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Looking back, I feel internship is all about endurance rather than actual learning.I will go about in the order of rotations I was posted to :ENT : 15 days : Realised 4 years of med school didn't teach actual stuff, got scolded for reporting late ?, repeats / dressings etc, OPD hours seeing cough, cold, fever (CCF :D), assisted a few minor endoscopies / procedures on ear / nose.OPTHAL : 15 days : Dark room dilating pupils for examining fundus, looking through Automated refractometer for checking eye sight, spent some time in prescribing lenses, OP clinic assisting consultants seeing patients, don’t remember going to OT.PAEDIATRICS : 1 month : 4 NICU duties looking after new borns (temperature, glucose levels, ventilators etc), 4 PICU duties looking after rather bigger kids, blood sampling, monitoring progress, at times yellow iv caths. One thing I can't forget is we had like only 3 hours to sleep. Nightmare.GEN MEDICINE : 45 days : Had like 7–8 IMC (intermediate care) duties, around 7 ICU duties. Hectic as hell. Missed dinner for most post duty days, didn't remember when I slept or woke up. Ward work involved case sheets, sampling, chasing lab reports, treatments etc. Got a few intubation chances, femoral lines and LP. Put paid replacements for 3–4 IMC duties as didn't find that useful. Lost all interest in Medicine by the end !PSYCHIATRY : 15 days : Mostly OPD hours seeing schizophrenia, anxiety disorders, alcohol withdrawals, suicidal ideation patients, somatic disorders etc. ICD classification, learnt and used it first time. Never used them again. lol! Made a presentation on schizophrenia whose starting slide was “If you speak to God, its normal, but if God speaks to you, its schizophrenia”SPM : 45 days : PHC posting : We lost like 2 weeks for strike as stipends were not paid till then. Rest of the days we divided among ourselves to make sure at least 2 of us were at the primary health centre posted. Overall chill time. No night duties. However, travel was arduous each day as we had to travel for more than 20 km to get to the PHC.FEVER HOSPITAL : 15 days : Tropical diseases institute posting : Dedicated institute for treating routine infectious diseases like typhoid, diarrheas, food poisonings, dog bites, tetanus, diphtheria etc. 2–3 night duties. Mostly spent time in OPD seeing cases, wards involved sampling and treatments. Post OPD time in casualty giving anti rabies serum to dog bite cases. Overall good time.ACCIDENT AND EMERGENCY : 15 days : Got drained physically and emotionally. 5 days each of morning, afternoon and night shifts. Night shifts were particularly hell. Lacerations, head injuries, burns, all sorts of accidents, stabs, all failures (heart failure, renal failure, respiratory failure etc). Drunk patients with all sorts of injuries and illnesses. Learnt suturing simple wounds, doing venous cutdown etc.SKIN : 15 days : No night duties. 9 to 2 pm work. Spent most time seeing OPD patients, monitoring autoimmune diseases who were started on steroids, PUVA therapy for psoriasis, minor procedures like sensitivity testing, leprosy ?nerve biopsy, warts removal etc. Overall good exposure.ORTHOPAEDICS : 1 month : Lot of trauma related fractures. OP hours seeing patients with pain in different joints, duties were relatively better as we had 12 hour shifts. Duty days involved assisting with putting slabs / casts. Assisted a ilizarov procedure, ILN tibia nailing, K wire insertions etc. Found real interest in surgical branches for first time. However, wearing the lead apron made my shoulders ache !GENERAL SURGERY : 45days : One word —— epic !! Was thoroughly impressed with surgery by the end of posting. Had good hands on with debridements, wound dressings, assisting emergency cases like appendix, obstruction, spleen, peritonitis, ICD insertions, liver abscess tapping etc. Learnt how to hold instruments and suture properly.ANAESTHESIA : 15 days : few LP’s, 1 intubation, monitoring patients under anaesthesia, loading drugs in operation theatre, helping with writing progress notes etc. Most of the time I spent seeing the surgery rather than vitals monitor.OBSTETRICS : 45 days : One hell of a posting. Got around like 10 duties, did a few deliveries of babies, done a few repairs of perineum from episiotomy, got spilled on with amniotic fluid, spent a lot of time going around blood banks as most patients were anaemic or lost blood. I remember spending an entire duty in blood bank. Damn!FAMILY PLANNING : 15 days : Assisted a few tubectomy procedures, observed a few lap procedures, motivated a few mothers to undergo family planning, updated registers, spent time preparing patients for surgery the next day. Overall, a good time.27 March 2014 : Last day of internship : Mixed feelings overall.

Given the narrowing of the contest to one between Mr Modi and the Congress, one would expect the critics to compare the accomplishments of the former in Gujarat to the latter's nationally. But no critic would hazard such a comparison.The data leave little room for anyone to credibly question the superior performance of Gujarat in industrialisation, agricultural development, and overall growth.Therefore, critics have invented the argument that thanks to its long-standing entrepreneurial tradition, Gujarat has always grown fast.But if so, why is Rajasthan not a growth powerhouse despite its legendary Marwari entrepreneurs? Attracted by the superior business environment, those entrepreneurs have in fact migrated to Gujarat.Between 2004-05 and 2011-12, overall poverty in Gujarat fell by 15.2 percentage points compared with 15.3 percentage points nationally.Given that the poverty ratio in Gujarat in 2004-05 was already 5.4 percentage points below the national average, this progress is nothing to scoff at.Else, we would berate even more the 12.7 percentage point decline in Kerala over the same period.Gujarat also deserves applause for the large cuts in poverty among the Scheduled Castes (SCs) and Muslims.poverty among the former fell 21.8 percentage points between 2004-05 and 2011-12.For SCs, poverty is now only 1.4 percentage points higher than that in the general population. Nationally, the gap is much larger.At 7.7 per cent, Gujarat now boasts the lowest poverty ratio for Muslims in rural areas. The state also counts among the seven states with lower poverty ratio for Muslims than Hindus in rural and urban areas combined.It has achieved this distinction by cutting poverty among Muslims by 23.3 percentage points in rural areas and 27.7 percentage points in urban areas since 2004-05.Gujarat has been widely admonished for its poor achievements in the area of child malnutrition. But the criticisms rely predominantly on the National Family Health Survey data that end in 2005-06.Estimates based on the more up-to-date data from the Integrated Child Development Services (ICDS) paint a very different picture.Cited by the Comptroller and Auditor General of India in a 2012 report, these estimates show that Gujarat cut the proportion of underweight children between 2006-07 and 2010-11 by a gigantic 32 percentage points..According to Gujarat state officials, quoted in a media report this month, the state has achieved an additional reduction of 14 percentage points in 2011-12 and 2012-13..The Gujarat government can be accused of failing to identify problems, but not of failing to act once a problem is identified.Finally, critics argue that state-level experience is irrelevant to governing a nation. But this is incorrect for two reasons.First, Gujarat is not a banana republic: it is approximately equivalent to the United Kingdom in population and area.Second, a chief minister brings with him valuable grassroots knowledge that modern-day national leaders often lack.The success of Prime Minister Narasimha Rao was in no small measure due to his on-the-ground knowledge acquired as chief minister of Andhra Pradesh.Modi critics say that he is hardly the only successful chief minister in the country: look at what Nitish Kumar has accomplished in Bihar, Prithviraj Chavan in Maharashtra and Bhupinder Singh Hooda in Haryana.But these critics miss the point that Modi and Gujarat are inseparable. The Gujarat experience matters precisely because Modi, who nurtures national ambitions , leads it and he matters precisely because he is the man behind the Gujarat miracle. Without Modi at its helm, Gujarat would not be the centre of attention ; and without the accomplishments of Gujarat, Modi would not command the attention he does.Begin with the accomplishments of Gujarat. No doubt, the state saw strong growth even during the 1990s, before Modi became chief minister. But growth rate during that decade fluctuated wildly from year to year. The state's economy also suffered a massive shock from the earthquake in 2000-01 , just before Modi became chief minister.Under Modi, the Gujarat economy not only made speedy recovery from the shock, its growth rate also accelerated significantly and became much more stable in the subsequent years. The average growth rate of the gross state domestic product (GSDP) during the Modi years, 2001-02 to 2011-12 , edged out those in Bihar, Haryana and Maharashtra.You can dent this top ranking by playing with the starting and ending years but you cannot rob the state of the distinction of being one of the fastest-growing states during the 2000s. Moreover, under Modi, Gujarat has decisively moved up two places in per-capitaincome rankings. It now ranks ahead of Kerala and Punjab and trails only Maharashtra and Haryana among the large states.A persistent critic might ask, what about Nitish Kumar? After all, confining to the years of his rule, 2006-07 to 2011-12 , growth in Bihar beats Gujarat by a solid 1.5 percentage points. Moreover, after decades of neglect by both the central and state leadership, for the first time since Independence , he has brought hope to the people of Bihar. And, of course, no one can accuse Nitish of lacking national ambitions.But, alas, there is very little by way of economic policies that one can glean from the Bihar experience for the national economy. With just 11% population in urban areas, today, the state is not only the least urbanised among all states in India, its current rate of urbanisation stands where the national average stood in 1901.Bihar also remains the state with by far the lowest proportion of households with electricity. A depressing 16.4% of its households light their houses using electricity. This is proportionately less than half of the households in Uttar Pradesh, the state with the second lowest achievement in this area. With the share of manufactures in the GSDP just 4.3% and declining, Bihar is also by far the least industrialised state in India.Critics have often pointed to lower levels of education and health indicators in Gujarat relative to states such as Kerala, as the Achilles heel of its experience. But they neglect to mention that a significant part of the difference comes from historically higher levels of those indicators in these latter states.If one goes by the progress made in education and health, Gujarat's performance, especially in areas in which the problems were identified by the early 2000s, is quite respectable.Gujarat holds many records in India in terms of economic development20% of S&P companies have offices in Gujarat.7% of India’s GDP belongs to Gujarat.20% of India’s Industrial Output.9% of India’s Mineral Production.22% of India’s exports.24% of India’s textile production.35% of India’s pharmaceutical products.51% of India’s petrochemical production.The cover story highlights the achievements of Gujarat under his Chief Minister ship. “What’s certain is that during his 10 years in power in Gujarat, the state has become India’s most industrialized and business-friendly territory, having largely escaped the land conflicts and petty corruption that often paralyze growth elsewhere in the nation.” – Time MagazineThe world’s largest shipbreaking yard is in Gujarat near Bhavnagar at Alang.98.86% village connectivity with all-weather roads, one of the highest in India.Nearly 100% of Gujarat’s 18,000 villages have electricity connection for 24hr power through the Jyotigram Yojana.4. Gujarat has largest OFC network of more than 50,000 km. There are more than 900,000 internet users and all villages are connected with broadband internet.5. The state registered 12.8% agriculture growth in the last five years against the national average of 2%.Most people are not intellectually capable of doing honest research on a development model of the state. I won't trust individuals on Quora or Indian politicians commenting on Gujarat development model for mere political gains.Two major financial/consulting companies of USA have endorsed Gujarat's Model of development which can be trusted.Goldman Sachs, the major investment firm from USA.(Warren Buffet is investor)Goldman: If Only India Were More Like Gujarat - India Real Time - WSJMcKinsey & Co. Top 3 consulting firm which hires from IIMs.Gujarat leads in growth, Southern states need to catch up: McKinsey reportsources:The Narendra Modi economic model offers a compelling alternative to the mess at the CentreAccomplishments in Gujarat - Modi360Here's proof that Gujarat has flourished under Narendra Modi

It depends on what the client is being treated for and the specific insurance company that they have used. My answer will focus on insurance companies that pay for a client to undergo a mental health assessment and treatment.My answer does not specifically address the complexity of Compensation claims! Compensation claims are much more complicated especially if the client was injured at work and has their own legal representation, their employer is disputing their right to claim Workers Compensation and so on.Additionally, the following information pertains to a client that has contracted with Medicare or Medicaid. Under the current system, the above insurers have very strict policies in relation to the treating therapist maintaining adequate documenting.Generally speaking the insurance company's auditor will request a report from the clinician or therapist rather than notes per say.The notes can be requested if the insurance company auditor finds an anomaly in the therapists report. In most instances the therapist will tell the client that the insurance company has requested a report about the process of their therapy.Sometimes the insurance company will advise the client that they have requested a report. And they may ask the client to attend an interview if they are not happy with what the therapist has provided them.Essentially your question has raised a very important question, namely, who is the client! Obviously the client being treated is the client. But because the insurance company is paying for the client’s treatment, they too can be considered to be the client. And they have the right to assess if they have received an adequate service for the money that they have paid out.Why would an insurance company request a report or notes from the therapist?The insurance company is seeking to ensure that the therapist has provided a "needed and professional service that is appropriate to the specific client". The above sentence is used consistently between insurance companies.Or in other words, the company is seeking to determine if the therapist has been following the standard insurance company definition of medical necessity.In many instances, the insurance companies are making sure that the service provider has the correct qualifications and experience. For example, they don't want to pay for a therapist with a Master's Degree or higher to treat someone that can be treated by a therapist with lower level qualifications.For instance, a counsellor without postgraduate qualifications can assist a person with a mild mental health condition.What does the insurance company auditor look for in the therapist’s report and progress notes?In order to obtain the work and money from an insurance company, many therapists tend to exaggerate or provide a false diagnosis that enables the client to be trusted by them. For example, the therapist may diagnose a client with a Major Depressive Disorder (MDD) when in fact the client does not meet the DSM or ICD criteria for MDD.The insurance company is also seeking to ascertain if the therapist is suitably qualified and experienced to provide the required treatment regime. For example, if the client has been diagnosed with a duel diagnosis (Major Depressive Disorder and Intellectual Disability) the therapist must have training and experience in treating people with intellectual disabilities as well as MDD.Moreover, the auditor will review the therapist’s treatment plan and its appropriateness. They will also look for notes that indicate if the therapy is proceeding according to plan.That is, they will try to ascertain if after several months of treatment, if the clients mental state and functioning has improved.Or not!The auditor will be very thorough. They will want to see detailed weekly progress notes that document weekly treatment interventions and weekly assessments of the client progress.Finally, the insurance company will be seeking to evaluate the appropriateness of the therapist’s long term treatment plan. Not all clients progress at the same pace!However, if the client is not progressing as per treatment plan, the insurance company’s auditor will be expecting the therapist to develop an alternative plan that will actually assist the client’s rehabilitation.Basically, the insurance company overall objective is to make sure that the therapy has an end date. They do not like to pay for long term therapy.Kamal