Wednesday, April 22, 2015

Long ago...

it was long ago
you said yesterday
when we had met
and shared a life
but it was so long ago
hence irrelevent today
that we had shared
not only joys
but sorrows
yes it was long long back
so we shouldot worry
why what happened, happened
a shared world collapsed
and traces wiped
because it was long ago
you said yesterday
and I still remember

You and I continuum...

You and I
like the banks of a river
walk along side by side
in this journey through time
and the water we hold
between the two of us
takes my soil to you
and yours to mine
we need to hold it together
to hold off the flood
that annihilates the shores to ruins
do not let us overflow
and merge the boundaries
leaving ourselves behind
'coz we meet underneath
the faltering stream
the bottom is our shrine
You and I
two entities to the world
are still one in mind!

Saturday, April 11, 2015

Reflections IV- Feedback on Feedbacks!

Feedbacks are important. We have feedback mechanisms in our body which help control the physiological mechanisms  especially the neuro endocrine circuits. In schools and workplaces, Feedbacks help us understand the other person's perspective so that we can improve our performance. But what does a feedback do that is less of a negative feedback and more of a complaint?
 So a patient who is depressed and is having interpersonal problems in marriage gives a feedback that the doctor is not empathic. Her father offers the same feedback because he is trying to make me remember his other daughter who probably saw me a year or two back and since I am at loss of recalling her and trying to focus on the current patient, he feels I donot care. The management wants to dig the issue with me, it helps me understand the extent of depression the family is in, but how does it help me improve.....from a clinical perspective it is actually expected and in therapy we call it transference, but from a practical perspective, next time I am vary of  any such patient. The doctor patient bond gets traumatized a little. Next time, a patient's husband mentions that he had to wait for 30 minutes to see the doctor and then he was sent back to the ward unattended.Well, he of course forgot to mention that the doctor was in session with another patient who had come with an OPD appointment and since the indoor patient was getting restless, doctor had taken time to suggest that either they could wait or go back to the ward because the doctor couldnot make patients who had taken appointment to wait. What does this feedback teach me, that I shouldnot allow any indoor patient to come and see me in OPD even if the patient needs to be addressed in the privacy of the psychiatrist's chamber or simply because it is convenient.Another good blow to doctor patient relationship. While psychiatry addresses issues of transference, it also addresses issues of counter transference, wherein the therapist develops negative feelings for the patient or family. This eventually hampers treatment. And this reactive pattern of interaction extends itself to all medical specialties (I refrain from saying all human interactions because the treatment part is not part of other interactions).
There are inherent dilemma's in human interactions, views/opinions/perspectives differ and if everyone stood at their own vantage point, it's difficult to understand beyond one's own needs. From administration's perspective, they need positive propaganda to get the patient back, from patient's perspective, they need exclusive care and attention, even a doctor needs patient satisfaction and positive feedback for good business but they still end up facing the flake. Nobody talks about doctor's feedback.So while the doctor should maintain OPD timings, noone takes responsibility for him/her waiting  in OPD well beyond the scheduled time because 4:00 pm appointment reached the hospital at 5:00 pm but certain people have the audacity to fight to see the doctor before all those waiting because he took an appointment for 10am but reached at 3:00pm. The doctor is told that he/she charges too much consultation fee, or why can't he/she see patient for free for followup because the patient is anyway better with treatment, or he/she is responsible if the medicine doesnot work or causes side effect and therefore again should see the patient for free, or should spend as much time with patient during consultation as the patient needs rather than the scheduled time slots. The cherry on the cake is  when patient's family assaults doctors in emergency rooms across the country and all that happens is a day's strike before everyone starts blaming doctors for being heartless and earning too much (!)
What is of greater concern?
For one, due to the current trend , doctors are becoming too practical in their profession and while medical practice is loosing its heart, the treatment protocols are becoming too rigid leading to less innovation in clinical set up.
Secondly, as the heart goes, the soul will go too. It's already happening at several places especially with greater corporatization of medical practice and setting of goals and targets that do not revolve around improvement of overall health in community but improvement of patient and procedure count for the hospital.
Thirdly, since patients turn consumers, there are higher and higher chances of litigation which lead to the first and second outcomes anyway.
But currently my personal concern is that it will change my own practice strategy. As a psychiatrist, I try to be empathic, but as a human being, I get angry and frustrated and loose trust in the idea of doing good. If I just do my job, I will never intervene and let the hospital and staff tackle people while I follow a rule book where sessions are strictly timed and no interactions outside of clinic are advised. And all those good people who are sensible as well as sensitive will loose out on good care while the one's who are the cause are anyway beyond help!

Lets just hope it does not come to that....

Reflections III- Time Paradigms- free time/me time/no time etc

Time is a mystical dimension that we try to understand using clocks and calenders while following the movements of sun and moon, but when it comes to managing life time, it takes an even more mysterious turn. This is ironical because as a professional, time management is the first thing I preach to my clients. As a working person with various social roles to play, it becomes imperative that we are neither too rigid not too careless with our 24 hours everyday. But what do you say to an individual who asks," Doctor, when are you free?".
What is free time....

Am I free, early in morning when I am trying to wake up, wake children up, sending them to school?
Am I free, later in morning when I am trying to catch-up with the newspaper, morning tea, honing lost communication skills with my husband, bathing, dressing, managing household and trying fervently to reach work on time?
Am I free, during the day when I am trying to explore/understand/diagnose/treat people of their various issues?
Am I free during lunch hour when I am trying to collect dry-cleaning/ tailoring/groceries/paying bills, reaching home, trying to  eat lunch while instructing my maid and trying to feed my baby, catching up with elder one's school activity, and sometimes looking to breath before I start seeing patients again?
Am I free later in the evening when I have to again become a little more instructive to all those instruments that balance my fragile work-family balance while trying to get dinner on table- feed-listen-instruct-feed-listen-instruct?
Am I free later in the night when I want to take a few moments to relax, surf channels or read a book or pen down my thoughts before I start another day?

Would I be absolved of hitting another if I took a phone-call while driving?
Would I be allowed a positive feedback, if I responded to a patient while seeing another?
Would I be sane if I allowed random people to talk to me while I try to interact with my friends and family?

If free means something available at no price, then I am never free. My time does not always cost me monetarily. I am forever paying something or the other, important to me, in order to give you time, and in that process, I need to choose...I need to priorities...I need to even give up the monetary benefits of using my time to guide another if I have to spend emotional currency and in turn feel more depleted than ever. My time is not the government's  property and its not the property of those who pay for a 20 minute consult and then wish that I be available to them whenever they feel the need.

When it comes to judging others, we as a race are pretty adept at it, but to be able to realize that everybody is blessed with the same 24 hours a day while earth completes a rotation around it's axis, should-not we be more sensitive to other people's time. Instead of asking for free time, if we could ask for someone's valuable time and not think that we have a right to have it because one would be NOT eating/sleeping/working or generally Not being busy performing all those mundane things that actually make up the most important part of our lives.

I am not somebody who would not give you time, but you will have to earn it by respecting it.

Tuesday, April 7, 2015

who is the one?

Amidst the applause
stands the question
all those verses
are for which one
Is this for him
who never came
Is this for her
who seems so lame
I look for reasons
I look for rhymes
I look for the feelings
despite the whys
while you float through dimensions
I sketch you in mind scape
i explore you in words
and let you escape
You are so like the movie star
but still common
waxing and waning
in myriad emotions
hopping through zodiacs
like the moon and the sun
are you the one
the one
I saw in you
the one
I married to
the one
I lost often
the one
still waiting to come
Its all and none
yet the only ONE