Family Medicine—A Clinical and Applied Orientation CS Madgaonkar
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1Family Medicine2
3Family Medicine: A Clinical and Applied Orientation
CS Madgaonkar MBBS, FCGP Consultant Family Physician Hubli
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672 Fax: +91-11-23276490, +91-11-23245683
Branches
Family Medicine – A Clinical and Applied Orientation
© 2006, CS Madgaonkar
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2006
9788180617881
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd, A-14, Sector 60, Noida 201 301, India
5Dedicated to
MY DEAR FATHER
Shri Sachidanand Govind Madgaonkar
There is no death! The stars go down
To rise upon some other shore,
And bright in Heaven's jeweled crown,
They shine for ever more.
— John L. McGreery6
7Preface
“Before everything else, getting ready is the secret of success.”
… Henry Ford…
“All things are ready if our minds be so, “said Shakespeare.
Now that you have made up your mind to invest in this book, is this investment going to help you be a SUCCESSFUL DOCTOR?
Is SUCCESS elusive or tangible? More so, in medical practice, is SUCCESS elusive or tangible?
It is generally said that joy, which is internal to one is tangible and success, which is an external measure, is rather elusive.
Look at it this way—at the end of each day, you can actually count the number of JOYOUS episodes you experienced, spread over, familial episodes, patient-related episodes and so on. But, you will never be too sure of SUCCESSES that you may achieve during the course of the day!
This book is about increasing both the TANGIBLE JOY that you experience as a Doctor and the SUCCESS that you hope to achieve as a Physician. In a way it is like excellence and perfection. Perfection may be an illusion, but the process towards it is NOT. Granted that success may appear elusive, but the PROCESS towards that elusive end is NOT. This book is about THOSE PROCESSES.
Although this book is for Doctors, it is also intended for anyone interested in the domain of medicine. It is not just about medical practice that one usually learns in medical college. This book is about SUCCESSFUL medical practice, something that was not taught to you, but perhaps learnt along the way.
I believe this book would have served its purpose, if you were able to pick up some points from the book and enhance YOUR SUCCESS in medical practice.
“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head”, said Sir William Oslar.
So, let me sign off by encouraging you to write to me if you have found interesting or unique success formulae for yourself by using your heart and head equally.
CS Madgaonkar
8
9Acknowledgements
Writing this book was a kind of distillation of knowledge and teachings from many wizards in my medical schooling years, from whom I have imbibed a lot. Many of their ideals have made such an instant impact that they have inspired my practice of family medicine, especially those whose writings have been included in this book. As this subject matter has been collected – and cherished – for nearly forty years, I am unable to recall their exact sources adequately. I am, however grateful to many teachers, authors, and publications which I have freely consulted and utilized their knowledge and experience.
Publishing a book has always been a team effort, involving a harmonious blend of many individual's brains and brawn. This is my occasion to thank them all.
First of all, I wish to recognize major assistance from Mr Balkrisna Shivram Sawant, Ms Varsha Kamat, Ms Shaheen Pathan, Ms Shweta Chatpalli, and Mr John Eda for their editing skills and willingness to type and retype numerous drafts of this manuscript.
My special thanks to Mr Ajitkumar Warrier, CEO, Arpita Office Automation, and Mr Ashpaq Ahmed, who took immense care and pains to provide innumerable printouts of the manuscript and formatting them ever so patiently and meticulously.
I have received the most generous assistance from Dr Garth Manning, MRCGP, Medical Director, International Development Programme, Royal College of General Practitioners (RCGP), London, Ms Claire Burden, International Manager, RCGP, London, and Mr Spencer Stith, Manager, International Activities, American Academy of Family Physicians, Leawood, KS, USA, in compilation of the data on evolution and history of general practice and family practice in the United States.
The astute and innovative ideas of Mr Narayan B Gad, President, Nicholas Piramal India Ltd., Mumbai, have greatly inspired most of the chapters in this book. My colleague, Dr Subhas Babruwad, has been of great help in the preparation of chapters on preventive care.
I am most grateful to Shri Jitendar P Vij, CMD, M/s Jaypee Brothers Medical Publishers P Ltd., New Delhi, and Mr Tarun Duneja, General Manager (Publishing), who have displayed rare patience, understanding, and professionalism in handling this project – from conception to its completion. The advice and encouragement of Mr RN Mandal, Regional Manager, Bangalore Branch, has been exemplary.
The preparation of this book has been truly a tremendous family effort, which must be acknowledged. It is the most encouraging support of my loving wife, Dr Vidya MD, DA, which really made this effort a pleasure. This book is, in fact, her brainchild; it's seeds being implanted over two decades ago, when she encouraged me to study for higher qualifications in family medicine. It is her 10mentoring, which has helped make this book a reality. A special word of appreciation to my son, Varun, who did much of the “spadework” in the formative stages of this book with his speed and agility with the computer. I also owe a debt of gratitude to my mother, Smt Sumitrabai S Madgaonkar, for her unstinted support, encouragement, and forbearance. My immence thanks to my close family associate, Mr Vikram Shekhar, for valued deliberations related to the book.
Last but not least, I am indebted to my patients, for providing me hands-on experience and continuing opportunity to learn, which gives a book like this one it's form and substance.
This book is a reflection of all those who participated, knowingly and unknowingly, in making a dream into reality.