Social Media and Medicine - #Caution is the keyword

It seems a little ironic that this is a post on social media being written on a social media platform.

There is a growing concern amongst people of the medical fraternity regarding the sharing of medical views and patient concerns and details on social media.

The biggest worry is you tube with videos on patient conditions and surgeries being found a dime a dozen, mostly with the patient in full view without any blackening of the eyes or any attempt at concealing their identity.

The other big worry is group chats, be it on hangouts, whatsapp, viber, or any other messenger of repute. Case histories, diseases, conditions, fears, anxieties and even mental health of patients is being freely discussed.

The crux of the matter comes down to two things:

1) Is the patient aware of these discussions and sharing?

2) Has the patient given consent for the same?

In most cases of photos and videos being shared, I would hope and assume that the Doctor or health authority concerned has obtained the necessary consent and permissions of release from the patient involved.

More often than not, however, this does not seem to be the case. I have seen many photos and videos put up for discussion where the patient is not even aware that he/she was being photographed or recorded.

Clearly then the question of obtaining consent for the same does not even arise.

Shockingly though, in India, most patients would have already signed consent forms with added lines to include photos and videos of their condition. I have had many patients who sign consent forms only because they have to, with most of them, not even bothering to read past the basic demography information section. How is someone who is not even concerned with information regarding their condition going to worry about their information being shared on social media?

This being said, social media plays a vital role in today's healthcare scenario. Like always, it is the perfect marketing tool for corporate hospitals to reach out to a wider audience regarding new technologies and innovations. It's no surprise then that most corporate hospitals have jumped on the social media bandwagon. Hopefully, they have hired professionals to do the job instead of just trying someone in house which is where problems could arise.

It also has a pivotal role in rural healthcare especially in India where most villages do not have access to even the basic trained medical doctor. Video conferencing, telecommunication and mobile health apps and clinics have been a boon and all this is possible only because the patient at that point has consented to have his information broadcast over thousands of kilometers to a doctor in the city for discussion and further management.

Even physicians in the city use message groups and forum discussions for difficult cases where they are able to obtain expert views without having to set aside a day for conferences.

Caution is warranted for use of such discussions in the open forums and groups of non medicos namely in open social media like facebook or linkedin even.

What is the way forward then?

A clearly worded and explained informed consent taken on paper would work wonders for all those involved in such cases. A voice recording or better still a video consent considering this is the information age would erase all medicolegal doubts over the consent offered while offering the chance to the patient to see how they would be projected.

You tube video uploads need a special consent as the video will never truly be erased if so required in the future.

Photos on instagram should ideally have black marks over the eyes or some sort of identity protection.

Discussions on whatsapp, facebook, hangouts should be free from patient identity information at all costs.

Avoid all discussion about patients on any platform if consent has not been obtained no matter how serious you think it is. If required, go back to the patient and obtain a release for the same.

Knowledge sharing is vital, identity sharing is not. Respect the privacy of your patient and you will earn their respect in return.

I'd love to hear your views, please do share them in the comments sections.

Do Pain Relief Lasers Really Work?

Millions around the world suffer from pain at any given point of time and most of it is chronic pain. Chronic pain has always been the bane of any medical practitioner. You tend to treat it with all you've got and most of the times all you achieve is a minor improvement.

Various theories abound regarding chronic pain ranging from "It's all in the mind" to "Chronic Pain Syndrome" akin to chronic fatigue syndrome.

The sad thing about it is that the patient is rarely satisfied, and will, more often than not, fish around for another Doctor who may be able to provide some modicum of relief which was clearly achieved with the previous Doctors.

Speaking plainly from personal experience, I've been hunting around for some new technology to somehow help in chronic pain, with the motivation for doing so arising from my home itself. There are enough and more people in my extended family suffering from some aches or pains.

This research led me to obtaining a novel portable machine which promised excellent results, while being compact and user friendly.

The theory of the gadget works on a Cold Laser combined with TENS (Transcutaneous Electric Nerve Stimulation) which is used very often by almost all physiotherapists worldwide. The laser is supposed to help your muscle tissue heal itself and the stimulation acts as a sort of electrical massage. The fact that it is FDA approved helped me cross the line and buy the machine.

I've used it on quite a few people till now and almost all of them have had fantastic results even though no one has completed the entire prescribed course of therapy. The initial results are encouraging and I hope to get a comprehensive list of patients who will swear by it by the year end.

A simple 10 minute protocol daily for five days is something that should appeal to anyone who is fed up of chronic pain or just can't stand that acute spasm anymore.

I'm guessing that any pain relief (even if it's not complete) is the driving force behind this initial success and I hope that the results sustain for me to promote it further.

If anyone has any questions regarding this, please do not hesitate to contact me. Please do find the brochure below.

Medical Negligence

A fair amount has been written about medical negligence in the past and it is a topic guaranteed to continue to be written about in the future. Purely from the Indian perspective (since each country has its own laws), negligence often is declared via the media and press.

Such is the state of our governing bodies in the medical field, that most cases reach the print media before they reach our regulatory bodies. A huge bias exists on both sides of the fence, with the medical fraternity, well, most of them, willing to stand behind the Accused and the rest of the population going with the media.

You may have heard this many times, but it warrants repetition. Doctors in general would not intentionally harm their patients simply because their entire career depends on their reputation and word of mouth publicity. It defies logic that they should then perform acts that would sully the very reputation that they toil so hard to build.

This, by no means, abdicates his responsibility towards errors in judgement and lack of communication skills. This, according to me, is the crux of the problem, in most countries, but especially in India.

The Doctor Patient Ratio precludes a  successful and unwearied hearing of the problems faced by the patient, often leading to incomplete history taking and jumping to a diagnosis, just to accommodate that line outside the doctor's office.

This causes problems right from the diagnosis to treatment options and consent taking. The end result is usually treatment first, followed by re-investigation, if the treatment doesn't work, which then makes them look deeper and more thoroughly. If this was done in the first place, many of the problems Doctors are facing today would vanish.

Taking a consent before a procedure is a joke in our setting. The task is usually delegated to the junior most member of the team, who goes about it thinking of it as just another form to be signed by the patient before getting on to the real business of the procedure at hand. Rarely, if ever, are the risks and complications, completely explained to the patient and their relatives for routine cases. Of course, major heart and brain surgery, where the risk is proportionately higher, is usually handled differently and more attention is paid there because of the real risk involved at the Doctors end as well. Consequently, most general surgeries and out patient procedures are carried out with a blanked consent with the patient trusting the Doctor with all he's got.

This is where the problem comes in. If, something now goes wrong, the patient feels like his trust has been shattered. The person he trusted his life with, turned out to be untrustworthy. Friends and relatives start giving their valuable opinion on which better Doctors they could have suggested who would 'never' reach this situation. People start suggesting that the patient and relatives consider legal action to recover costs. Yes, it is about the money and anyone who says otherwise is living in denial.

Once a lawyer gets involved, the situation only gets worse because its in the lawyers best interests to keep the case running as long as possible or to secure a win. There is no option of compromise or losing initially.

9 times out of 10, the patient still trusts the Doctor to make it right or in the worst case scenario believes that the Doctor did all he could to save the patient. It is almost always outside intervention that leads to medicolegal escalation.

To avoid this entire scenario is completely plausible. Communicate with the patient at each step of the way. Take him into confidence and trust his ability to deal with harsh news. Often, we try to soften the blow. It is not required. If the patient can deal with coming to a Doctor, they can deal with bad news, if given in a timely manner. Explain the procedure, if any, and talk them through all the possible risks involved, even minor reactions. They will respect you for it and will understand if anything happens. The foremost thought in the mind of a patient who is suing you is "Why did he not tell me about this?". Allay their fears, support them and leave the decisions to them at all times. Even when their life is in danger, it's their choice to decide with their relatives. Of course, immediate life threatening danger is an exception as are many other situations. In general, though, give power to the patient and they will trust you more.

The same thing works with children. They are mostly treated as if they are not in the room and they don't understand. They will surprise you. Tell them what to expect, say there will be pain and after a bit of crying they will cooperate and beautifully so. They will also return with a renewed trust because you did not lie to them. The same thing applied to the geriatric population and cancer victims.

Bottom line. Communicate. We were given the power of speech, lets learn to use it effectively.

Laparoscopic Surgery in a 4 month old child

I was fortunate enough to be part of a case which I doubt many surgeon's will get a chance to see or assist in their medical lifetimes.

A 4 month old baby presented to us with a history of failure to thrive, with vomiting after every feed and generalized lethargy. The baby weighed just 4 kgs and was fairly weak. On investigations, it was revealed that he had a large hiatus hernia - a condition where the stomach rolls up into the chest cavity through an abnormal opening in the diaphragm between the abdominal cavity and chest. This was causing him to vomit and reject all milk and water since birth. He also had bilateral inguinal hernia and a hydrocephalus with very low growth hormone levels.

We decided to operate laparoscopically on him. It was the first time I would be involved in a laparoscopy in such a small child. We had the OT in the evening at 6 p.m. As is the case in such delicate situations, we were greeted by the news that the endotracheal tube which the anaesthetist required was not available at the OT stores. He insisted on a No. 3 non cuffed endotracheal tube and the stores only had 3.5 and above. This delayed us for about half hour till they could procure the same.

Once the patient was under, only then did I realize how small he actually was. The distance from his chest to his pelvis was the length of my extended hand! Keeping this in mind, we had to use speciliazed mini lap instruments measuring 3 mm to 5 mm.

The surgery took about 5 hours with findings of a large hiatus hernia with almost the entire stomach resting in the left chest cavity. We pulled out the stomach, divided the sac, delineated the 2 crura of diaphragm and proceeded with the repair of the defect with a fundal wrap (basically wrapping the stomach around the lower end of the oesophagus so it won't slide back up). One of biggest challenges in this case was the constant struggle for space, not only for the instruments, but also for the surgeons to stand without hindering the others movements.

The stomach going into the chest wall through the opening

The hernias were tackled subsequently and the patient was fortunate enough to be extubated without the need for a ventilator and went back to the room and did not even need the NICU.

The patient is doing well as of now and should be discharged in a day or two and most probably will show dramatic improvement in terms of weight gain and development provided there are no other morbidities.

Medical Holography....Astounding!

Happy New Year!

2014 promises to be a year of immense change and potential all over the globe, starting with our very own India and the rise of the Aam Aadmi Party (AAP)! While India rejoices the victory of the common man, the Israelis continue to do what they are best at....Research and Innovation in Medical Technology! If the U.S. is the current superpower in terms of finance (and guns) Israel wins hands down in Medical Innovation.

I was sent this link for a video that could change the way Doctor's would practice medicine forever! Usually I ignore such mails and prefer to read new innovations in journals once they have been tried and tested, but I just happened to watch the video and was amazed!

Israeli startup Real View has come up with a 3D Medical Holography that would allow Doctor's to virtually see the 3D model of organs in their patients bodies and take a call as to what line of intervention must be followed.

While the video focuses on the heart and cardiologists, the potential here is mind blowing. The end of the video has a short clip on a 3D image of a fetus.

Imagine the possibilities of having the option of seeing your unborn child in full 3D hovering above your hands. Imagine the number of children we can save by diagnosing and treating conditions before the child is even born.

Imagine having the option to correctly see the organ you think is damaged prior to surgery, pin pointing the exact location of damage if any and then prepping for surgery. If you know exactly where to look and what to do before even opening the patient, it would save time, resources, improve recovery times, allay patient's anxiety regarding the diagnosis and procedure and yes, make better doctors.

Imagine the countless number of heart procedures we could save by getting a model right in front of us instead of advising every third patient for an angiography (invasive) or a bypass or stenting. You could see the extent of damage to valves before deciding whether they need replacement.

The possibilities are limitless but this technology is in it's infancy and must be given time to mature before we jump head first into it.

Watch the video and be amazed (nothing graphic in it)

Please share and leave your opinions in the comments section below.