Assessment at Sri Ramachandra Medical College (SRMC) – Day 4 the Final day !!

This is the final day, where we went only to collect the report from speech department and have the final consultation with the doctor. We lost interest on day 2 in this exercise, but still we want to bring this to a proper conclusion, hence proceeded till the day 4.

We went to Speech department for collecting the report, we were asked to wait. After which the report was given to us, we opened the file and found everything is different. We realized that they handed over a file of a different patient to us! @#@$#$$!!! We went to the speech department again and asked for correct file, then they realized the mistake and gave the correct file. We read the report, it was detailed. But the report had few incorrect mention of facts such as our son’s age, where he is going for therapy now and where he went for therapy earlier etc … We did not bother at this point of time, any further corrections to this would mean another visit to SRMC which we really don’t want.

We collected the report and gave the file with all pending reports to the Organizing lady. She said it will take 1 hour for her to prepare a consolidated report, so we can break for lunch or etc…Also she mentioned that Dr.Udayakumar is unavailable which was unplanned, so there will be a lady doctor who will review the reports.  We were actually happy that we did not have Dr.Udayakumar on that day. (No offence to the doctor’s experience or qualification, it’s purely based on our personal experience with him)

So we went to canteen, and ordered for two watermelon juice at 11 pm. One of the non-peak hours, not much crowd, but it took 40 minutes to get two watermelon juice from them. Since our purpose of having juice was to kill the time, we ignored it. We became numb to inefficient people at all corners of SRMC by now, nothing can surprise us further.

We went back after one hour to the organizing lady, she asked us to wait. We waited for 20 minutes, after that we were called in, where the lady doctor who took out initial case history on day 1 was there. She simply read the highlights of the consolidated report which was prepared based on the reports given by different departments and suggested supplements for vitamin/mineral deficiency. In my opinion the consolidated report and the consultation was not a productive one. There was nothing new apart from what we have communicated to them. (Again she spoke too many words in a minute very fast, might be difficult for many to follow).

We were asked to buy the supplements from the pharmacy and the file was given to us. Before exiting C2 for the last time, it looks like a sticker needs to be placed on the file by the C2 reception which we did. We went to ground floor for the pharmacy, the crowd at the counter was NOT encouraging at all, we decided to buy the medicines outside and left the hospital once for all!

In my opinion, i feel the following should have been taken care by SRMC for a unit that assesses kids on the Autism Spectrum:

1) Parents who bearing the news of carrying a child on spectrum comes with a heavy heart and emotionally unstable, the foremost basic expectation of the pediatrician would be to enforce positivity and listen to what they have to say. In our case, we knew we had a child on Spectrum, which may not be the case with all other parents coming for assessment, breaking the news for the first time requires some compassion.

2) Do not highlight or stress that bad parenting is the cause of their son’s autism. Parents need all the more support and confidence after the assessment to help the child and be self-motivated, do not kill the hope. I personally give a shit about suggestions given by unqualified people. I can google and give million such suggestions. (Its like a doctor with obesity is asking us to eat healthy, follow diet and exercise well ….)

3) As a pediatrician you need not unload all your experience and knowledge on the patients, unless called for. You may have seen 1000 kids, but do remember every kid is different. As parents, the amount of research on google, number of books read, number of awareness sessions attended, number of workshops and conversations between other special parents made them more knowledgeable and aware about the available options. As allopathy doctors, you have limitations as to what you can recommend to patients, which may not be the final course of action left in the parents hands. So don’t think you are smarter than the parents. Remember you are diagnosing a condition for which cause is not known till date, cure is not found till date by Allopathy.

4) As a pediatrician following allopathy, yours tests and diagnosis should be based on the concrete proofs/evidence and not mere professional judgment. Cover possibilities of known theories such a Vit D, Vit B12, Calcium, Zinc, Iron, Magnesium, Lead, Allergy etc for deficiencies and abnormal levels. This would become the base line for Nutrition. Also a MRI scan, X ray, Ultrasound scan as necessary, even though children get exposed to radiation, it may be beneficial to rule out possibilities of other theories.

5) For a place with lot of waiting time, dealing with children having challenges, the places is not children friendly. There is no play area, no cartoon characters on wall, no balloons etc., no chocolates inside doctor’s office…. We saw few drawings in room number 9, other than that the place is a very dull atmosphere. It is impossible to keep a highly energetic autistic children sit on the chairs for hours. They need their sensory processing as and when required, will not keep quiet for long. If the body needs the jumping / running / screaming sensation they need to do it.

6) All the tests that are required to be taken care by the child should be kept next to each other, which will be hassle free for parents to carry the child, luggage, to each and every different blocks.

7) I saw that OBGYN appointments also happen at C2, which in my opinion is not correct. As a pregnant women, if you see multiple special children on the same floor, it impacts them emotionally and brings up fear of such a situation happening to them.

8) I found that there were toilets separately kept for Doctors / Staffs and that of patients. The Staff toilets are always locked up and key is kept somewhere. C2 does not have a toilet for male patients or visitors, it has two toilets for patients, and both of them are marked as Female. If you are a male patient/visitor you have to go to a different block. I see that Staff toilets are cleaned frequently by the cleaning ladies during our long waiting time. Not sure what was the attention given to the patients toilets. Instead of segregating, why not clean all the toilets the same way, so everything remains clean. I assume doctors also pee and shit in the same way as patients/visitors.

Overall Report

A Brief summary of what the report expressed for my Son is given below:

Psychological Evaluation was based on the Wechsler Preschool and Primary Scale of Intelligence – IV Edition, since my son did not co-operate for the full evaluation, they cannot provide an IQ score. Instead they have given a CARS II (Childhood Autism Rating Scale – Second edition) score. This was 26 for my son.

15 to 29.5 is considered as Non autistic (i.e. minimal to no symptoms of ASD)

30 to 36.5 is considered as range for mild diagnosis of autism

38 to 60 is categorized as moderate to Severe Autism

Speech report was done based on Westby’s developmental play scale where my son corresponds to Level V. He is a year behind on his expressive language.

Occupational therapy suggested to continue therapy, more outings, socializations etc .. the report (i.e. standard form) was based on PDMS 2 Scales (Peabody Developmental Motor Scales–Second Edition)

Trifer Syrup was suggested for Iron Deficiency

Jusdee tablets were suggested for Vitamin D Deficiency.

There was no mention on the diet, for vitamin Iron deficiency we were asked to give greens (keerai) to our son thrice a week. She did not advocate on the GCFC diet, as it is causing series nutrient deficiencies on the children.

Below are my Suggestions to fellow parents who are going for Assessment in SMRC:

1. Arrive early to the hospital to get the registration process complete.
2. Pack food from home for lunch, if possible have breakfast at home before leaving or have it in an outside restaurant before reaching the Hospital. Canteen food is not tasty or Healthy, you can tell the difference.
3. Pack for snacks, additional dress, diapers, activities to occupy your child like coloring books, puzzles, story books, etc. A Blanked if the kids fall asleep during waiting.
4. Pack everything in a backpack which will be easier for you to carry, as you have to manage the kid and luggage, carrying the bag on hand will prove painful later.
5. Take necessary cash, even though the assessment services package were 750 rs, the additional tests that may be suggested for you kid involves extra payment.
6. Be prepared for multiple visits
7. Make note of the issues faced by your child in a book, so that it will be easier to mention. Due to the stress, we may forgot to include certain piece of information during the consultation.
8. Carry a pen
9. You can take a flask for coffee/tea, so that you need not have a lengthy walk to the canteen each and every time you need a coffee/tea.
10. The assessment process is very stressful for the child, so take items/things that excites him or brings him back to good mood. You require it.
11. Keep your power bank fully charged.

All the above posts related to SRMC is purely based on my personal experience with them, I am not saying they are bad or good, I am saying that we did not have a positive experience.  It may not be the same for all.

If money is not the criteria, I suggest parents to get the kids assessed from independent practitioners who are best in their skill and get detailed report of your child. You do not require an MBBS or Pediatrician for Autism assessment.

Regards,

Karthikeyan

karthiksaranyaparents@gmail.com