Internship: A window of opportunity for improving diabetes care

Sir,

Internship is a phase of training wherein a graduate is expected to conduct the actual practice of medical and health care and acquire skills under supervision so that he/she may become capable of functioning independently as doctor and as medical officers of government who run primary health centers.[1]

I was in final year when I read about diabetes mellitus to pass my examinations; at that time, I got interest in diabetes, so I tried for Indian Council of Medical Research short-term studentship, but unfortunately my topic was not selected. During my internship, I got an opportunity to continue my research. I used to sit in endocrine outpatient department where I came across many diabetic patients. It was very striking to see that there were so many patients of diabetes. Through a questionnaire, I screened and analyzed 150 patients of Type 2 diabetes regularly attending the diabetic clinic. I was fortunate to get an opportunity to see many patients of Type 1 diabetes, gestational diabetes mellitus, and a few cases of maturity-onset diabetes in young patients also.

In the cases I analyzed, many of them had been undetected for many years and diagnosis was made when they developed any complication such as retinopathies, diabetic foot, chronic kidney disease, skin infections, and many more. A few were incidentally detected during routine or executive health checkup through an abnormal blood or urine glucose test.

Most of the patients coming from lower socioeconomic group had poor control due to poor compliance with medication. Some patients were taking ayurvedic and Unani treatment, at times this was attributed to poor affordability.

I found that youngsters who have been recently diagnosed with diabetes sometimes do not wish to accept and reveal their condition due to the social stigma attached to the condition when seeking marital alliance.

Many patients were ignorant about their health; in spite of counseling, they did not follow the diet chart or take regular medicine.

During internship, I connected with the people, patients, and that made me feel, for the first time, what it meant to be a doctor. It helped me in narrowing the gap between theory and practice. Unfortunately, many students do not take internship period seriously.

• References

• 1 Medical Council of India. Salient Features of Regulations on Graduate Medical Education. New Delhi: MCI; 1997. Available from: http://www.mciindia.org/know/rules/rules_mbbs.htm [Last accessed on 2012 Jun 15].
• 2 Kalra S, Julka S, Joshi R, Shah A, Jindal S, Agrawal N. Strengthening diabetes management at primary health level. Indian J Endocrinol Metab 2015; 19: 443-447
• 3 Ali MK, Singh K, Kondal D, Devarajan R, Patel SA, Shivashankar R. Effectiveness of a multicomponent quality improvement strategy to improve achievement of diabetes care goals: A Randomized, Controlled Trial. Ann Intern Med 2016; 165: 399-408
• 4 Standards of medical care in diabetes-2017: Summary of revisions.. Diabetes Care 2017. 40 (Suppl. 01) S4-S5