Counseling Consent: Fill & Download for Free

The following I learnt as a practising doctor and not during my MBBS.Palliative care. Yes, it is important to take care of the people who are dying. They need to die with dignity. They need to be kept comfortable, pain free and treated with empathy and compassion. You don't see hospices in Medical colleges and there are very few palliative care centres or hospice in India. It is an important and neglected field.Pain control. We underestimate how much pain our patients are in. We even advice them to bear it for some time. Indian patients also have a higher pain threshold. No one should be in pain. Adequate pain relief produces dramatic improvements in a patients health condition and daily life. They become happier and more mobile. We need to routinely use pain scales and document pain.Communication skills. How you talk and counsel the patients and relatives determines how much they trust you and your treatment. Breaking bad news, explaining prognosis, bereavement counselling, consent taking are not focused on much in Medical school. But these are some of the most important things in your practice.Healthcare is expensive. The cost of treatment and the financial implications on the family doesn't really hit you if you have been trained in a government hospital.Personality development. Doctors are not taught to take care of themselves in Medical school. There is no exposure to financial planning, career counselling, insurance, marriage, social media, mental health of doctors and medico legal problems. Experts on various subjects should be called and asked to speak to trainees and interact with them. Only a doctor who takes care of himself can take care of his patients.Research. Although it is coming up it is still inadequate. Doctors need to know - What is research? What are the types of research? How to write a protocol? What is ethics? What are clinical trials? How to write a research paper? How to interpret a journal article? More exposure to statistics. I learnt all the above during my residency and not in MBBS. A chapter in community medicine in MBBS does not do justice to research. What ever medicine has achieved today is because of research.Resuscitation. Adult and Pediatric Basic and Advanced life support (ACLS, ATLS and PALS) courses should be mandatory for medical students in India. All doctors need to be recertified in resuscitation. All medical colleges should have ‘code blue’ as mandatory. Frequent mock resuscitation scenarios should be held to be up to date with resuscitation.Portfolio development. It is important to maintain a record of your achievements, courses attended and skills gained. If you have a log book it is excellent. In USA and UK doctors maintain online portfolio or e-portfolio of the interesting cases they see, procedures they have done, research and courses attended. This portfolio is signed by your teacher. If you are planning to go abroad the portfolio will be useful to show your competence.Mentorship. Students need to be given mentors from early in their life. The mentor helps them to grow and guides them. The concept of mentorship is lacking in India. It should start from MBBS. I was fortunate to have wonderful mentors during my residency, I still fall back on them for help.I did my MBBS almost 20 years ago. Things might have changed.Dr Venkatraman

advice means to suggest, to give wise counsel or just counsel. consent means to agree, to say yes, to go along

This makes me think of Vern and his wife May. He originally came in alone “for advice.” Vern was a big guy, forty five, loud. He filled up the room. Vern claimed his wife “just doesn’t understand how men are, Doc.”I said “Well, why don’t you bring her along so we can straighten her out?” He asked me if I was serious. I said “Yeah, invite her, why not. We can explain how men are.”Vern knew I was messing with him a little but he brought May next time. I took another chance and wrote up new papers and consent forms for couples counseling.Just ten minutes into the session, May’s tears were falling when she said in a strong even voice, “Vern, Dr. McPhee, I want you both to know that unless things change, I don’t think I can stay in the house any more.”Vern’s eyes opened wide. I saw fear and confusion there, not anger, even though he looked away quickly. Then he turned to me and said, “Doc, she doesn’t mean it, she’s just a little upset.” (I did the marriage counselor thing and said, “Don’t talk about her, talk to her.”)Vern: “You don’t mean it, May, we’ve been married twenty years and we have two kids!”May: “I do mean it, Vern. I’ve tried so hard, so hard. The twins are seniors now and soon they’ll be gone. I don’t see staying after that. You’ll be OK.”Vern: “I don’t know what you want! What do you want? I’ll do whatever you want!”May: “I want you to stop yelling in the house. It scares me and the twins. I want you to talk to me like a person. I want to know what you’re thinking, what you’re feeling. I want you to listen to me, really listen. And the twins too.”I summarized what May was saying until Vern understood and could repeat it back, more or less. Then I took guesses at what Vern was feeling and tried that out. When they both started nodding, I made them an offer: I’d do my very best marriage counseling for them, and they’d both have to try out some new ways of talking to each other, and it would be really hard sometimes and there’d be plenty of homework.They signed on.We started with strategies to stop Vern from yelling in the house — that was basic and not difficult given the stakes.The rest consisted in teaching old-fashioned empathic listening skills. It was hard for Vern at first, but fairly soon they were almost competitive about whose empathy was the most accurate. I still smile when I remember those middle sessions when they were showing off about their new skills.I think the whole counseling wasn’t more than 10 or 12 weeks. At the last session May hugged me, and to my surprise and delight, so did Vern.