Doctors and their charges, should the Government intervene?

The State Government of Karnataka is considering tabling a bill in the Winter Session of the Legislative Assembly which would make the private medical practitioners in the state come under the Karnataka Private Medical Establishment Act (KPMEA), 2017 (Amendment).

The act in question aims to bring down costs of healthcare in the state of Karnataka by enforcing certain caps on the treatment costs incurred at the said private medical establishments. The act also seeks to form a district grievance committee which will perform the role of a civil court. The role of this body would be to respond to complaints at the district level. The complaints received will be reviewed and a recommendation sent to the manager of the establishment with a copy to the Karnataka Medical Council or the Ayush Medical Council. It will also inform the registration authority, comprised of the deputy commissioner, the district health officer, the district AYUSH officer and two members from recognised associations, which can also register a private medical establishment. Any complaints regarding the services offered by a medical professional belonging to a private medical institution can be made to this district grievance committee, which will decide the process further.

The entire state of Karnataka is at this point in time in a state of us vs them. The lines have been drawn and the game is afoot.

The major issue here seems to be the fixing or capping of costs for medical services which the government states, they are trying to do, in order to compile uniform rates for procedures across the state. They claim to have set up a committee to decide fair and just prices for standard services like an OPD consultation, basic surgeries like appendectomy, hernia repair, delivery, cesarian sections etc.

Let's look at this objectively for a moment. On the surface, to the general public, this will sound great ,at first! I get to meet a consultant who used to charge Rs. 5000 for 15 minutes of his time and all I have to pay him now is Rs. 200 (Super specialist Fees). Awesome!! 

Let's get back to reality now. Do you think he charges Rs. 5000 only because he wants the money? The more probable answer is that he is a senior citizen who is now working for a few hours a day, using all his years of experience, giving opinions and second opinions to patients who haven't found answers elsewhere, all while trying to keep the lines down to a minimum because everyone in the city wants to be treated only by the 'best doctor' in the field! The price point is probably a technique to fend off those who may not really need his advice and to make it more manageable for the Doctor to see genuine cases who he might be able to help.

Another Doctor charges a sum of about Rs. 500 to Rs. 1000 depending on his qualifications and specialty as a routine consultation fee. A lot of the general public might find this expensive, a lot of them find it fair. The point is they have a choice. As should he, to decide what his time is worth! This has nothing to do with how much he spent on his education and how much time and money and how many years he's invested in becoming the Doctor he is today. It has to do with his freedom of choice as to how he wants to position himself. If he isn't good at what he does, even if he charges the stipulated Rs. 50 that the Karnataka government wants him to charge, he won't have any patients. Even then, and especially then, the choice is still his, because the last I checked we don't live in North Korea (with 5 haircuts allowed and a dictator with the worst one).

A lot of people in the past few days have tried to defend this saying it's not targeting doctors but private medical establishments. How ridiculous is that? There is a reason private medical establishments are expensive. They have spent money obtaining the land, building that structure you marvel at, keeping the place spic and span so that you are satisfied about the cleanliness of the hospital, not to mention, it ensures that you don't get infections once you're admitted in there, hiring the best staff so that your experience in the hospital is a pleasant one, hiring the best nurses and Doctors so that your care is epitomised. Even then, if you think they charge more than required, remember that open MRI machine you wished they had because you are claustrophobic and can't get into a closed one, that costs some more money now doesn't it. The wonderfully reclining bed so that you can watch your TV post surgery, that non-squeaking cushioned wheelchair, that doesn't hurt your backside when they wheel you to get an x-ray, that non greasy x-ray machine that takes the perfect x-ray so that your tiny kidney stone isn't missed...the list goes on. Unfortunately, these cost money. Money that the government isn't giving to the hospital, neither is it spending on its own public hospitals so that you don't need to go private at all.

That really is the crux of the matter isn't it. Do we really need a cap on the private medical practices or do we need better sustainable public healthcare? As an example of Mumbai, would you mind going to a public hospital if it was made as Kokilaben or HN or Saifee hospital? I would gladly go there if they weren't so badly maintained, ill equipped, badly staffed, unclean, and terribly stocked.

Why only medicine? Could we cap a lawyers fee just because he isn't a public prosecutor? How about a cap on those who build our roads (rather potholes)? A cap on the MLA's allowance....I mean he isn't really providing a service is he? He could do it for free? A cap on architects and interior so they can't charge you to make you house look beautiful? 

As a last point of contention, I've worked in both public and private hospitals. I am a surgeon. Once the patient is admitted under our care, we no longer look at where you've come from or what you own or how much you make in a year. All we are concerned about is how to get you well again and how to send you home in better health than you came in with.

This article appeared in the first post website and I think it's worth a read.

26/11.. My Experience from years ago

Although I was not in any of the places where people got shot / bombed, I've never gotten around to writing what we were doing on that night, but, looking back it's pretty scary!

This happened at the time when I was still working at Hinduja Hospital. There were two observers working in our department of Surgery from overseas. Karan was from South Africa and Nitin from the US. They had both come down to gauge the clinical processes in the Indian Healthcare System.

We had planned a night out, seeing that they would be leaving towards the end of November. They wanted to go to a place where they could chill and have a drink. We got all our friends around and decided to go to Leopold.

My wife and me have been Leopold fans for a while now, but off late their service had become greatly tipped towards foreigners. We decided to head off to Mondy's (Cafe Mondegar) instead.

There we were, sitting and enjoying the jukebox and beer when all of a sudden they started closing their long wooden windows. On inquiry, the waiter told us there was some sort of gang shooting happening outside and we should stay put and it should all be fine soon. This was around 9.15 pm. I clearly remember a BEST double-decker stationary outside.

Strange, I thought and made a mental note. In a couple of minutes, between my wife and me, we received 5-6 phone calls ranging from Ahmednagar to Dubai saying that there was some sort of blasts in Colaba and asking whether we were safe? Of course, at that time, all I could do was say in the usual Bombay drawl, it's all cool, there's nothing much happening here.

We continued our drinks till about 10.30 pm blissfully unaware of what was happening outside. When we finally decided to leave, the bus was gone but there were barricades outside and about a dozen cops. When we took the car out, we were told there are some people walking around Colaba with guns and we can't drive down causeway. I told them that we live at Strand and we need to get home. They asked us to go via madam cama road. We did. We had with us a dear friend from Navy Nagar and she had to be dropped home. We took the back road and reached RC Church to find armed guards at the naval gate. They would not let us in to drop her home. My wife got into a heated argument with the guards along with my friend saying that if there was a dangerous situation there, wouldn't it be foolish to ask a lady to walk back home from the security gate. Anyone who knows navy nagar knows there is a fair distance between the gate and any of the buildings. After a while, they agreed to let my wife drive my friend home whilst the rest of us, Karan, Nitin and me waited outside at the gate.

Once she was back, we were slowly starting to realise that the situation must be pretty bad for the security guards to behave in such a manner. We decided to head back as soon as possible. On the way back, we were once again stopped at Sassoon Docks, with people telling us we can't drive through there onto S.B.S. Marg. There has been a bomb blast on the road, he said. How am I to reach home, I asked them? They said take the back road.

This back road I keep referring to is actually the Badhwar Park Road. The same place where the now infamous group entered my Bombay! We took that road and reached the electric house signal. Once again, we were stopped by the public. There were hardly any cops here yet. As luck would have it, one of the people knew us quite well. He worked in my wife's cousins shop. He convinced the crowd to let us go and that we stay close by.

This is another thing that is clearly etched in my brain. I made that drive from Electric house to Strand Cinema in less than 20 seconds and I did not see one thing moving on that road at that time. It was close to midnight and it was a strange sight to see Colaba empty.

Keep in mind, till now, none of us either heard or saw any gunfire or blast. We reached home safely and the first thing we did was switch on the television to get the news! Almost as soon as we did so, we heard a powerful blast that shook all of us to our very bones, including the house. It came from Nariman House, just a few buildings away.

My friends from overseas were in shock. So were we. We spent the next 3 days glued to the television, up on the terrace (rather foolishly now that I think of it) looking at Taj burn and Nariman House make shooting noises. My wife got goosebumps when she saw the commandos being air dropped on the roof there. Not something any of us will ever forget.

I applaud the staff of Cafe Mondegar though! I'm sure someone there knew it was a terrorist attack but they made sure none of the patrons knew that before we were ready to leave. It could have been chaos if they did.

What Next Bombay?

I’m not going to recount the episodes that have occurred in the past. I’m not even going to dwell on the 3 blasts that brought about this post.

I am just going to vent, so if you do not want to hear complaints and anger, get away from this now!

The psyche of people living in BOMBAY (this is how I am going to refer to my city, and anyone who wants to pick a bone with me regarding this, I dare you!) has changed so drastically that now that something even remotely close to tragedy happens, we’re tuned to brush it off unless it has affected us directly. We were called by many people living outside the country, family and friends who are as close as family, all afraid because the BLASTS had taken place in our city. All concerned and rightly so. The atmosphere at home and the clinic was slightly different though. According to them, we were nowhere close.

My wife, bhabi, nephew and son were all at Metro that evening. I was at babulnath. Yet we thought it was fine because we were ‘nowhere close’ to the blasts…It was close enough for people not in the city to call us, but as long as we were a kilometer away, we were far off and not affected. Most people in areas of terror attacks fear for themselves even if they are miles away. It just doesn’t matter to us anymore.

26/11 was frighteningly close to my home. I was at Mondy’s as it happened. Our friends stayed over that night! We were afraid then. Nothing this time. Repeated attacks have either made us really strong or extremely stupid.

The other thing I want to rant about is people blaming the politicians and the intelligence agencies. What do you think they were supposed to do. We live in our city, spit on our roads, litter like there is no tomorrow (or dustbins), get irritated when cops stop us or have a nakabandi because it screws traffic and still proceed to blame them the next time something happens.

I remember the drunk driving crusade that the cops started. I loved it. Used to feel proud when I stopped seeing cops working in the dead of night to prevent people like us who drink and drive from dying. Most of us though, disliked it. Hated them for catching us, if they did. Cried foul when licenses were taken and court appearances demanded. Would you drink and drive internationally….I don’t think so!

You want to live in a safe city, reclaim it from inept politicians. Take your own responsibilities seriously. Stop at the goddamn red light for a change. Even better, get your license legally without a bribe or an agent. There are enough and more rules and laws. All we need is to implement them, and we shouldn’t need the police to tell us or force us to do so. Of late, I have been intentionally driving into people coming down the wrong way in a one way street outside my home. One uncle on a scooter almost fell, yelling at me for doing it purposely and was shocked when I said yes I did. Hopefully, he won’t be riding down the wrong way again. I also picked up some chewing gum a 40 something Aunty spit on the road because the shopkeeper wouldn’t let her use the bin. Small things but it’s a start.

Do something, don’t just rant on facebook and twitter.Also, don’t dismiss candle marches so easily. It may not have got the desired result last time, but it did shake up the government. Libya also started with something as small.

If you think you have the guts to make a change happen, stop the next cop you see riding on his bike without a helmet and ask him where the hell it is. My mom has done it and I have never been more proud of her. Stop the cop riding on JJ flyover when he won’t let other bikers ride there. Yell your lungs out at someone asking for a bribe and watch him wet his pants. They only do what they want because the majority let them.

Lastly, this thing is not about religion. It never was. It’s about making a stand and voicing opinions. They want our attention and they have it. I liked Advani’s point about learning from the US. He, however, did not specify what to learn. Should we learn to give body cavity searches to people in wheelchairs, or learn how to bomb the countries we like least?? Or is it the fact that there has not been another attack there…. You can’t copycat nations. You don’t have an identity if you do that. We wouldn’t be independent and a democracy if we did. We got through the British, we can get through terror. All it takes is a few very angry people from one very angry city to start something. Be it traffic rules, or terror. Do something!!!

Change is inevitable....dealing with it is not!

I bet you've been asked the questions at least once in your lifetime: If there was one thing you could change about your past what would it be?

The question is so rhetorical it's unbelievable that people get sucked into it and start thinking about answers.

There is nothing that you can do about change other than deal with it. Things change all the time. That's how the world works. If everything stayed the same, you would itch to change something and be the reason for the change. 

The only problem is the mentality of dealing with change. It's called adjustment. Adjusting your mindset to allow for the change. Adjusting your attitude towards the change. Adapting your mannerisms to suit the change. Adjusting yourself to be one with the change.

Any one who can't do it, complains and  protests. It is the feeling of helplessness that causes you to do so. It is the denial of the change that prompts you to join others doing so. It is the feeling of hope that you will have things back to 'normal'. Without realizing, that at that point of time in the universe, you too are asking for change. Change back to normal.

The answer is simple. Be prepared. Be flexible. Be adjustable (within limits) and be secure in the though that even though you may not like it, things will change again! One of the easiest ways to deal with change is to be the harbinger of change. Be part of the process and you will be surprised to see how easy it is. Now, I understand that this is easy when you like the change that is about to happen, when you're rooting for it, even.

The challenge lies in change that you are not comfortable with. How about looking at it from a completely opposite angle?. Force yourself to think completely opposite to what you usually do. It would help you perceive the change in another mindset and perhaps make it easier. Another suggestion would be to completely ignore it. Let people sound out their views, nod along and wait and watch. Either you adjust to it or while waiting it changes again. A more active approach would be to change something about you that matches that change so it doesn't feel so bad or negative.

The only thing I think we absolutely should not do is to react instinctively. Simply because, in this case, human instinct is always against change. Easier said than done, right. Believe me, I know!

Here are a few quotes that I really like about change. Do let me know how you deal with change!

My way of giving back!

This New Year's day, I decided to start treating all senior citizens (above the age of 70 years) free of cost at the clinic. Unconditionally. No strings attached. No hidden agendas. This is my way of giving back to our older generation with the hope that my kids learn the importance of respecting their elders and offering them their dignity.

A lot of people I shared this with had the obvious question ready - How come?

A couple of instances at my clinic really moved me over the past year. All this came in addition to my Mom's advancing age and her chronic and rather constant quarrel with pain (it's a quarrel because it hasn't turned into a fight yet).

My mother recently underwent back surgery for her chronic lower back pain. The surgery went off well and her pain and burning sensations started to reduce initially only to annoyingly come back every so often. It is getting to her. We all at home can see it. We see her struggling every day to keep herself as fit as possible, to exercise as much as possible without pushing it too much, to continue working for as long as possible because she will just refuse to sit at home and do nothing, such is her determination for independence. And still, it sometimes got too much. As is human nature, we first denied the pain, then tried to blame her for it, saying your doing too much or you aren't doing enough, anything but accept the fact that this could be a problem that is here to stay. It hurt her badly. Slowly but surely I realized what I was doing was wrong. It shouldn't have mattered if I was busy, angry, disturbed, ill, if my mother needed to vent out her pain, I should have listened. We generally don't like listening to our elders do we?

Another patient came to the clinic the other day. She had been abandoned by her family and was now living alone. She was facing what most elderly people face everyday - fear, loneliness and  abandonment. Their worst nightmare. She had avoided treating her illness for months for fear of no one being there with her and with the worry that she might run out of the little money that she had. I never want anyone to feel that fear again. It shook me up. I immediately realized that if our family wasn't as close or supportive as we are, this could have been my mother. Suffering silently just because of fear.

The last patient in this scenario just wanted someone to listen to her. All she needed was my time. She could not sleep and wanted a prescription for sleeping medication. She would stay up worrying about why she wouldn't get sleep. She broke down crying when I offered just a few kind words of support. All she needed was some love and kindness and a patient hearing. This reminded me of my father in law who also struggled with sleep. All he wanted was for us to believe him that he really could not sleep.

The elderly have earned our respect. They have sacrificed enough, been through enough, given us more than enough, taught us enough, faced more than we ever will and have been more patient with us than we generally are with them. They not only deserve our respect but have the right to command it.

I will not charge the elderly for any consultation or any procedure that I can do myself. It is the least I can do for them. I will offer them my time and lend them my ear because I think that little joy would help them for weeks. I will stay strong on this move for as long as I can. All I ask is for you to spread the word. That there is a Doctor that will see them for free, that he will not shoo them out of his office if they stay for more than 10 minutes, that he will do all that he can to help them feel better.


I found this on the net which I found very relevant.,.

Please do share with your contacts and feel free to contact me for any more details.