CONVINCE OR CONFUSE
CONVINCE OR CONFUSE
Retd. Prof. & H.O.D., O & G,
V.S.S. Medical College, Burla
Dean, I.M.S. & SUM Hospital, Bhubaneswar
Pro. V.C. , SOADU, Bhubaneswar
President, ISOPARB
“The art & science of asking questions is the source of all knowledge”
-Thomas Berger-
“An average friend flatters on your face,
A good friend praises at your back,
A true friend points out your short comings,
So that you can improve in future”
-Self-
It was the Pre-Lunch Session dt. 14.3.15 in the 31st National ISOPARB Conference, Bengalure .Topic of panel discussion was “IUGR – decision to deliver when enough is enough”. The topic was quiet thrilling. The moderators & panelists were highly knowledgeable, the hall was full with over enthusiastic audience. It was a war like situation as if the medical science is challenging the nature. Therefore, I was motivated to attend this session.
The moderator started the motion quoting “If you can’t convince, confuse.” which reflects her negative mindset. The panel discussion started with an interesting case history, “ A case with 30 weeks gestational age, hypertensive (BP 150/100mmHg) severely pale (Hb% - 6gm%), Fundal Height 24 wks, AFI – 6 & Urine albumin 1 plus (+).
How to approach ? The audience was quite excited looking to the complexity of the case & their expectation rose quite high to know the definite solution of this complicated problem.
WHAT WERE THE EXPECTATIONS OF THE AUDIENCE ?
- Whether Pre Eclampsia (PE), anemia & IUGR (remote from term) inter linked ?
- In such a case how to evaluate?
- If a delivery is warranted ( Vaginal Birth / CS), how to counsel & plan for the delivery ?
- What is the role of the Mother ,Anesthesiologist , Neonatologist , Physician & Obstetrician?
- If delivery is delayed what is the risk & benefit to the mother & fetus ?
- If delivered immediately what is the risk & benefit ?
- The other following issues need to be addressed
- Post natal management of mother & neonate including NICU treatment.
- Anticipated complications(immediate & long-term) of both the mother, neonate & chance of recurrence in future pregnancy.
- Cost effectiveness of any type of management.
- Social issues related to too much premature IUGR babies.
- Medico-legal issues related to decision making & management.
- Ethical issues in delivering a premature baby.
- What is the evidence based practice in such a case & that too in Indian scenario?
- The discussion should be scientific, informative, interactive & humorous in an electrifying atmosphere.
- Role of audience in such interaction should have been well defined.
THE REAL PANEL DISCUSSION:
- Before the panelists started their plan how to evaluate this case , much time was taken on the discussion like,
- Discrepancy in fundal height
- Prediction of PE
- Prevention of PE
- Low dose aspirin in prevention of PE which were not necessary for the presented case. Much time was wasted before the real issue.
Then came the real discussion only for few minutes like choice of antihypertensive, treatment of anemia (without evaluation), fetal monitoring etc. On these discussions almost 55 minutes passed. Then the moderator was in a hurry to proceed to the next case. In the mean time the audience has started showing their displeasure the way the discussion was heading. Some of them had started grumbling but no one was feeling comfortable to challenge the moderator. One delegate from the audience stood up & raised a question, “Madam! From your discussion you have successfully confused me. I couldn’t know what is the clear-cut take-home message for this case”. The moderator took it by surprise & replied to the member to discuss his problems at the end of the session.
At the end of the discussion the moderator wanted to know why the delegate was confused? Then the delegate replied that the discussions on that particular case was not up to his expectations, so he was confused. The moderator tried to explain the line of management of this case, but the delegate was not satisfied & jokingly commented, “ If my daughter with such problems was being treated by you then I would have taken her to some other hospital”, which was applauded by the houseful of audience.
The moderator instead of taking this comment sportively, suddenly lost her temper and asked the delegate his name & the place from which he hails. The delegate told his name & the place. Then the moderator passed a derogatory comment on his place; “What happens at your place is known to me. If you can’t treat such cases in your place, refer them to Bengaluru & we will take care”. The delegate without protesting politely kept quiet.
The story did not end there. At the end of the panel when the delegate went to shake hands with the moderator she refused to do so, saying, “ From the core of my heart I am telling you, that I cannot shake hands with you”. She even told to some of her friends & colleagues pointing her finger towards the same delegate, “This fellow is misguiding the audience”.
At the end of this short story few questions arose in the mind of the audience which need to be addressed :
WAS THE DELEGATE AT FAULT?
- What is the harm if a delegate raises a valid issue?
- Is it a blunder on the part of the delegate to ask a question to the moderator which is not palatable to her?
- Is he at fault to express his dissatisfaction over the discussion which is a freedom of speech & expression?
- Has he committed any crime so that he will be humiliated & that too his work place?
WHY DID THE MODERATOR GET UPSET?
- The moderator is the captain & leader of the team. She should have the exemplary qualities e.g. knowledge, patience, tolerance, broadmindedness, appreciation etc. She should have the personality & attitude not only to guide the panelists but also to control the tempo of the audience.
- The moderator should anticipate some bouncers from the audience & she should be well prepared either to duck or to hook it for a six, then only the session will be enjoyable. Instead, if she loses temper & then in the next ball she may be out.
In this story, in my opinion the moderator lost her temper & committed two blunders:
- Is it fair to hit someone under one’s belt? The moderator’s derogatory comment on the workplace (motherland) is highly deplorable. No civilized person can tolerate it. Because the delegate was generous he kept quiet. The suggestion of the moderator to refer such critical cases to Bangaluru for better treatment exposes her complexity & ignorance of demography of India e.g India does not live in metropolis like Bangalore but India lives in villages where majority of the mothers are poor & not health conscious.
- In the second episode, refusing to shake hands & passing an adverse comment on the delegate that he was misguiding the audience was totally uncalled-for. In this situation the moderator should have shown her generosity & greatness by appreciating the question of the delegate. The moderator instead devalued herself by insulting the delegate in the public.
CONCLUSION: Medical science is vast & fast expanding. Therefore there is no place of dogmatism & vindictiveness in it. Our brain should cope with the expanding science & our mind shouldn’t be too narrow to appreciate this. In the above episode the treatment received by the delegate from the moderator is open to all readers for judgment but the approach of the panel discussion should have been “controversies & consensus” rather than “convince & confuse”. Where expectations are high frustration is the rule.
After writing this short story I feel to quote Swami Vivekananda;
“You can like me or hate me,
In both ways you are doing a favor,
If you like me, I am in your hearts,
If you hate me I am in your minds”
Interestingly the delegate was the author himself.
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