Mandatory Vaccination In Schools

The government of India is running an ambitious program since 2017 where it is targeting eradication of Measles and Rubella via a single dose vaccines to be given to children between 9 months to 15 years of age.

            

It has already conducted this drive in many of the southern states and mostly in Municipal and State run schools. Of late, they have extended the project to northern states and to private schools as well. The obvious problem they faced is getting consent from the parents of the children going to these schools.

I was inundated with calls asking me for my opinion about the vaccine, how it's going to be performed, who is going to do it and of course, whether it is safe of not.

As far as I am concerned, I believe that each child should be vaccinated and even if taken previously, the booster effect does play a major part in effective immunity. Furthermore, the concept of herd immunity necessitates that we vaccinate the maximum number of children possible in order to safeguard those that could not or would not get the vaccine! So, my answer to all questions was, Yes! Get the vaccination done.

The notice that the government of India sent out, unfortunately, does not inspire confidence. There are no details available about when exactly it would be done, how it would be carried out, who would be administering the vaccines and which vaccine would exactly be given (by this I mean multi vial or single vial units). 

There was also a lot of doubt about how they would take care of any reactions that could possibly occur and who would take responsibility for the child's well being in case something untoward happens. The notice gives no assurances, the school absolves itself of responsibility while asking for the consent, the persons administering the vaccine are unknown and probably work on contract basis and are not permanent healthcare staff and the government, well, is the government.

I truly believe, there should have been an option of getting the vaccine privately and showing a proof of vaccination towards the drive to ensure everyone is vaccination. If not, there should have been a more clear picture painted with parents being allowed to accompany their children to the vaccination as most children are anxious about needles anyway.

I also wish the schools concerned would call a meeting to address these concerns before sending out the consent forms to be filled with any sort of deadline. Many school principals that I know personally have asked me how to proceed and I asked them to demand more details from the government program before sending out consent forms.

Perhaps, in an ideal world, all this would happen. Perhaps, in an ideal world, the above would be self explanatory and there would be no need to write this.

As of now, I am still undecided as to whether to allow my child to be vaccinated in school. This after me being a doctor myself. I can only imagine the confusion in non medical houses!

Here are some useful links I found with regards to this campaign:

https://timesofindia.indiatimes.com/city/gurgaon/govts-measles-rubella-vaccination-drive-hits-consent-wall-at-schools/articleshow/63852172.cms

http://vikaspedia.in/health/health-campaigns/measles-rubella-mr-vaccination-campaign

Reborn

Every once in a while, you read a book that forces you to think differently, to imagine what all is possible, to take the road less traveled, to change drastically for the better and to flip your understanding of the world at large.

'Reborn' by Aarti Asrani is one such gem. 

This is an easy to read, simple and effective book which would classify as a self help, self improvement kind of genre and is timed just right since the world seems to be begging for any form of positive energy we can find.

The book is neatly divided in various sections and each section can be either read independently or as a whole. The effect each chapter will have on you is very subjective but if you just remember to accept or 'receive' as she so aptly puts it in many of her chapters, you will get the message loud and clear. In addition to this, if you think you get it but can't implement it, you could always call her for help. Her contact details are on her website www.aartiasrani.com and I personally know for a fact that she will help you through it, not matter how busy she is!

Just a few specific points to touch on to give you a feel of the book:

Feel the vibrations. Make sure you send out the correct vibes in order to receive the correct vibes in return. This has been taught to us from time immemorial. You greet a smile with a smile, no matter what mood you are in. 

Be ready to receive, the universe is begging you to take what you ask for, provided you ask well and are ready to receive what is given irrespective of the packaging. It is truly said that the world works in mysterious ways.

Change the way you say NO. Replace it with positive words of refusal! Works like magic!!

Receive openly, without doubt, without thinking about what to give in return, without considering the reasons. If you get a compliment, don't think twice about imbibing it in your conscience!

Break the conditioning spell we all are under. Let go of preconceived notions to open up the possibilities of choice! This was an extremely intelligent chapter in my view!

Because! What a powerful word. I'm not going to write more about it. You have to read that chapter to understand, because... Anything can be right and everything can be wrong is my favourite line in the whole book! Look for it.

Money, everyone's boon or bane is quite well explained too and the reason you choose to have more or spend more and the reason to keep wanting more have never seemed clearer!

Relationships are the next thing she has tackled and you must read this chapter slowly and completely to understand how to be the perfect partner for yourself and others around you.

The reason that this is even here is that all of this plays a part in your well being and health. This has also been tackled well in the chapter on health consciousness. A look at how emotions, all emotions, are just signals from your body asking for more awareness and how ignoring these can lead to health issues is well described and dealt with.

If you are suitable intrigued or impressed with any of the above, it's time to stop reading this and head on over to her website to order yourself a copy. Also available on Amazon as Reborn: by Aarti Asrani. Yes, there are some grammatical errors and some print fallacies, but none of that takes away from the content. For her first book, I think Aarti has done really well. I read through the whole book and I strongly suggest you do too!

Doctor Shaming at It's Best!

This past week I read a post on facebook by a woman who had lost her mother and she vented out on social media against the hospital and Doctors that were in charge of her mother's care. It took all of my restraint to not post on her wall as a reply, because I knew it would do no good and it wasn't the right time to justify things to someone hurting. Also, I didn't really think it was worth it as I thought people would be more intelligent than to accept everything written on face value. Unfortunately, the link came up on my high school group with some questions being asked and instead of just replying to them, I thought I'd write about it.

Before you read any further, I would suggest you to visit this page and read the article or even better, keep it open side by side and read through.

The article which linked to the facebook post

The headline itself is inflammatory and sets the bias for the article which I think is grossly unfair. 

Girl's FB Post Tells How Doctors Cheated Her Family & Charged Rs 1 Crore But Couldn't Save Her Mom

This implies that she was cheated for sure and the Doctors charged her the amount and there was some guarantee of saving. Now, I'm not going to nit pick and argue fine details and take sides here but read the article and the title starts to stink right from the third paragraph.

"Doctors are considered as God on Earth as they have the capability of not only curing a person but also saving his/her life. However in the present times, as many doctors have been found guilty of illegal activities such as organ trafficking, gender determination, etc., the faith on doctors has decreased to some extent."

We aren't considered as God and never asked to be. We have the capability of treating someone but that treatment will not always result in a cure or life being saved and we're only too well aware of this. Unfortunately, it seems that the general public is not. It has become some kind of inane expectation that if you pay a certain amount of money, the life that was handed to us must be saved irrespective of the disease or condition.

"it won’t be wrong to say that the big hospitals are no less than 5-star hotels and they charge exorbitantly from the patients and doctors play an important part in milking the patients for cash."

Big hospitals are like five starts because the people demand a certain level of service and they have to be satisfied for the hospitals to run. Last I checked, most of the so called 5 star hospitals were not charitable, neither were they forcing people to come in and get admitted, nor were they set up using public funds. They have a right to charge an arm and a leg for them to survive because of the level of expectation set up. This may sound horrifying to all of you but let's put it into perspective. I know of hundreds of people who won't watch a movie in any other theatre than an Inox because of the quality or whatever. I know people who wouldn't touch tea cup from a road side tea stall for fear of leprosy or some other disease being contracted. I know people who refuse to travel in buses for all the above reasons. When these people require healthcare, most of them have accepted the fact that quality healthcare is expensive and sterility costs a bomb. They understand the reasons for the high costs of healthcare, which by the way, compared to the rest of the world, is still dirt cheap here in India. The problem is with the other end of the spectrum where you have people who save their life savings going to these big hospitals. There is a clear reason for this. THERE ARE NO GOOD ALTERNATIVES THAT ARE ACCEPTABLE.

I don't even need to ask you, I will tell you that it is the role of the government to provide quality healthcare at affordable costs, not the role of Doctors or Private Establishments. At the same time, I will also tell you this, there are enough and more Doctors who will go to no ends to push the limits of how much money they can squeeze out of you. This is sad, but very true. The choice, however, still lies with you. Pick the correct one who you can trust. Find one out there, because there are more than enough of us around/

"Parul’s mother fell sick due to ammonia attack and it was later found that she was suffering from Liver Cirrhosis which is the last stage of liver disease"

Factually incorrect and inept journalism. There is no such thing as an Ammonia attack that I have encountered, in my medical training, as far as I remember.

"they tried out to churn out money from them without providing proper treatment and how they harassed them for paying the bills and purchasing medicines from their dispensary at high prices rather than buying it from outside at low cost."

I wonder how she decided it was not proper treatment and when she would think was the right time to harrass someone to pay a bill. It is standard practice in a corporate hospital to send out daily bills to patients in the ICU with a three day period to clear those dues because even hospitals realise that costs add up and if they don't do this, there will come a time towards the end of a long hospitalisation that the bill suddenly sky rockets and causes severe mental trauma to the relatives. This was actually an order passed by the government towards the same. It allows the relatives to think of alternatives when the costs seem to be going above their heads.

Again, unfortunately, I agree about the point of overcharging by the hospitals for medicines that are available cheaper at regular chemists outside the premises. This is something we really need to look into. It is the same as going to a movie and being forced to pay more than double for pop corn and water bottles.

"have spent nearly Rs 1.2 crores on her mother’s treatment who took her last breath on May 7, 2018, due to multiple organ failure despite successful liver transplant. Parul also told that her mother was kept in ICU for nearly 100 days by these hospitals and they charged them Rs. 1 lakh per day for this purpose"

Well, if you want to stay admitted in a 5 star hospital for over 100 days with Intensive Care support which is required after liver transplants, just what would you expect the bill to be? ICU is extremely expensive and I would invite any of you to take up a job running an ICU to try and bring down the costs and offer that model to any hospital. We would gladly pay you for your service! Also, I wonder what Parul's idea of a successful liver transplant was?

At this point I have reached out to several news channels like Aaj Tak, Zee News, News 24 and the honorable CM and Health Minister of Delhi and the Indian PM, but I have not received any help or support in the matter. I have no other option now but to go public with this information so that appropriate action can be taken against these so called hospitals, established to help the ailing members of our society

Maybe there is a reason none of them are ready to help. Possibly, there is nothing to help about. I would love to know what is the appropriate action she would like to be taken against these hospitals? Also, just to make it perfectly clear, no corporate privately owned hospital exists to help ailing members of society. That is an illusion that defeated people hold on to. They are a business here to make a profit and provide a living to thousands who are employed there. To help ailing members of society, we are supposed to have a robust health budget from the central and state governments who are supposed to provide world class care in their state and municipal run hospitals. The BMC is supposed to be the richest civic body ever, how about asking them to spend more on their hospitals and provide basic care, forget world class facilities.

"January 04, 2018: Doctors at BL Kapoor Hospital advised her to undergo a liver transplant. Total cost mentioned: Rs 18-19 lakh."

Sounds like a reasonable budget to me for a liver transplant with private hospital care and post operative medications and ICU care.

"January 12-13, 2018: a lady named Jyotsna Verma (link to her website: http://www.indialivertransplant.com/…/jyotsna-verma-liver-t…), claimed to make a liver available to us in a very short time. Total cost estimated: Rs 23 lakh.

January 16, 2018: Ms. Jyotsna called us to inform about a liver from deceased patient being available at Yashoda hospital, Secunderabad. She charged us Rs. 1 lakh for the information shared."

These two lines perhaps are the only reason I am reacting to this. What remarkably poor judgement to trust a lady who claims to make a liver available rather than Doctor's at the hospital in Delhi. As far as I can see, her costs are also higher, this again leads us to the point of a choice being made. Parul chose to trust someone who wasn't a doctor over the doctors at Delhi. Moreover, she had no problems paying 1 lac for information about a liver but has a problem paying one lac for intensive care for failing organs. Something to ponder over, I think!

"January 16, 2018: My parents flew to Hyderabad and were given a cost estimate of Rs. 27 lakh. The doctors at Yashoda Hospital would quote a fee from Rs. 24-29 lakh to the different patients for a liver transplant."

Looks like she chose to go with the 27 lac quote rather than the 18-19 at Delhi. Furthermore, different patients have different conditions to be dealt with and will accordingly be quoted different costs for the transplant depending on how much pre and after care would be required. This is, however, something I don't expect her to understand but perhaps she could appreciate it after some research.

"February 05, 2018: My mother underwent a successful liver transplant.

February 08, 2018: She was put on ventilator because of a lung infection."

Lung infections are extremely common in hospitals and are one of the reasons for maintaining the 5 star cleanliness and sterility that make up much of the costs of the admission process. Unfortunately, with the number of germs in the hospital and the immunosuppression involved in liver transplants so that the transplant doesn't get rejected (thereby a successful transplant) the patient is always at a high risk to contract infection.

This is followed by how her mother was in the ICU on the ventilator and how the costs escalated. I've already touched on those points and again reiterate that healthcare is bloody expensive.

"My mother developed Jaundice on a Friday evening and doctors from Yashoda Hospital in Hyderabad recommended the doctors in Delhi to immediately install a stent in her liver to prevent the spread of jaundice in her body as she had a similar problem while she was in Hyderabad"

The story is far from simple as there are multiple episodes of health issues and infections coming and going. No one is going to assume that this was easy for the family but mostly all would agree that this doesn't sound like a routine patient with a successful liver transplant. The costs were to be expected and there is nothing the hospitals or the Doctors could do about it. Yes, they could have been more polite, yes there could have been more empathy but who is to say there wasn't. It's just one word against the other. I will not defend the Doctor here though because I've seen some really rude ones in my life and I agree that most have a superiority complex and an ego the size of a football field.

"for the doctors in Delhi, their weekend was more important and they delayed the installation of the stent to Monday afternoon (April 23)"

I don't know the circumstances as to why the stent was delayed but perhaps, just maybe, the patient wasn't fit for the procedure yet or there were some complications due to which the stent could not be placed. I've never known a Doctor to enjoy a weekend when they have a serious patient in their care. It just doesn't happen. Ask my wife!

"They kept on performing kidney dialysis almost every day on a person who was practically dead, in an attempt to make more money."

Would you believe that perhaps it was to try and keep her alive? Perhaps, it is the only thing they could do to stop her from dying there itself? Or would you have preferred that, because that then is an argument for euthanasia which is anyway a topic I can discuss with you for days! Besides, no one makes money with dialysis, it's more lucrative to not offer dialysis and give more medication and treatment. Dialysis is now so cheap that it would cost less than the room rent for a 5 star hospital!

The bottom line is that the poor woman died. Parul is clearly going through the 5 stages of acceptance and needed to vent. It was unfortunate, but certainly not negligence nor was it a money game or an incidence of cheating.

There are a lot of you that will be on her side of the fence. Reach out to me, come live a doctors life for a month and see how much we care for our patients. See how we lose sleep just so that patients get theirs. Watch how we crumble under the pressure in the privacy of our own lives just so that we can put on a strong face in front of you. Feel the pain we feel when we miss important events in our families lives just so we can put in a stent on time.

Anyone who would like to take this further can reach out to me at any time. Leave your comments if nothing else. Share this so more people are aware of the lack of affordable healthcare which our government should have provided us years ago. 

Guaranteed!

Have any of you noticed how every healthcare practitioner you go to now seems to be giving guarantees of treatment? Life time guaranteed treatments for common ailments. Guarantee boy child with certain powders and medications. Assurance of a cure even though we may not even have a diagnosis yet. Almost every consult ends with don't worry, everything will be alright!

I was wondering, perhaps, if this is the cause of the growing mistrust amongst patients and their Physicians. 

Why is it that we feel compelled to make the patient feel better by lying to them? Why is it so hard for us to tell the truth to their faces? 

Is it compassion? Is it being a good human being? 

Would it be better to be a better human being rather than be a good doctor?

I don't recollect anything in the Hippocratic oath asking us to be emotionally available to our patients. Empathy is something completely different as far as I'm concerned.

Look at how we take consent for procedures. Everything will be fine. There is nothing to it. Don't worry. Not one word about the chances of complications and the chance that it might not work out. We do not have guaranteed treatments for anything (at least not 100%). I know of people who have been told that everything will be alright even when the Doctor is sure the patient will not survive. Why not just say that the situation is grievous and seriously might not end well?

So, what is the answer here? How do you make sure you are capable of giving the truth as it is meant to be given without attracting negativity from the patient?

Would it even be possible to be brutally honest all of the time with everyone? I guess not. I guess somewhere down the line we have to use our judgement and take a call whether to lie or not.

Some of us do it subconsciously but perhaps it's time we all take a course in communication with the patient.

This truly has me stumped. I would love some replies from my Doctor colleagues but even more from non medical people reading this as to what they would prefer. That's the real crux isn't it. Let us ignorant Doctors know what we need to tell you. Perhaps, it would stop all this negativity against Doctors once and for all

The Cult of Snap, Bapu!

Human beings are exceptional people. As per my last guess, I would estimate at least 80% of our population to be either downright dumb or having below average intelligence.They would have to be, for the amount of gullibility they display.

Every third person you come across in this world (at least, in India, for sure) is a believer of some or the other self styled Godman. The problem is so entrenched in our society that people are willing to not only follow them, their ways and their teachings but also work proactively into getting others to follow them. It's as if by getting one more person to follow, they somehow, justify their own folly. What's worse is that they also work around getting their kids to blindly follow them. This unnecessary act of faith has severe repercussions as evidenced by the number of them being caught out for heinous crimes. 

I cannot fathom how people can follow Godmen/Babas/Cults/Gurus/Preachers etc etc whatever name you would care to give them. Almost all the time, they are proven to be frauds and tricksters. Unfortunately, almost always there is a sexual component involved in their outing. They always have a cult following with people willing to physically harm any doubters just to protect their so called sanctum and society. 

Also, is it just me or do they all look wicked and like creeps anyway? I can't imagine trusting them for a minute and I haven't even met any of them face to face. My mind would not let me believe someone who says he does things that are otherwise impossible to achieve. Mind games are big in their repertoire and that's how they gain followers which loops right back to the first paragraph of this write up.

For anyone who thinks and justifies these things by saying this was the last hope and everything else had failed, why would you think if everything that made sense failed, this thing that makes absolutely no sense will work!?! Is your brain and sense so fragile that you would knowingly go against what you know is right to try and get something done? You have these guys kissing, hugging, making out with women, raping them, sleeping with them, molesting boys all in the name of some godforsaken healing? Any you still believe in them?

I just don't get it. Perhaps, the only one of these that made sense was Osho. At least he was open (pun intended) about his intentions when he started his Ashram in Pune.

Just in case, you think I am going after easy targets, let me also put in here that although I do believe in a higher power and God etc I'm not convinced about any of his messengers on earth. I'm not about to name the messengers of God but you know who I'm talking about. Let's just say, there has always been an ulterior motive to get people to follow you and that's exactly what these new found miracle workers are working on. Be it money or sex, the 80% I was referring to are only too easily giving it up to them.

Educate your children and even if you are one of the believers, at least give the next generation a choice to be foolish on their own accord, instead of pushing them to believe something they might not and have them regret it later on.

I'm open for debate on this with anyone who wishes to challenge my views. The comment form is right below!

Have a holiday the right way

It's the holiday season and everyone is making plans on where to go and what to do. Some have already left, some will leave soon.

What is your ideal holiday like? What should it be like? Do you think you're doing it the right way?

This is a complete personal account on what I would like a holiday to be. Considering I have Toofan and Bijlee, my holiday wishlist is skewed towards holidaying with children.

The planning phase.

I completely love doing this. I can't seem to holiday without it. Also, I seem to plan way too early but it's therapeutic for me to have all the information I need before confirming anything.

I must know where to go, what is there to do, what I am going to do when I get there and what I am definitely going to avoid. I need to know the best options to get there and back. Admittedly, even after planning in advance, I rarely book at the cheapest price. This is probably because I take too long to finalise and am always hopeful for a better deal. I do get good deals most of the time though.

The build up phase.

I love getting the people who are due to travel with me involved in the travel plans. I will show them pics, discuss the good things that are there, play down expectations where required and basically force them into knowing what's in store. I get the kids excited about things they can do there, what they can experience and the buffet table which seems to have become an important part of their holiday breakfasts for some reason. If their friends are joining in, I talk to them about the games they can play, what they can carry to entertain themselves and how late they can sleep.

The packing phase.

This is completely left to the wife and I give her full credit for this. The only thing I do in this phase is make a list.

The day of travel.

Always chaos. Yelling. Get ready, eat breakfast, we'll miss the flight for sure! You can't wear this, it's green and your t-shirt is blue! Wash your face, you've got food all over your chin. Oh no, I've forgotten my glasses. Did you book a cab yet? Why isn't it here? 2 more minutes!!!

Once we've loaded the bags and are sitting in the car, however, everything changes. There is a sudden calm that overtakes us all. It's as if we've finally managed to escape a prison that was holding us against our will. Inadvertent smiles crop up. Goofiness takes over. Everyone is happy. We eat, drink and take trolley rides at the airport until it's time for the security check. The kids are most excited to be screened. They have now been given the responsibility to hold on to their own boarding passes and carry on bags with their art and games. Getting on the flight is great when there is an aerobridge, not so much when they have to take the bus.

On the flight, it's a fight for the window seat or a quarrel to sit with their friends. Out come the colouring books, the playing cards, the reading books and we are at peace till it is time to feed them. This is really messy on the flight and we need to come up with a way to feed kids without dropping things on their clothes.

We're there.

Land at the destination and this is where the fun is supposed to begin. I have a few issues at this stage. I hate my phone and would love for it to be switched off or unreachable. Not so much with other travellers. I don't get how you go for a holiday and then stay close to everything you are getting away from by being on the phone that links you right back. 

I love to get out and explore the place on my feet. I like walking about the local markets and getting a feel of the place. Kids sometimes make this difficult but encourage them from the start and perhaps they will develop the habit. I eat local. Sure, there might be a chance of an infection but that is part of the experience.

I don't believe in the dictum that you must do and see everything the place has to offer. It is a holiday remember. Just relax, take it slow, ease into it and do what you feel like doing. If you don't like sightseeing, forget about it. Take a good book and read. If not, spend a few hours in the pool. If that's not your thing, walk around and do some shopping. Don't break your day trying to reach 5 spots in 24 hours and then just see them for 10 minutes.

I like doing nothing on my holiday. I could sit on a lounge chair and stare into nothingness. I don't need music, I don't need entertainment for me to enjoy my time off because it is my time off. A place where I can do nothing! I can hibernate and am proud of it. A lot of people get upset with me for wanted to do nothing and not participate, but it's ok. I get it. Some people need to be busy to enjoy themselves.

What is your ideal way to holiday? Let me know in the comments below.

Protests aren't going to do it.

This post is not going to be well received at this point of time because emotions are at a high and we are thinking with our hearts and not completely rationally.

Almost everyone who reads even a little bit of news or listens to an odd story on the telly or radio knows about the recent events and protests organised as a consequence. There has been enough and more said about the rapes that I don't need to delve into those lines. 

Yes, they happened. Of course, it was wrong. Yes, we need to do something about it. Sure, we should show the ruling government that we care. Yes, we have to send a strong message to society. No, protesting is not the answer. It is a movement, but not the ultimate answer. What is, then? Read on.

The government and their uncles know what happened was wrong. They are well aware about it. They don't need you to come on the streets to make them realise this fact. They were smart enough to con people into voting for them so they're smart enough to know what is going on. They can understand that the general public is angry and they probably share your feelings (most of them anyway).

Think for a minute, though. What are we trying to achieve? Are you protesting and marching to make them change their ways or are you doing it to bring about a positive change in society so that the number of rapes and molestation come down? Are you trying to show support to the victim or to show that you are completely against the perpetrators?

Let's answer these one by one. These are my personal opinions and are subject to change with the situation. 

1) I think the only thing protesting achieves is a feeling of us doing something. It makes us feel like we have somehow made a difference and have not let a wrong go by.

2) It may at some minuscule level affect the government entities enough for them to do something but it definitely does not make them realise anything they don't already know. Does it make a positive change in society? Yes, but not in the way you are thinking about. It doesn't actually reach the aggressor at all. He is blissfully oblivious to everything we do on Marine Drive and Bandra. He couldn't care less. The only positive change for society is that we are still coming out in support of each other. We, as a society, are still bonding over issues that affect us indirectly and this is of extreme importance to democracy and our way of life. 

3) Are the number of reported incidents going to come down by this? No, not by this alone. We have a lot more to do than protest for this to happen. Yes, we can build awareness, but, are we bringing that awareness to the places where it is needed most. I seriously doubt it.

4) We show neither support to the victim nor do we prove anything to the perpetrators. We don't need to. The support is obvious. The rage against the criminal is natural. The protest doesn't do anything to increase or decrease this. Would you support the victim less if you were not at the March?

Let me come to the crux of the matter over the next few lines. I am not against protest marches. Yes, it is a show of solidarity. Numbers do make people take notice. Once people take notice, only then can change be set into motion. What I am against is this false belief that once you've marched, you've done your bit. Nonsense. This is not even the first step.

What we should be doing is talking to our kids. Don't get me wrong, I'm sure we all talk to our kids and teach them right and wrong and respect for women and gender equality and everything (if you aren't already doing this, I'm pretty sure you aren't on my mailing list). What I'm talking about is teaching them the most important thing in life. 

Teach them the values, yes, but more importantly, teach them to teach those values to others. Teach them to share their ideas with others, not only with their friends who they are comfortable with but with those they think might not have learnt it from people around them. Teach them to stop joking about things that are inappropriate and make sure they stop someone else if they hear something inappropriate as well. 

Tell them to have the guts to tell people off when they know what those people are saying is wrong. Make them confident enough that they can stop adults around them from passing crass and crude comments and jokes. Help them identify this as the root cause of the injustice in our system. If each of us start to do this today, perhaps, the effect will percolate from our big cities down to the smaller towns and villages where there is no one to teach them this first hand. The classic Trickle down effect!

Just for an example, our kids talk to other kids in their own environment, other kids talk to kids outside familiar environments, they talk to others in parks, they talk to staff, drivers, watchmen, washerwomen, dhobis, waiters etc. These in turn take what they are saying and pass it on to their families, back to their relatives in the towns down to their relatives in the villages. It sounds like a dream but it can happen.

Have them stand up for themselves, yes, but more importantly, teach them the courage to stand up for others who may not be able to stand for themselves. Teach them to fight against things that are wrong but more importantly, teach them to defend others when something wrong is being done to them and they can't fend for themselves.

If we can try marching, we can surely try this!

Happiness Is Simple!

We had a reunion this past weekend and almost half of our batch from Medical College attended. Some people travelled really far to get there, some not so much. Everyone made the effort and finally after years of trying, we managed to get together!

There was a positive feeling about it all. As soon as we saw our old mates, everyone was smiling from ear to ear. There was not one moment I remember where we were not genuinely happy to be there. Old memories came racing back, bonds were reformed and existing ones strengthened to last a lifetime. 

All through the weekend, I was happy. I saw people who were really happy. Most of us had not got our families but we were still happy being there. We found happiness in the success of others, we felt happiness with their children playing with us, we were happy babysitting others children and dancing with them, we were happy to just sit together and not have anything to talk, we were happy to remember those that couldn't make it.

Happiness is simple. It's a choice of how we decide to feel at any given point of time. We could focus on all the good things that happen or all the bad things that happen. More often that not, when we are alone with our thoughts, we think of the bad things because bad recall is easier than good recall. This has been scientifically proven. However, when we are with friends, family, people we like, we mostly focus on the good things.

Next time you want to feel happy, really happy, just take a moment, go to a secluded space and give yourself the biggest smile you can. Your brain will automatically dig out a really happy memory and you will feel true happiness. It's that simple.

Or else, have a reunion!!

Euthanasia, who decides?

In the follow up to the last post on Euthanasia, let's get into some more details. Do read this only if you have gone through the previous post and feel that you understand the terms involved. This is not being condescending but is vital to the debate that is bound to arise from the next few paragraphs.

I got a fair amount of responses from who I consider intelligent people. Most of them still seemed unsure of the side they were on but there was one common theme emerging. End suffering and allow death if there is no chance of a near normal life. As far as DNR goes, it is another discussion altogether and will be taken up in the next post.

The biggest dilemma in this case is, who decides? Do you leave the decision with the person directly affected by euthanasia? Do you leave it to the Doctor you trust implicitly? Do you even trust your Doctor that much in today's time? Do you leave it to your relatives? (we've heard enough horror stories of loving relatives turning on their loved ones). Do you leave it to the courts (by which time you've probably been reborn only to die again)?

A friend emailed me her father's living will in response to the last post detailing his wishes on the control over his final days. He made it plainly clear that he was not to suffer for more than 48 hours, not spend more than a certain amount of money on care, and not receive life support if there is no chance of reasonable survival.

The begging question here is who gives you 48 hours to live? Certainly no Doctor in his right mind will predict death to within 48 hours, at least on the record! How do you know for certain that you won't recover in the 71st hour of ventilation? How do you assume that once you are in a comatose state, you will never wake up normal again? Why do you think that there will be no or less chance of recovery after 48 hours?

These are grey areas in medicine and will continue to remain grey for time immemorial. I firmly believe that life is unpredictable. Yes, as people of science, we have guidelines that increase the probability of us being right, but honestly, we've been proved wrong on more occasions than any of us are comfortable with.

The issue of pain in certain illnesses keep creeping in to this discussion. However, pain is a very subjective sensation with different levels of tolerance for different people. Also, it is the most easily feigned emotion. All the world's pain scoring charts cannot tell if the patient is truly feeling the pain that is expressed. How much of morphine can you give while under the pretext of alleviating suffering? How close is that administration to assisted suicide?

A dear friend mentioned that someone who is terminally ill with no cure in sight or someone with prolonged suffering should have the right to due process. I agree. It's time this discussion reached the decision makers because the quicker we discuss this, the faster the law will come, either for or against. The point of discussion  here will be the contention that there is no cure in sight? For how long? For ages, there was no treatment against the pox. Now, it's eradicated. There was hardly any treatment for HIV just a few years ago. Now, those patients live near normal lives right up to the expected age of mortality for the given population. There are new cures being found everyday.

In continuation to the above, another friend messaged that if the person was too old and the physical body has no more strength to combat the disease process, they should be allowed Euthanasia. Why can't we recover that strength in the times to come. I've recovered from paralysis and have run a marathon! Who decides what is too old? Is 70 too old? I've seen people in their 90's running and exercising. Is 90 too old, I've seen 100 year old grannies laughing with their grandchildren!

There was also mention of quality of life being a factor. This single line condemns almost everybody below the poverty line to death simply for lack of quality of life. Imagine a footpath dweller with an illness showing up to the hospital demanding death because they have no hope for recovery and have a dismal quality of life. Remember Hope?

                                

By the above paragraphs, would you condemn to death, a patient of Alzheimer's disease, HIV patients, Multiple Sclerosis patients, patients with Chorea, patients with widespread paralysis. Remember Stephen Hawking. He's still kicking ass while most people in his position would probably have chosen death!

Switzerland has taken the bold step to form laws and clear the path to euthanasia. It has become the destination of choice for a peaceful death! There are numerous British citizens opting to choose the country for their euthanasia needs. It is a raging debate in the UK right now, as it rightly should be in the rest of the world.

This all boils down to the argument of the right of the patient. Unfortunately, this also leads to the state of mental health of the patient while asserting these rights. Do you think you should have a right to decide when to live and when to die? The most likely answer is Yes! Fair enough.

Honestly now, with a deep thought, do you think you are emotionally controlled enough as a human being to not abuse this right when all the chips against you are down and you slip into a depressive state, which is where all the suicidal thoughts come in? Have you ever felt the need to end it all during one particularly disturbing event in your life, only to end up living life to the fullest thereafter? Would your assertion to right to death then be the correct decision you make?

It's all good and welcome to write out a living will and starting the will with the line saying of sound mind and body, but that is a state of mind at that point of time. What is the mindset when you really decide to end it all? These are the complications we must address before we take the high moral ground and say end all suffering.

Maybe it looks like the easy way out as of now when we aren't under any pressure to think about it. I've seen patients and their relatives deal with death. I wouldn't wish it on my worst enemy. It is an intense, blood curling time which *#^#^* your brains. I've seen people watch the people they love, die! I've seen the emotions in their eyes when they're loved ones are close to death. I've seen the immense relief when the person comes back to life. 

Think about all that before you say I support it or I don't. If you still do, you are a hell of a strong person. Even then, when the time comes, you will shake, you will tremble, you will falter. Stay strong, write it down somewhere so when the time comes you have something to reaffirm your decision, make peace with it early. 

I personally feel the law must come. There is no choice. Either make it legal or people will do it anyway in a hidden manner. Making suicide illegal isn't making it stop. Neither will the choice to die.

Euthanasia. Active or Passive, For or Against?

Euthanasia is the practice of intentionally ending a life to relieve pain and suffering - Wiki

The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma - Oxford Dictionary

Origin Greek Eu=Well Thanatos=death

Almost everyone has heard about it. Almost everyone has an opinion. Almost no one can stoically defend their stand. There are just too many variables involved.

There are various forms of Euthanasia

Active Euthanasia: Doing something that deliberately causes the patient to die

Passive Euthanasia: Allowing the person to die without any intervention. This also includes either withdrawing treatment or withholding treatment.

Voluntary Euthanasia:This occurs at the request of the person who dies

Involuntary Euthanasia:A decision is taken on behalf of a patient who is either unconscious or otherwise unable to take a decision due to some or the other debility.

Indirect Euthanasia:Providing medication that reduces suffering but hastens death.

Assisted Suicide: A person who is going to die anyway requires some help getting through the line.

Go through the above very carefully one more time and read them as slow as possible.

Where do you stand? What would you choose if you had to? Would you rather not choose, in which case would you have someone choose for you?

Do you believe in the right to decide your own fate? Are you competent enough to know the intricacies involved in doing so? 

Have you even thought of DNR (Do not resuscitate) orders for yourselves or your family members? Do you realize that there is a very thin line between DNR and Euthanasia? In fact, it is literally on the fence.

I would love to hear your thoughts on this before my next post which will cover Euthanasia in real life situations

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A Noble Profession...Should we still bother about tags?

I was very recenty part of an excellent group discussion with my colleagues from medical college about whether or not Medicine still remains a noble profession.

 

 

There were numerous view points, lots of defending, a little aggression and even some private messages asking us to cool it down. The most striking part of that conversation for me at least was the lack of cohesion and the wide variety of what people thought they understood to be the definition of a 'noble profession'.

It seems to be a mindset created through years of being told that it is a noble profession without being told what being a noble profession really entails.

As expected with the discussions in the media in the recent months, the first defence was about the charges and fees of doctors. There were a number of examples of free OPD's social services, discounts offered and charity work done.

There were talks of kickbacks, gifts for promotions, sponsorships for educational conferences, pharmaceutical inputs from our friends in the pharma industry, prepaid treatments to avoid confrontations, fees per minute charges like some astrologers and vaastu experts and a whole plethora of things.

There were many positives to come out as well. It's good to know Doctors my age still have pride in their profession and the work they are doing. It was great to see them ready to defend the fact that they are here to support their families as well and not work for free. This is the correct attitude to have. No one is going to work fulltime for charity unless they have enough money handed down ancestrally.

The harsh truth is that we have been forced to go from healers to service providers by the recent laws enacted by the government. What was a profession has now become a business, not only for private practitioners but more so by corporates that have entered the healthcare industry and are now running the most successful hospitals. 

They must be doing something right if we prefer going to them rather than at our government and municipal run super speciality hospitals, right?

There was the heartening point of view that there are still young doctors willing to refute cut practice and work hard to set up on their own seving all classes of society equally.

International views poured in as well with an extremely valid point about not just looking at the present scenario but trying to get to the root of the problem. We need to unite to curb the so called Black Sheep that have led us up to this point unchecked.

The education process is in dire need of a major overhaul as most fresh pass outs cannot be trusted to deal with a patient on their own without supervision. Standardization is required but in a very controlled manner. Closing our eyes to the problem or looking away will not help this situation. Denial is the biggest danger right now and it needs to be addressed before the government intervenes too much because we can't solve our own problems. 

The opinion of the public towards the doctors at this point of time isn't something they have just thought up over the past month or two. It has been building up slowly and gradually over the years with the slow change in the way we treat our patients, the way we have lost the famous doctor patient trust relationship, google based diagnosis, trigger finger law suits and medico-legal instigators.

Everyone seems to agree that cut practice is a disease but almost everyone is doing nothing about it. So is pharmaceutical promotions, gifts, sponsorships which have been defended by words like 'items of clinical utility' etc which is just sugar coating gifts that are given on promoting their products. They are very intelligent businesses so they stave off responsibility by saying it is the 'learned customers' choice to accept or reject that gift. What starts with a clinical utility pen and prescription pad soon escalates into items for personal use, printed material for personal consumption, household items, cars, foreign vacations etc etc. It is conveniently forgotten that it all started with that one pen that the Doctor could afford on his own if it was that important from a clinical utility point of view!

Justifications still continued about things like as long as I don't harm my patient or change the way I treat it should be ok, but really it is not. You may be morally superior to others in your profession but what you can control they may not be able to and so some regulation has to come in to clearly define what is ethical and legal and what isn't.

This discussion can continue for eternity but I guess it has to be an individual choice at this point of time until concrete guidelines are developed towards the same.

The fact remains that almost any profession can be a noble one provided one remembers the definition of being noble - "Being of high moral character and principles and showing fine personal qualities."

The best line that came out of that discussion was from a fellow surgeon who said he would ask his patients not to consider him noble or God but to think of him as a moral human with regular flaws. Perfect! What do you think?

How would you prefer to communicate?

Happy New Year!

For this year, I've decided the only way to write more would be to write whatever comes into my head and make sure it gets put up here. This would also mean that we will have shorter posts, but hopefully, more often.

Carrying on from what has been the theme over the past few months in India, this post is meant to ask you one very important question:

How would you like to communicate more with your Doctor?

I understand that everyone has their preferences including the doctors, which is why I think this is an important but often overlooked question in the Doctor Patient Relationship.

Would you prefer a face to face encounter, a telephone call, a video call (Skype, Google Duo etc), Whatsapp messaging, SMS, via a friend or any other means?

Once you have this answer, I need you to think about one more question and I would appreciate both answers in the comments field. Having made up your mind about the first question, do you ever think about your Doctor before initiating the said means of communication? Things like whether they would be comfortable with the same means of communication, have the same tech that you would like to use, be in the same frame of mind as you to answer your queries etc etc.

Please do reply in the comments section and share with your colleagues so we can improve the relationship to a 2018 level :-)