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. 

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?

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.

Trust your doctor. However....

1st July is Doctor's day. You would probably be sending out happy doctors day messages to any doctor you've visited and been satisfied with.

That satisfaction comes from a level of trust between you and your Doctor. This trust is, today, at it's most fragile state. There are reports everywhere of Doctors betraying their patients' trust, their own Hippocratic oath, their own conscience and more importantly their livelihood.

However....

These reports are like a lot of the other media sensations carried out by the ratings syndicate. They do sensationalize just a wee bit, dramatize for effect so you would read the article and of course zing it up with a bit of creative writing.

However.....

I do confess, there are a couple of rotten apples (ok may be a couple hundred) amongst my brethren. They do things that make me sick to my stomach, like, scaring the heebeejeebees out of patients for small, minor ailments, which could use just an aspirin or a paracetamol (no pharma affiliations here).

However....

This post is not about that. This post is about the way forward in this current scenario. Here is my tuppence on the matter.

The family physician is dying out. The good old GP who knew everything about your family, your children, your great grandparents, your maid, is today, no longer your first point of recourse if someone falls ill in the household. It's all gone bonkers with specialists and consultants running straight in for trivial matters.

You really do not need a specialist for about 80% of the problems that generally come up health wise. The remaining 20% can also be effectively handled by a good recommendation by your primary physician.

However....

There is no trust, no faith, no motivation to go to your GP anymore. There are a few reasons for this, primary of which, is the easy availability of specialists. They are no longer only at the major hospitals with a waiting period of 2 months. Secondly, the elite breed of Family Physician is just not being produced any more (the reasons for this wound need another post). Lastly, every distant relative that's never even seen you before has the best doctor to recommend to you (doesn't matter what the specialization is in this case).

However....

There is a way forward. Find a Doctor, one you think you can trust. Let him/her be from any field of medicine/surgery. Pick them because they are the ones you know you can trust. Then trust them for everything they say. Most specialist Doctors will probably know more about any disease more that your relative staying two countries over or that nosy neighbour who just happened to hear what was wrong or even that person you occasionally say hi to in the office parking lot!

Once you find a Doctor you can trust, place that trust completely and know that they will only do what is best for you. If they know they can't treat the condition at hand, they will refer you to someone else who is more capable to do so. Keep the trust and do not think it's because of a cut back or referral fee (here is a tip - the fee does not change whether there is a referral fee involved or not. You're going to have to pay what you're going to have to pay). Follow up back with your primary doctor after the referral. Trust him/her to now maintain your health ahead!

However....

To do so, the Doctor has to be able to trust you too. This is something that is not spoken about at all (primarily because it's a non media issue). Your trustworthy Doctor has to be able to trust you to do as he says, take his prescriptions exactly as they are supposed to be taken, go back when asked and rest when advised so. Any deviation from the plan of treatment is on your head not the Doctors. Something to think about isn't it? How many times have we felt better and stopped medication or started work because we just had to go back before the advised duration of rest, not do those silly breathing exercises because really it's just brainwashing isn't it?

However...

When we then relapse, it's the fault of the Doctor of course! He must have not given me the right medication. He wasn't reassuring enough, he wasn't clear enough in his instructions. He didn't specifically say we couldn't go back to work! Excuses flow fast and thick in order to justify our actions.

Trust is a two way street. Put in that little effort and be a model patient and you will automatically have a model trustworthy Doctor.

However...

Find one you can trust first. Once you figure you are happy with him/her, stick to them like superglue!

However.... Don't take my word for it, let me know what you think!!

Those evil hospitals and their vampire doctors

Seemed like an apt title for this post. Now that everyone is climbing on the doctor bashing bandwagon in India, the surefire way to get people to read on would be to toe the line and badmouth the hospitals and doctors.

Reality Check: Most of what is written is true!

A corporate hospital is one run by a corporation who intends to expand the hospital chain like it had expanded itself into a corporate entity. By virtue of this simple statement, it is understood that they will run the entity like a business, and why not?

We consumers are a fickle minded people. We want the best hospital every time, with the cleanest floors and the best service with the best staff and the best care with possibly the best food ever tasted in a hospital along with possibly the best views on offer along with the best amenities with of course the best possible and cheapest tariff known to mankind!

Let's take a pause here since at this point a whole bunch of you are saying, hang on, we don't mind paying for quality!! Sure you don't, but you aren't the one's complaining are you?? Also, that's kind of not the point is it? 

Everyone seems up in arms about hospitals pushing doctors to make a profit and how unethical it is! 

Reality Check: There is nothing unethical about hospitals pushing their doctors!

The thing is, every business out there, is out to make a profit. You would be lying to yourself if you thought otherwise. Anyone who thinks hospitals and doctors should be more charitable, please head on over to the number of government and municipal run hospitals there are. Even better, move to the UK and face the NHS!

Even today, India continues to be at the top of the healthcare chain and is one of the cheapest destinations for quick healthcare the world over. We must be doing something right!

Coming back to the point of this post, corporate hospital management is correct to push it's doctors. The only problem is that they seem to be pushing without direction. This could be attributed to people in high places with no healthcare experience whatsoever. Which is where the need for trained post medicine admins come in, but that is another post.

The ethics debate which is where this is blowing up, lies and should lie solely with the Doctors! It is up to them to decide whether they do what the management asks without regard to their medical training or continue ethical practice of medicine and be the best doctor that they can be!

If the Doctor is as good as he/she should be, the patient load and revenue will come in anyway. Once the doctor has a roaring practice, the management will have no choice but the accept the terms he works with, otherwise, there are enough private hospitals out there poaching good doctors.

The ethical dilemma, in my opinion, is only with those Doctors, who either can't bring in patients on their own merit, or the newbies who were drafted into the big hospitals, and want to prove themselves. Either way, the load of ethics still stays on the doctors shoulders.

An illustration to help understand this better. A recent newspaper article cited a hospital as suggestion to its cardiologist to perform angioplasties on at least 40% of his out patient visitors. A negative look on this suggests the hospital deciding for the doctor how many procedures his patients should undergo. A positive outlook is that the management is informing the Doctor about the average turnover of cardiac patients that a busy established cardiologist may have as industry standard.  

At the end of the day, every doctor gives the patient a choice. If you choose to believe in your Doctor, you would undergo a procedure. If you have less faith, you would get a second opinion. Either way, the doctor is acutely aware that he/she is being scrutinized, more by the patients than the management. Believe me, we doctors care more about what our patients think than what anyone else does.

The Doctors who do push patients for uncalled for surgeries and procedures are few and far between and must be pulled up. However, writing articles in the newspaper about the entire healthcare system being bad isn't cutting it. The book dissenting diagnosis is getting a lot of publicity with this and I wouldn't be surprised if the doctors who wrote the book aren't laughing all the way to the bank about this, but I wonder.....

The crux of the matter is, the book interviews a couple of hundred doctors. They got a few positive answers. They haven't mentioned all the others that they did not interview or those who gave them negative responses to what they were looking for.

Bottom line. Find a Doctor you can trust and stick with them until given reason not to. If you can't find one you can trust, always take a second opinion. The best way to do this is not Google, but going to a second doctor without telling him about visiting one before hand. This gets you the best unbiased consult. Once you are convinced about your condition, decide where you want to go by reading about the hospitals suggested. I'm in the process of launching a website that gives honest, first hand user related ratings and reviews of hospitals. Visit the site at Best Hospital Reviews and learn about the place. Then make your decision on an informed basis. You would never need to criticise a doctor or hospital again since you'll have done your due diligence. Yes YOUR due diligence. You play a part in this as much as the ethical doctor you want does!! Any views and critique are welcome and will be replied to in the same tone as this post!

Aamir Khan Vs Robin Hood

A rather curious name for this post, wouldn't you think? Let me try and express what I mean.

First of all, let me make it clear that I had no intention of reacting to the television programme, Satyamev Jayate - which translated means "Truth alone prevails". Unfortunately, a slew of facebook posts and email from doctors has made it necessary for me to write this and clear my mind for more important things like my kids!

Aamir Khan, was, is and most likely will continue to be one of the most respected stars of the bollywood industry. He also is very successful and has a following that will ensure the success of his show. The contents of the show, therefore, must have been reviewed by him, much like a manuscript of a film before he signs.

Now, a lot of people, mainly Doctor's are going on about how his research is incomplete, how he hasn't shown the full picture (pun intended), how he was biased against us in that show. But of course! How do you expect the show to gain ratings unless there is some sensationalism in it. He has to bat for the underdogs to garner support from the mass public that watches his show. He, in effect, has to rob the rich to win over the poor.

Before you take off on me being one sided and blind to the facts, let me state here that most of what he said on that show was and is true and will continue to be so. Yes, there is a large pharma doctor nexus, yes there are benefits we get from them, yes there are many doctors that claim and give referral fees, yes most of the big hospitals have started doing so officially as well. 

But.....

No, not all are like that, no, not all doctors prescribe only expensive medicines, no, not all doctors go on all expense paid vacations to foreign lands and no, not all Doctor's accept referral fees, No, the fee DOES NOT CHANGE if the Doctor refers you somewhere (Surprised?) , no, not all doctors are like politicians! (Ok, I just slipped that one in). 

The only reason he is getting so much attention from the Doctors, is that there has to be some measure of guilt there. Otherwise, no one would have bothered reacting. They're scared that what they do would come out in the open. Like a wounded tiger, there are ready to strike, fangs bared! Like the robbed king they want to get rid of this robin hood! Which only serves to make people think what he said is all true and all correct.

Getting to my main point at hand. Should we get the Medical Council of India (MCI) or the Maharashtra Medical Council (MMC) to change the way Doctor's behave with their patients. I have a few suggestions which are so far out, that probably at first no one would agree with them, but I urge you to read them twice in light of the facts.

1.) Change the way we receive the education needed to save lives. 

As of now, this is just a theme to give and pass the exams. At this point of time, 99.99% of freshly graduated MBBS Doctor's would not know how to do CPR, or treat a patient of Malaria in this country without supervision. We learn by experience and we learn during our internship.

2.) Our internship is basically manual labour where we collect blood, write out reports and histories and rarely if ever prescribe medication

3.) On completion, we are so busy trying to study for post graduate examinations, that there is no time for practical hands on treating knowledge to be gained.

4.) The Government wants us to serve in the Rural areas and to stop us from going abroad to pursue higher education and specialisation. Offer better universities with transparent admission without charging crores to gain admission into super specialisation. This is rampant and ignoring this has the problem so far.

5.) Allow all medical practitioners from all countries all over the world to practice where they want. You'd be surprised at how many Doctor's want to return to their home villages and practice there.

6.) Allow generic drug prescriptions. Shocker! I'd probably get shot by the pharma mafia for this. Most developed countries have generic drug prescriptions and for that matter, qualified pharmacists attending chemist shops and pharmacies!

7.) Consider allowing medicine to function as a brand partner. Allow sponsorships in medicine. Keep in mind this has to be combined with generic drug prescriptions or it won't work.

Look at it this way, in today's world Branding is everything. If I offer my patient a choice between generic ciprofloxacin and branded ciprofloxacin, they most likely choose the latter. If the patient is party to the choice, then why can't I endorse a brand of ciprofloxacin. Make it legal. Make it so that the patient makes the choice! It is possible, just not doable. Anyway, most of the chemists, dole out what ever they see fit in spite of prescriptions saying its the same drug. Just because Aamir says Thanda Matlab Coca Cola, does not mean I will drink only coca cola. I know this is a far fetched generalisation but to an extent it is true with the influence he has.

Further, how come the law makers get away with allowing supremely high prices for drugs available in generic form. If the Pharma companies are working to recover their costs on Research and Development which costs them crores, how about Doctors working to recover their costs of studying till they are 30 just so that they can make a living. 

According to a financial planners estimates, the amount a doctor spends on education (and now Continuing Medical Education, CME) can be recovered only by earning for 50 years taking into account discounting for future value of money and inflation. Which means, if I were to invest all the money I'd spend on my education, I wouldn't need to work for 50 years! I chose to do so, because I want to treat patients. Make them healthy. Have that respect that I deserve. 

Most Doctors would treat a large number of patients for free throughout their lives as medical practitioners. I'm not even counting the ones we serve during our internship and college days (they are still getting treatment remember!) How many shows would Aamir do for free if he wasn't making the millions that he does today?

Would he have gone to the borders if he wasn't a successful Actor and was not sponsored by some product.

Almost everyone lives on sponsorship of some sort. I'm not saying it's ok. I'm just saying it's prevalent and therefore the norm.

Consider this, you come to me as a Patient and I reassure you that you need no medications, You promptly thank me for my wisdom, then question why you have to pay me because I didn't prescribe anything, then go off to the next willing Doctor who is only too eager to write a prescription. Who's the good Doctor now?

Lastly, the issue of consent. This is such a worldwide problem, that it shames me to even address it. Written Informed Consent is something that is 99.99% not successfully obtained anywhere in the country. The reason is this. It is impossible in today's world, to accurately describe all the possible complications of any procedure to the patient in the language he understands best. This is for 2 reasons. One, the Doctor cannot list out everything that can go wrong in details to each patient for each condition and second the patient may nod and assume he has understood but he may not have and will turn at the slightest hint of something going wrong. That is why, the courts, work on the assumption of satisfactory medical effort and not exact workings. The other thing with consents, is that they are most difficult to obtain in emergencies, because they are either given without thinking during such emergent times or the people are just not ready / there to sign the forms. In this case, we're damned if we treat and damned if we don't!

It's not easy being a Doctor. Certainly not as easy as being a TV show host. But, no matter how money minded we have become, we still try and do our best for the patient. Yes, we may try to earn as much as we can out of it, but that's what everyone does. Try and make a living. Only, we do it with the intention of healing someone at the end of it. What's your motivation?

Can you trust your Doctor anymore?

I was reading over some blogs while I came across this one about the writer having a bad (well, really very bad) experience with her Doctor! She's written her heart out and I'm assuming she channeled most of her anger into the blog. However, she made one mistake! She forgot to look at the other side of the coin. I am trying to show a glimpse of that other side if possible in this post. Do both of us a favour and read her side of the story first to understand this post better. She writes at A-Musing.

Can you trust your Doctor anymore? I would think you don't have a choice. It's like politics. You have to vote for someone, so you do but you may not like the person you've voted for. Let me explain. If you can't trust your Doctor, you have but 2 options left. The Internet and God! Here's why the Doctor is a better bet.

The internet, although a vast whorehouse (yes this is intentional and not a typo for storehouse) of information, will only allow you to read what you want. Try it sometimes. If you have something, and are looking for the symptoms, you would tend to read more into what symptoms you have rather than analyse the whole situation. For eg, A fever can be almost anything, but it is most likely to be nothing. Start searching the internet for fever related diseases and the average hypochondriac (all of us are at some level) would probably end up thinking he/she has malaria, dengue, or Mediterranean Tick Fever!!

God, because, you would probably not realise God's helping you, until you're on your death bed and receive a miracle. Get real, no one attributes a cold going away to God being great! At that point, it's just something that would have happened anyway!

Coming back to the Doctor. There are some points I agree about. Specialities and Super Specialities are branching into areas as small as the pituitary gland (a couple of cms at best). How much would I need to study to know all I can about something as large as a pea! To this question, I have one standard answer! As much as you can! Medicine is not a static knowledge base where x and y always have definite values. There is no constant in medicine and no textbook that can highlight what each patient would go through during a particular illness. It's impossible. That's why its called a practice. The more we see, the more we know and I'll let you into a huge secret here....80% of our work is pure INSTINCT! We just know sometimes, that this fever is more than it appears, that this headache would be the last one of your life, that this little black spot on your toe is going to lead to an amputation of your foot, if you don't listen to the advise we give.

The grand old family physician works almost entirely on instinct because he know's your family, your background, what you are prone to getting and what you aren't. I agree with Purba, that this is a dying art, but it's more alive than you think. You're the one's that are killing it. Who runs to a pediatrician when your child has a cold. You think the G.P. can't handle that? What about when you have vertigo. This one's my favourite. Straight to the neurologist we go, when all it most likely is, is ear wax! Even then, we must see an ENT right? Hardly necessary. These super specialists are booming because you are feeding their fire. Post operative dressings can be done by any family physician, but patient's prefer going to the surgeon. He's a surgeon, for God's sakes. He can either operate or devote his time to simple dressings (of course complicated one's go to the surgeon, that's a given) . If you want him to remove time from his operating schedule and dress your wound, he is going to charge you for it. Then, don't wince about the costs!

Coming to the monetary aspect. We charge, overcharge and extort at times. Sure we do. We have homes to run, same as you. Are you telling me that the delicious bar of chocolate that you so relish, actually costs Rs. 30. I know for a fact, that the manufacturing costs, including wrapping, do not exceed Rs. 10 at best! You gladly pay for that don't you. Look at the fuel prices! Do you  think our government is losing money on petrol. Now, look at it this way. Out of the 10 years which we study to become specialists, we earn Rs. 0. However, during this time, we treat almost > 10000 patients (and this is a conservative average of 1000 patients a year, almost just 3 a day. I know OPD's that see 45 patients everyday) all for Rs. 0. When we finally get our degrees, after all the fees (of course there are free seats - these just cost Rs. 80,000 in a private college, a paid seat is about 200000), the exam fees (approx 50000 counting exams every year), the registration fees (about 10000), the travelling (because there are not enough medical colleges near home), we're almost 30 by now (assuming you finish school at 16, junior college at 18, MBBS at 23, Internship at 24, Post Grad by 28 and struggle for 2 years to get a hospital job / clinic if you have rich parents). After this, if I charge you Rs. 500 for a consultation (which is how much you would pay for a movie if it was a couple going) is that too much??

Let's take insurance. Most Doctor's hate insurance and insurance providers. You want to know why? Most patients claiming insurance request us to present inflated bills, hide previous illnesses, lie about the duration of the disease and more things I can't write about. They also expect the Doctor to help them out in whatever way possible to process their claim. When did we become insurance agents! The OPD insurance registration that Purba talks about is mostly in the big hospitals. You want to know why it's necessary. Some patients calmly walk away without paying many times. Who's the clinic/hospital supposed to catch then?

Investigations! This one can go on for another 200 pages. We prescribe them most often because we need them. Other times, it's because patients are ignorant regarding their health and don't maintain a yearly check on themselves. You want to prevent diseases but don't want to take the steps to prevent them. Studies in the US clearly state that half the number of colon cancers can be cured if detected early. The way to do this is yearly colonoscopies after a particular age. Would you do it? What would your reaction be if you were told you have a tumour? I'll tell you. You would say, but I feel perfectly fine! That's why we order tests! Sometimes, you feel nothing while a disease grows inside. On the other hand, I do agree, that most tests ordered today are over the top and unnecessary! This is a small group though.

Medications. I would love to send of some of my patients with just a simple Crocin. Maybe some warm salt water gargling. Would you be satisfied with that? I can guarantee that this is the correct modality of treatment for certain symptoms, but would you pay me for hearing this. Most patients are dissatisfied with the medication they receive as they expect more. I have actually had people walking into the clinic and demanding injections even when they are not required. What do I say to them? If I don't give it, someone else will and I lose my patient to another specialist!

It's a delicate balance between under doing and overdoing. Neither Purba nor I can decide which is right. It's up to you, the patients. Just leave with this thought though. Blood Pressure can change in minutes. If you have a high reading at a Doctor's clinic, most will tell you to get it checked again. Don't ignore them. At the same time, don't ask them whether they're sure you don't need an ECG / Echo. They will advise you for it if you do! Remember, we get sued for medical negligence if this happens. No one can sue the patient for not following instructions!