New Delhi – 2,The Doctor & Law,Author: Dr. S.K. Singhal ,Publishers: Mesh Publishing House Pvt. Ltd Mumbai – 400 026, Textbook of Ayurvedic Clinical Medicine –dr l mahadevan
“Anadim Avyayam Divyam Vyapakam Visva Bheshajam ,Trikala Abadhitam Nityam Āyurvedam Upāsmahe”
Dr. Ramya A
HOD & Associate Professor
Department of Panchakarma
Ashtamgam Ayurveda Chikitsalayam & Vidhyapeedham