Dr. Vasanthi Namala on Acute Internal Medicine, Patient Challenges, and NHS Experiences (Part-1)

Dr. Vasanthi: Hello. I am Vasanthi and I am a Doctor. I did my MBBS from Andhra and finished my Post Graduation in Internal Medicine with NBE in New Delhi. After a brief period of working at Registrar level in Hyderabad, COVID hit the country. I worked part time during COVID and later moved to UK along with my husband. I did my MRCP exam from UK and am currently working as a Senior Clinical Fellow in Derby.  

Dr. Vasanthi: Initially, it was my Dad’s interest which led me to this. I was always a topper at school and he believed that there is nothing I couldn’t do if I put my mind to it. I wanted to be a civil servant but dad wanted me to have a good back up career and like everyone in early 2000s, it was either an engineer or doctor as career options. When I managed to secure a medical seat, there was no looking back. It is a very fulfilling career, if you look past all the hardwork and years you put into it. 

Dr. Vasanthi: It is basically emergency and medicine combined. AIM is a medical branch which deals with immediate diagnosis and treatment of urgent medical conditions. If you are sick with, let’s say a chest infection, we are the people you see and get the treatment started.  

Dr. Vasanthi: General medicine is more wider, in the sense that it manages patients long term and deals with lot of chronic conditions as well. Let’s say some has Diabetes, Hypertension or any other chronic condition which needs monitoring and regular treatment, General Medicine is the branch which handles them. 

Dr. Vasanthi: It wasn’t very difficult to adapt to the structure at all, because everything follows a set of guidelines and there are systems in place for everything-from ordering investigations to prescribing medications. It is very well organized system. The difficulty was understanding how  the system works, but thankfully they did give enough training to get used to it.  

Dr. Vasanthi: The difference I say is the organisation. NHS is completely government backed, which essentially means all NHS staff are government employees. But the care is at par with what we have at corporate hospitals in India. Imagine having a world class health care free of cost! But the downside is that the wait list for anything non-emergency is months long. Someone needing a knee replacement waits years to have one in NHS. In India, because of increasing affordability, people are increasingly able to afford procedures and health care quicker compared to here. Of course, it only applies to a section of the population-the upper middle class and the rich, but considering our huge population, it is a significant number of people who afford quality health care in India.

I am not sure bringing affordable quality health care to all people is possible in a huge country like India, but we can possibly provide more support and funding to government hospitals. There are still certain areas which lack basic infrastructure and I know a lot of skilled doctors unable to provide adequate care because of lack of resources.  

The other thing,  which might be off track, but NHS has a strict policy about any sort of abuse towards staff. None of the hospitals even tolerate verbal abuse. I wish India brings such strong policy to safeguard it’s medical community. 

Dr. Vasanthi: It is a cool branch of medicine. Everyday we see a lot of emergencies-ranging from chest infections to diabetic emergencies to strokes and heart attacks. Once you have dealt with one particular case, your mind is already tuned and familiar how to handle the next similar one. It always helps to have a team and an organized process. The mantra is A to E, a streamlined process of checking a patient’s Airway, Breathing, Circulation, Disability, Extremities. Going through this routine when dealing with a sick patient gives us many clues as to the diagnosis and since this method of thinking is ingrained during all inductions, it becomes more like a reflex response when we see a sick patient. 

Dr. Vasanthi: In this regard, India and UK are poles apart. In UK, patients are more aware of medical conditions and are more involved in their care. The families are involved only if the patient consents to this-in short, it is more patient centric. Communicating effectively is very crucial, but when done right, patients and families accept the results very gracefully.  

I tend to explain in as much detail as possible about the situation and give them time to understand the information. Empathy goes a long way too. And sometimes, when I feel like I am not being effective, for whatever reason, I ask for help from colleagues.  

Dr. Vasanthi: There was a young chap with severe mental health anxiety, to the point where the moment he sees a Doctor, he used to start hyperventilating. I had to see him in the ward when he came in with liver failure. It was challenging since I couldn’t get any details and couldn’t examine him properly because of his anxiety and had to rely mostly on the investigations. It turned out he had a heart condition which led to his liver failure, which was totally unexpected. All his health anxiety regarding his inability to sleep turned out to be shortness of breath when lying flat! It was an eye opener for me and since then I always take extra care in patients with mental health issues. 

Dr. Vasanthi: To be frank, I don’t try and change anyone’s opinions. Everyone is entitled to their own beliefs and opinions. In fact, even in my own family, there are people who does not believe in Allopathic medicine and although it is quite frustrating, you cannot change them. What I can do is explain the facts and recommendations, in a language they understand and leave it to their judgement.  

There will always be someone who is not happy with you, for whatever reason. Concerns, I try and explain to them about what I know from my knowledge. Complaints, I let the management play judge. I always take it in stride, because you never know what the patients have gone through, but also, you are only human, to deal with everything impeccably. I always give myself the grace.