Ground Rounds In India + Wedding

May 13, 2015 (2:08pm)

Today began with what is known as “Grand Rounds” – a little different from my exposure to grand rounds in America. At VMH, only one patient is presented by fellows to the collective caregiving team – nurses, doctors, lab technicians, and students (in the U.S. I have seen grand rounds only with physicians). This case can be either examined under the ideology of Ayurveda or Allopathic medicine. I was pleased that this morning was an Ayurveda case (and spoken mostly in English).

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I will now discuses my incredibly fledgling interpretation of Ayurveda from what I saw during Grand Rounds and the content of a brief conversation with two non-Ayurveda trained Indian physicians following grand rounds. I have no exposure or pre-conceived notions of Ayurveda, and this account may have value for that reason (it would probably be most interesting to a seasoned Ayurveda physician, to know what it looks like to someone who has only experienced allopathic medicine without exposure to Ayurveda in culture). This is an account of what I took away…

Before the fellows began their presentation of the case, I was warned by Dr. Kumar that there would be terms that would be completely new. He was right. But the medical fellows did a good job of explaining what these Sanskrit words meant.

The discussion began around menstruation (disguised in a Sanskrit word) – all was well in that regard. While I anticipated a turn into the symptoms or history, the fellows began to talk about the patient’s feelings. The patient feels sad no one is at the hospital with her. The patient has grief that her child is not perfectly healthy. If you have had exposure to Allopathic medicine, physicians generally do not talk about the emotions of your patients, or consider that in your treatment therapy. I will not prescribe you a different dose of amoxicillin if you are happy or if you are sad. But this is not the case in Ayurveda. Treatment is integrally related to the emotions of the patient. In fact, if three patients with identical demographics have the exact symptoms in the identical degree, treatment will change based on the disposition of the patient.

This leveled me to the floor. I swear to you, Ayurveda medicine takes into account the psycho-social health of its patients in a way superior to that in Allopathic medicine. Not only that, it focuses on the causes. When your American physician prescribes you an antibiotic, he/she/they is not thinking about what caused your illness, whereas the Ayurveda physician is (although Western people may not agree with the attribution of cause – e.g. a high fat diet).

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During Grand Rounds (fundamentally a platform for teaching), it is routine for the attending physicians to question a presenters reason (the student) for including or excluding information in the presentation. One does not want to present superfluous information as much as one does not want to leave any pertinent information out. And at one point in the presentation I saw, the fellows digressed on how the diet of the patient was impacting some aspect of her health, and Dr. Kumar questioned this inclusion. I will try to recall the following as it occurred as it impacted me significantly. Any quotation is not exact.

The student said that the patient’s diet from the hospital canteen was partly responsible for her symptoms. Given that every patient in the hospital has the same diet, Dr. Kumar asked the obvious question “So, how many patients on the same diet will present with these symptoms?” – if 100 people are eating the same diet, and you are drawing a causal relationship for one, why not the other 99?

The fellows answered that in these exact circumstances, it was relevant – specifically due to her grief. Making untestable hypothesis in science and medicine is generally not a good idea and it sounded like that was what the fellows were suggesting. It sounded like: “In this case it matters, but it may not matter in other cases because those are different.” – untestable. Dr. Kumar pounced.

“Have any studies been conducted relating this diet, combined with grief, to these symptoms?” After 15 minutes of the students trying to answer the question by not addressing the exact question at hand (the answer is “No”), surprisingly, nearly the entire group came to the consensus that it does make sense, however, based on certain principles in Ayurveda (beyond my current capabilities to explain). The issue was that, while it makes sense, it has not been proven to generalize to all patients. Dr. Kumar illuminated this in a brilliant speech I will try to do justice from memory:

“While I understand I am fighting against the majority, we have to understand the idea of a theory. A theory is a potential truth that is not yet proven. That has not yet been proven. While we may apply principles now based on theories, we must constantly create and integrate new information as we make it available. There is a tenant in Ayurveda that we follow ‘What is true is only true now’. As new information is created, we have to allow that to change the way we think and treat patients. What happened to Nepal? Two tectonic plates moved centimeters and now Kathmandu has been raised 800 meters. If nature changes, why not we? Why don’t we change.”

That last point was incredibly salient, and nearly moved me to tears (I held them back, do not worry). Dr. Kumar then explained he used this tangent as a way to teach the students that we have to constantly re-affirm what we think we know, and create new information whenever possible. The trademark of a good scientist.

Addendum 6/9/2015

I was blessed with an invitation to an Indian village wedding and attended nearly two weeks ago.  If you have ever heard the song Click, Click, Click by Bishop Allen (lyrics included in video information), that is a great way to describe how I felt taking pictures to a groom and bride I still don’t know the names of.

Guess who doesn’t belong? Yes, its Balu, the guy holding up the peace sign – you are never supposed to do that at a Village marriage.
Out of those six people, I only know two names, and one of them is mine.

Luckily I found some friends at the wedding.