Share This

Archives

What They don’t Teach You in Medical School

Posted by on Dec 14, 2014 in Off the Beat | Comments Off on What They don’t Teach You in Medical School

What They don’t Teach You in Medical School

There are many, many things they don’t teach you in medical school which are essential to life after medical college. Things like the travails of the stock market; when, where and how much to invest; when to make career moves like shifting to another country. Imagine during internship, there was a two week posting wherein interns could get to know how to work in different countries- the licensing exams, the expected salary structure, the problems and so on. That would be fun. But unfortunately, this article is not about any of that. Its about another matter which is not taught in medical school- communication. Not the communication of findings between doctors but between doctors and their patients. Let me start with a small quiz. Imagine you are in the ICU and as you are leaving for the day, the attenders of patient approach you with the question: How is he? He’s not likely to make it. So your answer is: 1. You can talk to the doctor on duty 2. Please check with the nurse in charge 3. We can’t say anything till the next 24 hours 4. ————— (left blank to signify silence during which you look away and walk past) 5. ————– (left blank to fill in your answers, because I have run out of options) I wonder how many of us can be truthful and say- Its bad; he will die. Is there another way of saying that? Apparently, as one of my friends working in the UK told me, the concerned attender or patient can complain to the NHS about that. So what do we do? I don’t think there is any right answer. Because we are not trained for it. We are trained for recognising signs and symptoms, diagnosing and treating. But not for the talking to patients. Its so much easier to diagnose a cancer as incurable, stage the disease and estimate the five year survival than to tell all this to the concerned patient. As we progress further into the field of medicine, the danger of losing the point of origin becomes all the more real. That point of origin was to help others and to ease their pain. Unfortunately, all of us learn that the hard way. When we grope for words to tell someone he or she has less than five years to live. Communication with patients is not always easy. Patients usually assume that we as doctors can recognise one of them at short notice when we see them outside the hospital. I would like to illustrate this with a small parable. I had gone to deposit money in a bank, close to the hospital I was working in Kerala. Next to the counter, stood a man clad in white lungi and white khadi shirt. He leered at me. I did the best thing- ignored him. He declared’ “Can’t have anything cold.” It sounded like one of those matrimonial ads- Must Love Cats and such stuff. But the chap was definitely talking to me. I did the next best thing- answered him. “Nothing?” “Nothing!” he replied with complete confidence. I had some vague recollection that he had come to the hospital. Fishing for details, I asked’ “What happens?” “Same problem!” “Same?” “Same!” “What about lime juice?” I asked, having...

read more

CuraTED – Inspirational TED Talks For Doctors

Posted by on Nov 16, 2014 in Watch Doc | Comments Off on CuraTED – Inspirational TED Talks For Doctors

CuraTED – Inspirational TED Talks For Doctors

There are few things as rewarding to the mind and the soul as a dose of TED talks. Here is our brief list of assorted TED talks on Healthcare from the last few years; by physicians, social activists, strategists and patients. In this set, the first in a series, let us look at the talks that explore the essential humanity in healthcare in different ways. For best results take one HS over the next five days. 1. Be inspired…be very inspired 2. Physician-heal thyself.. 3. Physician thinker and Healthcare strategist, Stefan Larsson on getting out of silos and collaborating more.. 4. Taking control of your health- a way forward in the age of ‘super’ specialised medicine. 5. Reclaiming the sacred relationship- touching...

read more

20 Tips to come out of liquidity crisis

Posted by on Oct 26, 2014 in Fiscal Fitness | Comments Off on 20 Tips to come out of liquidity crisis

20 Tips to come out of liquidity crisis

When you have purchased a new house and settling down with the EMI or say spent a lot of money recently in your marriage, you may face a severe liquidity crisis, unless planned well. This means expenses shooting far higher than your income. Once you start using expensive credit card, home top-up or personal loans, you start getting stuck in a debt trap. So if you are in such a crunch, consider below suggestions. Obtain Low or No Cost Loans 1. Request an interest free loan from your or your spouse’s employer. 2. Take loan against your Gold 3. Use the home loan porting facility & reduce the EMI. You will have to pay a one-time charge of around 0.5% of the outstanding loan to the new bank. Your existing bank may as well allow you to switch to a cheaper rate loan with a similar one-time charge. 4. Withdraw or take a loan from your insurance policies 5. Get a loan from your parents or your spouse’s parents. 6. Borrow money from a close relative or a good old friend at say 10% p.a. This is far cheaper if you are using the credit card to fund your deficit. Reduce the Outflow 1. Extend the home loan from say 20 years to 25 years. 2. Target say 10% cut in your household spend. Announce this in your house. Lead by example. 3. Look at your Top 5 spends. If the discounts are not possible, ask them to give more quantity and or value at the same price. If not, hunt for bargains. Use internet. 4. Defer expenses to next week, next month, next quarter or next year. In a liquidity war, say no to every rupee that wants to go out of your pocket. 5. Stop all financial investments till the time you reach a surplus situation. Leverage Assets 1. Sell non-performing investments & pay-off most expensive liabilities. 2. Surrender insurance policies not earning good returns & reduce liabilities. Use the surplus by not paying premium to service the remaining loans. 3. Withdraw from Provident Fund. This can take 2-6 months. Use RTI if you get stuck. 4. Withdraw from your Public Provident Fund (PPF). Use internet calculators to know the eligibility. 5. Check for hidden assets. Any inheritance that you can leverage right away? Any NSC certificate or Fixed Deposit forgotten in your wife’s cupboard? Any Gold that you purchased for investment purpose? Any pending refund from Income tax? Old physical shares? Any loan you gave to a friend? Increase your income 1. Are you taking all tax benefits? Can you restructure your package with your employer? Any claims pending for reimbursements? Can you stop your Voluntary PF contribution, if any? 2. Is there a way you can increase your income? Can you take part time tuitions or write on blogs? Check out freelancer websites for opportunities. 3. Can you change your profile and earn more, say by joining sales team? Time to change your job? Working abroad is generally very lucrative. But you will first have to create an emergency corpus. 4. Can your spouse earn more by changing the job? If she is not working, can she work part time and earn? Check out freelancer websites for opportunities Best Practices While you make these efforts,...

read more

That tube around your neck

Posted by on Oct 17, 2014 in Off the Beat | 0 comments

That tube around your neck

The stethoscope has evolved over the years and the origin of the stethoscope and its history is as fascinating as the history of medicine itself. The origin of the stethoscope is credited to Laennec in 1816, who initially devised a cone made of thick paper and used it to hear sounds!! The stethoscope or “steth” as it is popularly referred to has come a long way. The tubing has changed in length and consistency and keeps evolving. The bell and the diaphragm keep changing to improve acoustics. The ViScope can, in addition to hearing sounds can also see the heart beating under vision. For a medical student, the acquisition of the steth marks the transition from theoretical to practical medicine. A doctor is synonymous with a stethoscope and the point of a time when a medical student starts using it is quite a milestone in his medical career. Though, many may not really use a stethoscope for the rest of their careers! Teachers and professors would continue to stress the fact that more important than the stethoscope on the ears is what is undoubtedly between the ears- that is the brain and its ability to make sense of what one hears! The steth is a bit of a status symbol for someone in clinical medicine. It could set you behind by an amount ranging from Rs . 200 to Rs. 20000 and beyond. It really depends whether you are going in for a Nano or a BMW! The way you carry a steth is also a very individual style statement. Most sling it casually around ones’ neck. There are some who bunch it into a very ungainly mass in one’s trouser pocket. I have seen doctors affixing it on to their trouser belt loop and the steth literally marches with the doctor. There was a lady I knew who use to drape it very gracefully across one shoulder like the “pallu”of a saree and it would miraculously remain in place , defying laws of gravity inspite of her vigorous forays all over the hospital. Doctors also vary in the ways in which they embellish their steth and look after it. Many pediatricians have small teddy bears or dolls stuck on the tubing to make them look less intimidating to kids. I knew an oncologist who had a miniature skull with a cigarette dangling from the lips affixed on the tubing –conveying the message in no uncertain terms. There are some who very religiously clean the diaphragm every morning with spirit and dab some cologne for good measure- don’t know if it improves the acoustics but I am sure it is a pleasanter experience for the patient. One is taught to warm the diaphragm by rubbing it against one’s own skin or clothes before placing it on the chest of the patient, especially in winters. I knew of a doctor who took this rather seriously and had a woolen cap knitted by his wife to store the steth , when not in use! The steth has functions beyond the obvious. At times, it is used to convey an air of maturity, confidence and worldly wisdom and give the impression of a veteran in business. It is sometimes used as a paper weight. Often, it is brandished and waved emphatically to...

read more

Mandatory Rural Service for Doctors ?

Posted by on Sep 30, 2014 in Contrast Study | 3 comments

Mandatory Rural Service for Doctors ?

Different opinions on contentious topics make not just for interesting debates but often help clarify the intricacies of the issue. Our community has no dearth of articulate voices making their points forcefully. In recent times , few topics have generated as much heat and dust as the call for mandatory rural service for doctors. In the first of our debate series ‘Contrast Studies’, we have two stalwarts from the field presenting their view. In support of the view, we have a Paediatrician and Public Health veteran and the contrary viewpoint is by a Paediatric Surgeon and bio ethicist. Presenting to you Antony Vs Antony- a study in Contrast (or is it?) Mandatory Rural Service for Doctors- a step in the right direction: Dr. K.R.Antony Is there an option for an Army officer to come back from a forward area while his infantry platoon is marching on saying that the terrain is rough and hazardous, weather is inclement and there are poisonous snakes under the bush? Perhaps, the answer is no. He is trained to face all that and stop at all costs the enemy invader. But imagine he argues that he has an option to pay up the “bond” and he decides to go for a seaside holiday at that critical period. Suppose the Army officer got his graduation from a Military college run by a private management, where he got his admission through a management quota seat paying Capitation fee; then he claims freedom to refuse. Ridiculous! Isn’t it? Unfortunately such a scenario in health sector does exist. Nobody can enforce a two year compulsory rural service bond. Whether country or society needs it or not is immaterial for the doctor who passes out and the passive government is a mute spectator to such blatant refusal. Paying up the bond money and escaping the rural service obligation has become a cheaper way of getting a medical seat in “not for profit” private medical colleges. If you want the returns of the heavily invested capital quickly, and that is why you refuse to go for mandatory rural service, then medical profession was a wrong choice of business to go for. There are much better business sectors in the market to opt. Your share capital investment Gurus will advise you better than me. Never buy an MD Radiology seat for Rs.3.Crore and think it is a smart buy! Nowhere in the west do you get your post graduate qualification so quickly as in India. There is no herd phenomena like that of African Zebras to en mass migrate to greener pastures of specialisation soon after MBBS. They practise the basic profession for some period before that. They are in no hurry to marry for a handsome dowry with specialisation or fetch a post graduate seat to climb up the ladder for a premature professorial position. If it is your own option to become a physician, then you should have known what it entails. You are aligning yourself to a disciplined army of professionals to face the disease burden and suffering wherever it is maximum, rural or urban, hilly or marooned areas and people of any type, class, religion, caste and ethnicity. You are inheriting a great tradition of a noble profession; a tradition of a long professional history since 5th...

read more

Gorukana

Posted by on Sep 20, 2014 in Breathing Space | 0 comments

Gorukana

Situated about 170 kms from Bangalore in the idyllic hills of B.R.Hills, Gorukana is a community based one of a kind project of the Vivekananda Girijana Kalyana Kendra where all benefits go to the development of the people and the conservation of the Wildlife and Nature of BR Hills.VGKK was founded in 1981 by doctor and tribal activist, Dr. H. Sudarshan who is also a Magasaysay award winner. VGKK  was started by Dr. H. Sudarshan who is a Right Livelihood award winner in 1980 with a eight bed hosspital and a minor operation theatre for the Soliga tribals of B.R.Hills. Following which the organisation grew with multiple projects to ensure sustainable and holistic deveoplment of the tribals keeping their rights.  An associate organisation : The Karuna trust was started in 1987 which has pioneered and established successful models of Private Public partnership in the field of healthcare especially by managing PHCs across many states. Gorukana is a resort consisting of ten cottages, one tree house and one tent house all built out of locally available forest material so that it blends with the surrounding trees and nature. . There is a rainwater harvesting lake, apart from an organic farm. Also, vegetables and fruits from the organic farm and fresh milk from VGKK dairy farm are supplied. Wildlife Safari , trekking, visit to the podus(tribal hamlets) apart from a cultural programme by the locals are some of the activities that can be undertaken. The resort also encourages the concept of VOLUNTOURISM integrating volunteer activities and tourism by giving oppurtunities to Volunteer at the Hospital or School. Gorukana is a perfect example of how biodiversity conservation and employment to the locals can go hand in hand. The immense biodiversity of the vegetation found in BR Hills is a reflection of the wide-ranging climatic conditions. These climatic conditions are in a large part due to the varying altitudes which peaks to as high 1200m above the 600m basal plateau and gives rise to an equally large difference in rainfall, from 600mm at the base to 3000mm at the peak. As a result, BR Hills boasts a beautifully diverse range of habitats that includes almost all the major vegetation types such as scrub, deciduous, sholas and evergreen to name but a few. Whilst driving around the BR Hills Sanctuary it is possible to pass almost instantaneously through one type of vegetation to another such is the ever-changing nature of the climatic conditions. These forests have nearly 800 species of plants from various families and a diverse number of animals. BR hills is home to about 26 species of mammals including the Asian elephant, which cross the ‘corridor’ during seasonal movements between the Eastern & Western Ghats. It is also famous for providing a home to the Gaur, Asia’s largest bovid. Sambhar, chital, the shy barking deer and the rare four-horned antelope are also found here. Carnivores include the critically endangered tiger, elusive leopards as well as wild dogs, lesser cats and sloth bears. The forests are also home to two species of primates and three species of squirrels. In addition to this sparkling array of biodiversity, the forests of BR Hills house the Soligas. Gorukana Gallery (Click to enlarge) Getting There Location Address: Gorukana BR Hills, Chamrajnagar – 571 441 Nearest Cities Mysore...

read more

Teacher’s day- Circle of Love

Posted by on Sep 5, 2014 in Off the Beat | 1 comment

Teacher’s day- Circle of Love

Teacher’s day- Circle of Love I saw something the other day, It made me stop in my sway. The door was open, I walked in Not realizing I would behold a vision. There was my senior professor, Bent over some old foot on the bed Carefully paring away a corn With love, with care.. i understood. For the old foot was my teacher’s teacher, Many moons ago, they were younger. None did realize that what one taught, N the other imbibed, Would complete the circle of love Would complete the cycle of life. I left quietly.. The scene was too sacred to disturb, I saw my intern, brow furrowed, Trying to master the skill, I had most zealously shared. And I wondered.. Many moons from now.. Would we complete the circle of love? Would we complete the cycle of...

read more

WHY SO SERIOUS???

Posted by on Aug 30, 2014 in Mad Med Men | 3 comments

WHY SO SERIOUS???

As the AIPG forms are out, we at ALTERDOCTORS have one question to ask : WHY SO SERIOUS??? Presenting to you a sneak preview of the trailers of a NEEEEEET experience. hitting computer labs near you this December. A legend will rise amongst us who will use theatricality and deception to conquer the darkness. His weapons are multiple ranging from Mudiths to Ashishs to Kalams as he ROAMS with them in hope of eternal glory ACROSS the other side of life as a medico. Presenting to you , a MAD MED MEN version of NEEEET trailer through the characters of DARK KNIGHT.                   Disclaimers: Resemblance to any exam/exam conducting agency/exam situation/persons are purely coincidental and not deliberate All the characters are properties of DC comics and Warner Bros and this usage is purely meant for entertainment purposes and is a non profit non commerical usage . These Medical Memes are first featured on ALTERDOCTOR website TREAT and cannot be reproduced without...

read more

Dr Robin Williams- RIP

Posted by on Aug 13, 2014 in Editors Desk | 0 comments

Dr Robin Williams- RIP

You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome. Robin Williams moved on to the theatre in the sky recently. A man who entertained generations had incredible acting skills, unbounded energy and great sense of humour all embedded in his compassionate persona. Little wonder, Williams was tailor made for his performance as a doctor with a very human touch. Here is a brief recap of some of his most famous roles as a medical doctor/ therapist: Awakenings (1990)– Based on the semi autobiographical book by the Neurologist, Oliver Sacks, Williams plays Malcolm Sawyer, a compassionate physician taking care of catatonic patients in the 1920s USA. Incessantly searching for a solution, he stumbles upon a possible medical cure in the form of L-DOPA. The awakening that this brings about and the subsequent relapse explores the gamut of human emotions in the protagonists.   Patch Adams (1995)- Perhaps his most celebrated role in this genre, he plays the real life Hunter “Patch”Adams in the movie about this rebel with a cause whose life mission is to bring joy in his patient’s lives in whichever way possible. Set in the straight laced 60s, Medical School teaching rarely veers from the conventional. Adams, with his unconventional views and antics, livens up the proceedings considerably to the happiness of his patients. The upheavals in his life and the bitter sweet ending, again gives Robin Williams an opportunity to explore a tragicomic character. Through a more uni dimensional storytelling, the character was explored in Indian cinema in the Munnabhai series and its numerous regional avatars.   Good Will Hunting (1997)- This movie is about a prodigiously talented youth, Will Hunting working as a janitor in the MIT. Frustrated by Will’s callousness towards his natural brilliance, his mentor turns in desperation to an old acquaintance, the psychologist and therapist Sean Maguire (Robin Williams). Interacting with the compassionate therapist, Will starts viewing his talent and opportunity differently. This interaction, at the same time has a cathartic effect on the therapist. Here again, Robins’ character deals with personal loss and eventually comes to term with it.   Of course, with Robin Williams, complete madcap performances every once in a while was par for the course. William’s bumbling overwrought Russian Obstetrician in the movie Nine months is an example of this. Over a career that spanned almost four decades, Robin Williams entertained people with his movies that crossed genres. In most of his roles, he played layered characters with endearing qualities. A hint of sadness always lurked around that larger than life bonhomie- a portent of things to come. For us medical students and doctors watching him act as a fellow being, he reminds us of the essential humanity in our profession- a trait which we are often afraid to show. Thank you for the good times and goodbye, Mr Williams....

read more

Chance and medical discovery

Posted by on Jun 9, 2014 in Class of Chiron | 0 comments

Chance and medical discovery

  Some discoveries are the result of slow, painstaking (some would say painful) research, logical step following logical step until a faint glimmer of light appears at the end of the tunnel. Other discoveries emerge as a bolt out of the blue – they still need to be recognised as such though. And there are some where Chance conspires with Circumstance to produce something quite revolutionary. Alexander Fleming’s discovery of the antimicrobial property of the penicillium mould falls into this last category. Some might dismiss him as a sloppy microbiologist who failed to dunk all his petri dishes into the bucket of antiseptic. The mould which grew and which cleared the staphylococci colonies (penicillium – a brush) might not normally have grown at all. But as Richard Gordon (better known for his Doctor series books which were later serialised for television) writes in his book “The Alarming History of Medicine” – Fleming had all the luck! The petri dish was exposed to one of Britain’s most horrible Augusts, the low temperature being ideal for the mould to grow. The fact that the mould itself was around was more than chance – it did not descend from the ceiling but rose from the lab below where Alexander Fleming’s colleague had a laboratory and was studying moulds! Fleming’s departure to Scotland on holiday gave the penicillium time to work its magic! When Fleming, Florey and Chain were awarded the Nobel Prize in 1945 “for the discovery of penicillin and its curative effect in various infectious diseases” it would spark a debate about the actual contribution of Fleming – was he merely around at the right time? Others will dismiss this view as uncharitable, since Fleming still had to derive the importance of his observation. Several centuries before Fleming – a young, French army barber surgeon was to be similarly smitten by Chance. It was 1537 – the battle for Turin. Now that guns had become an integral part of warfare – much of the casualties were from gunshot wounds. Gunpowder was generally thought to be a poison and therefore had to be burnt out. The method employed was by cauterization with boiling oil and treacle. On the day in question, the oil ran out. Ambroise Paré who had obediently followed the instructions of his seniors was in a dilemma. He decided to improvise – egg yolk, oil of roses and turpentine – he then left, expecting his patients to be dead in the morning. Surprisingly, not only were his patients alive but they looked better than those treated conventionally. “Abandon this miserable way of burning and roasting”* he urged, with little success. But that did not prevent him from pursuing his own path. He abandoned cauterization in favour of a practice that had fallen into disuse – tying the arteries with bits of thread or cord – the ligature was reborn. Ambroise Paré combined his love of innovation (he also developed a truss for hernia, invented the artery forceps and created all sorts of prostheses to help war veterans) with an uncommon humility, for one who was honoured much later in his life. He would often say – “I dressed him and God healed him.”* *Patrick Pringle. The Romance of Medical Science. George G Harrap & Co. Ltd. 1948 Mario...

read more

SKINTILLATING

Posted by on May 31, 2014 in Book Nook | 0 comments

SKINTILLATING

SKINTILLATING : A review of  SKIN-a biography Don’t judge a book by its cover- in this case I would ask you to disregard the advice, the textured jacket evoking the sense of touch is just an apt covering for a full bodied book on the largest organ of the human body. For us, coming from a country which puts undue emphasis on the colour of skin or to be more scientifically accurate, lack of the same, this book is a reality check of the first rate. The author, Cutaneous Oncologist and Surgeon, Sharad Paul is also a novelist. In Skin, he skilfully weaves evolutionary biology, anthropology, history, folk mythology and contemporary experiences into a rich tapestry. Bear with the sometimes long winded scientific sections, there are rich rewards at the end. Watch out for the quotes and anecdotes liberally used in the book; from the classics, archaeology, literature, spirituality and even contemporary fashion practices. There are some incredible human stories which Paul brings us-  the one about Zeng Bailiang’s art classes  is one such that has stayed with me. The illustrations by the author himself, lends a personal ‘one on one’ feel to some of the didactic explanations. Linked to this is also a minor quibble with the book- some of the analogies used to illustrate scientific facts seem a tad forced. On the other hand, the writing fairly sparkles when describing events and experiences- a gift of observation that obviously enriches the writer’s twin passions of research and writing. The test of a true ‘scientific bestseller’ is that it informs, provokes thought and entertains. Skin ticks all these boxes. From a healthcare professional’s perspective, Skin brings much more than a good informative read- it makes us look at our own ‘niche’ spaces with a new curiosity and respect. Thank you for that, Sharad...

read more

Doctors Beyond Orders

Posted by on May 23, 2014 in Cover Story | 0 comments

Doctors Beyond Orders

In the nascent stages of TREAT, when the team debated on the kind of stories we needed to bring to light for our readers, social impact and change always came to the forefront. Taking a leaf from those early days, we decided that we  should bring to light the experience of healthcare teams and specifically doctors who volunteer for medical relief in disaster torn places. Driven by a sense of altruism and adventure, their perspective is unique, sometimes cautionary and always inspiring. There are many stories of individual heroism and group initiatives when responding to such calls of distress. Close to home, we found our story for the issue- from the St John’s Medical College and Hospital, Bengaluru. Over the last 40 years, starting with the Bangladesh floods and refugee crisis of 1971( ref.  from the archives)  , this institution has sent groups of doctors in response to natural calamities  across India. Over the past two decades, this has become the Disaster Relief Unit which liaises with governmental agencies and NGOs, sending out teams and setting up task forces. No story is relevant without the voices of the people- we bring you this story from the perspective of two young doctors who were among the first to volunteer for relief work in Uttarakhand. We use this story to bring to light the needs of the marginalized and while the story highlights a particular group, it is a tribute to all the healthcare professionals who step out of their comfort zones and bring relief to those who otherwise have none. Our title itself is, in a sense a tribute to that guiding light of such organizations, the Medecins sans Frontieres. IMPRESSIONS The editorial team at TREAT caught up with two young doctors Murtuza Ghiya and Alex Fonseca soon after their return from Uttarakhand where they had spent two weeks in relief work. They had gone as part of their institution , St John’s Medical College’s response to the relief call from Uttarakhand. AD: First of all would like to congratulate both of you for the efforts in being part of a disaster relief team during the Uttarakhand floods. It surely must have been an experience. But how did it all start off?     Murtuza: The busy PG life at St. Johns never let us spend time with the newspaper, and even when we managed to find some time, the  newspaper  would have been flicked by someone from the hostel rec room. So it was not surprising then that the first time we knew about the news of one of the worst floods in India, at Kedarnath, Uttarkhand (U.K.) that happened was when we decided to take the hospital lift and accidently saw the notice board- asking for volunteers to conduct a medical camp there. Before we knew it we were travelling in the Garhwal hills along the banks of the magnanimous and violent river Ganga on our way to represent St. John’s Disaster Management Unit and fight the fury of nature…or so we thought. AD:  What were your first encounters with the healthcare system when you reached your destination? Alex: We along with a team of nun nurses and a spirited coordinator from Catholic Health Association of India and one animator (guide) conducted medical camps in anganwadis, shops, pachayats, temples and...

read more

A Rural Practitioner’s Happiness

Posted by on May 3, 2014 in Off the Beat | 1 comment

A Rural Practitioner’s Happiness

  Dr. Lalit Narayan wrote this poem while doing his stint as a young Medical graduate at the Tribal Health Initiative, Sittilingi, Tamil Nadu. You might be tempted to ask why this has been the best year of my life. Here’s why. Tiny hands. Big eyes. The cutest damn expression in the world. That’s my reward. That’s happiness. Then I walk out of the labour ward. I can see hills all around. Green. That’s my reward. That’s happiness. My cottage sits on the edge of the forest. Full of books, art films and insects. That’s my reward. That’s happiness. The local women who work at our hospital Call me ‘Anna‘. That’s my reward. That’s happiness. An old therakoote vadiyar Is grateful I was with him during his second MI. That’s my reward. That’s happiness. When death comes. Despair. Loneliness and gastritis. I think of my rewards. I try happiness.        ...

read more

SAVE THE DOCTOR- INDEED

Posted by on Feb 17, 2014 in Editors Desk | 3 comments

SAVE THE DOCTOR- INDEED

(An open letter to the young Indian Doctor)   Dear Friends, The campaign started by the young doctors has gone viral. Much has been voiced by the junior doctors in the hot seat as well as policy makers. As expected from an educated community, the voices of passion are balanced by those of reason too. After watching the unfolding events and debates, here is my Save the Doctor (from) wish list for you- From Present day Medical Education– A system which while training the MBBS doctor constantly undermines the very degree by devaluing primary care and moving training to tertiary care paradigms. From the Consumer Market– A market that has created both the present day Doctor and his patient- consumerist by instinct, impatient by nature. From the politics of this country– Where vote bank protectionism may take reservations even up to super-specialisation, where ‘minority institutions’ cater more often than not to the ‘poor little rich’ minority. From the Unreasonable Society: Which expects their children to become doctors and rake in the moolah, while expecting their neighbour’s child to be the altruistic self sacrificing individual. From oneself– Who buys into the constant hype and expectation from family and society, starts putting oneself on the same illusionary pedestal, fostering a sense of misplaced entitlement. Doctors, don’t just ask for symptomatic treatment here. The systemic intervention required to correct this anomaly won’t come without pain. If recent history tells us anything, it is not to expect NEET solutions for complex issues. You can’t wish away the underlying reality which has created the public dissatisfaction with the Medical Profession. Think about it, even in this campaign, of the 95,000+ supporters, there is quite a number who got into the system subverting it and will continue subverting it irrespective of the outcome of this campaign. While putting campaign statements, every once in a while some introspection (evaluate the manifesto and the claims made therein clearly) will add value and eventually strengthen your cause. As for service, serve you must- that is the very nature/ cornerstone of our profession. Of course it works best when the motivation is from within.We are a democracy- where we have rights, we also have duties. Irrespective of how this campaign pans out, our responsibility towards the less fortunate (all patients in one sense and the likes of the ones who we ‘learnt on’ particularly) is a real one. Do not paint the entire rural service experience with the same brush, just as a bitter pill to swallow and get it over with- there are aspects of personal and professional satisfaction which has become a way of life for many. Save the Doctor Indeed- you have started a campaign which has captured the imagination of the Nation-listen to all the voices, even those discordant with you (there are some wonderfully articulate voices out there). Do not lose this opportunity to build a responsible, forward thinking, empowered community of doctors. When we look outwards for healing, remember-Physician, heal thyself (first). Good luck and Godspeed. Yours sincerely, Binu Joy Radiologist and a curious Watch...

read more

Why I became a doctor?

Posted by on Jan 3, 2014 in Off the Beat | 5 comments

Why I became a doctor?

Why indeed? The answer to this question changes over time. For instance, just before an interview for selection into medical college, the answer that almost all of us are repeating over and over again in our minds goes something like this: ’Ever since my –um- childhood, I wanted to help others. Um- and to heal them of their sicknesses and –um- diseases and also their illnesses. That’s why I –um- want to become a doctor to heal them-um. I want to –um- serve the poor and in the villages and –um- work hard. I want to ease their suffering. Health is very important. Um.’ Which, as people sitting on either side of the table know, translates as: ‘Let me become a doc. Then I’ll be on the first plane out of here, clear PLAB, put on flab, get myself a four bedroom mansion with a pool in the backyard and a couple of them German machines, one BMW and one Benz at least, in front, which will go a long way in easing my suffering. ‘ Fast forward to a couple of years, when on a dark and stormy night, there is a frantic hammering on the duty room door/ beep on your pager/ call on your mobile/ update on your Facebook status (depending on the era). It’s the much dreaded Casualty call. And you hear the same question: ‘Why did I become a doctor?’ The answer is rarely about the alleviation of suffering. More about that which must not be named in public forums. (or is it ‘public fora’?) I remember an emergency call I had while working in a village in Kerala, fresh from internship. It was about 4:30 in the morning and in the Casualty was a small group of people sitting calmly. The problem was that the patient who used to get up at 5AM daily, had gotten up at 4AM. Was that normal? “Four in the morning?” was what I could manage through the sleep laden haze. “Yes”, was the answer. “Was there anything wrong with him?” Of course there was! He gets up at five in the morning and calls that normal. Of course there was something wrong with him! There is that phase in our medical career when we know everything, can do everything, can tackle any emergency and can provide updates on almost all medical textbooks. But then, internship doesn’t last forever. Our entry into the real world is often marked with an acute awareness of our limitations and how much we have to learn. Then there are those things that medical school can never prepare us for. I remember during our ophthal OT, the surgery being done was enucleation for retinoblastoma. The patient was a child whose other eye had already been removed for the same condition. We know the aetiology, pathology, signs and symptoms, treatment, prognosis but unfortunately that’s all we know. We can never know the shrunken world the child is entering. We can never tell the parents of a child on the ventilator that the life support has to be removed because they can’t afford to pay. Talking to the family of a patient of renal failure who can barely afford the cost of dialysis is not easy. Telling the mother who has presented with decreased foetal...

read more

Drug Pusher or Healer – What are you?

Posted by on Dec 24, 2013 in Health advocates | 1 comment

Drug Pusher or Healer – What are you?

Few years, after the inspiring  Alma Ata Declaration that proposed the goal  of Health for All by 2000AD, the Indian  Council of Social  Sciences Research and  the Indian Council of Medical Research  set up a  joint study group to review  the health care  systems  in the country and recommend a strategy  to achieve  the Health for All goal. One of the most  intriguing and provocative  observation in this report, which has kept me  wondering all these years was  a call  to vigilance against  the over medicalization of the system since Health  is ‘well being’ and not just ‘disease control’. The committee consisting  of some of the senior most   medical and social science  professionals  in the country observed that “ Eternal  vigilance  is required to  ensure  that the health care  system  does not  get medicalized, that  the doctor drug producer  axis  does not  exploit  the people and the abundance of drugs  does not become a vested  interest  in ill health” As a young  faculty  member of a well known  medical college, I found this call to ‘vigilance’ against  making ill health and drug prescribing  a vested  interest  – a  rude shock considering that doctors often thought of themselves as a noble profession concerned only about the wellbeing of their patients. This  stimulated  a life-long  learning effort  at understanding  the doctor – drug – producer  axis  in reality, identified  by the report  as the major villain and the prescribing  practices  of the doctors  as the key culprit. Two more  observations  of this expert  group based  on extensive  review of current  data and trends  were equally  disconcerting. These were : “One of the most distressing aspects of the present health situation in India is the habit of doctors to over prescribe  glamorous and costly drugs with limited medical potential . It is also unfortunate  that drug  producers  always try to push doctors  into the using their  products by all means – fair or foul”. “There is now an over production of  drugs  ( after  very costly ones) meant for rich and well-to-do while the drugs  needed by poor people  ( and these  must be cheap) are not  adequately  available. This skewed pattern of drug production is in keeping with our inequitable ‘social structure which stresses  the production  of luxury goods  for the rich  at the cost of the  basic needs  of the poor”. Over the years,  I worked  closely with the medico friends circle and numerous  networks  and associations to help  initiate,  the All India  Drug Action Network ( AIDAN)  at National level and Drug Action Forum – Karnataka ( DAF-K)  at state level,  committed to policy  advocacy on  rational prescribing   practices  and rational/ethical  drug and pharmaceutical  policies . We used many creative and interesting  methods  in the campaign to encourage doctors to adopt  prescription  practices, more  aligned  with the Health For All  goal.  A short questionnaire was evolved by me  to help  health care providers  – doctors  and nurses –  check whether  they were   ‘Health For All’  oriented  healers  or ‘Drug  pushers’.   I list these questions out  today in this column to help you decide what sort of health care professional  you are: Have you accepted  the concept of an essential  drug list in  your practice to help select  efficacious, safe and good  quality low cost  drugs  from the over 80,000...

read more

EVOLUTION

Posted by on Dec 1, 2013 in Alter-Natives | 0 comments

EVOLUTION

The retrospect-o-scope is one of the finest instruments of knowledge. We understand that each developing civilization evolved its own perspective on Health and Disease. The cross-currents across these human settlements being few and far between, healing expressed itself as localized approaches isolated in their repertories that addressed local problems tackled with local resources. The simplest were “remedies” drawn from the knowledge of the shepherd and the largely unrecognized “home” bank, the chief possessor, implementer and propagator of such treasure being the woman, usually the mother. The grandmother is the wiser version of this trove, with the needed checks, balances, validation and such stuff. It is even so till date.“Therapies” derived from them were prolonged and involved, requiring more experience and understanding of the human organism and responses to disease and interventions employed. The ingredients for such interventions were mainly plant and animal (also mineral, where the other two were scarce, or this resource in abundance) with different modes of processing and differing effects being taken into account. The same stuff was given raw, crushed, dried, roasted, boiled, fried, pickled and so on – good research indeed. The philosophers and religious enter the picture now and adopt (is it co-opt?) these “peoples’ practices” into their world view. The intellectual domination begins, with a framework laid down to explain the how, why, which of what’s observed and the grounds for further development – the cons and pros (so to say) of the evolutionary path taken. The rituals, taboos, dos and don’ts get incorporated and have their say in the matter. The simple, subjective understanding of “hot” and “cold” is characteristic of explanations involving home, herbal and tribal remedies. What happens when you (manage to) consume six eggs in one meal – that’s hot (specific dynamic action of protein in current lingo)!! Why avoid buttermilk after getting drenched in the rain, while it is the recommended drink when you come in from the sun during summer? Yes, you got it – it’s cold. These are sort of everyone’s experience and easily validated by common understanding – objective, in a subjective way. It’s the elite cited earlier who made it more cerebral and therefore abstract to the commoner. In a way, the professional and his client are equally foxed. What do you tell the patient who asks about what hot foods to avoid when he is taking the prescribed antibiotics, since such medicine increases the heat in his system! The Chinese system of Acupuncture uses the concept of Yin and Yang to explain how it works. Ayurveda, Siddha Yoga and Naturopathy (the systems of Indian origin) explain their philosophies on the basis of the interactions of the triad of Vaata, Pittha and Kapha. Unani-Tibb (remember Hippocrates being the father of this system from Greece?) explains health, disease and life on the quadruple concept of four Humors, named after colors as the Yellow, Green, Red and Black humors. These theories extend their reach into all aspects of life, such that food, seasons, constitutions, behavior, activities – in general, all and sundry – are classified as one type or the other, depending on the “system-lens” one adopts. The concept of BALANCE and HARMONY is common to all these systems, between the dyad, triad or more components in their philosophies – signifying health. Imbalance on the...

read more

Medicine and Movies

Posted by on Nov 30, 2013 in Skin Deep | 1 comment

Medicine and Movies

“Medicine and movies ?”, you may well ask. The traditional stereotype of a doctor is one of a nerdy individual with thick soda glasses who is far removed from anything that Vidya Balan may refer to as “ Entertainment, Entertainment, Entertainment !” Boring, bookish and bland. None of the doctors I know come even close to this cliché. Some are singers, yet others are classical dancers; some are smart and sassy and still others are downright funny. So who creates these stereotypes ? Is there peer pressure to fulfil them ? I still remember my father giving one of my senior medical colleagues the once over and declaring with a disdainful sniff “ He doesn’t even LOOK like a doctor “. Doctors have to look, dress and behave in a prescribed manner ? Doctors are like regular people – they practice medicine and deal with ill people. But as human beings they are not from another planet.I thought I would have a look at doctors and the practice of medicine in movies and see if these stereotypes arose from cinema which usually gets blamed for all society’s ills. A lot of medicine in movies is poorly researched and superficial. Jargon and myths abound. Social beliefs and misconceptions are reinforced. New diseases are trivialized or demonized. One bout of projectile vomiting and the nubile young lass is pregnant. Diagnosed with alacrity by the village dai who perfunctorily measures her pulse. The said young lady climbs a stool to reach an object, and a miscarriage is waiting round the corner. A drizzle begins and labour will proceed among torrential rains to climax in the lusty wails of an Apgar score 2 infant. Sex is never mentioned in the good Indian movie. Children arrive on the scene because the heroine falls in icy cold water and the hero finds no other way to warm the hypothermic young lady ( Refer : Aa Gale Lag Ja with Sharmila Tagore and Shashi Kapoor or Roop Tera Mastan in Aradhana). The Mahesh Bhatt school of unbridled passion and Ekta Kapoor’s rare case of Love, Sex Aur Dhokha is a recent advance in the Journal of Movie Medicine Vol 420, pg. 1- 69. Diseases are either generic like the ubiquitous “ blood cancer “ or become super specific like “ lymphosarcoma of the intestine “ which was immortalized by Rajesh Khanna in Anand. Frank Capra’s famous observation” Tragedy is not when the actor cries; tragedy is when the audience cries ,” perfectly fits Hrishikesh Mukherjee’s Anand that milks a terminally ill patient’s story for every tear in the lacrimal gland. . It is a film that keeps its protagonists dry-eyed but makes the stoniest member of the audience blink with emotion. Disease has been used to give a character colour, content , motivation or meaning. Sanjay Leela Bhansali exploring a blind –mute character in Blackor a paraplegic’s dilemma in Guzaarish are two recent examples. Asperger’s syndrome helped to create My Name Is Khan and dyslexia made a quiet entry into the Indian living room with Taare Zameen Par as did progeria with Pa. International Cinema has been doing this successfully for years. Daniel Day Lewis used just his Left Foot to bring cerebral palsy worldwide attention. Way back in 1967 Satyen Bose showcased schizophrenia in Raat...

read more

Monthly Investments

Posted by on Nov 16, 2013 in Fiscal Fitness | 0 comments

Monthly Investments

There once lived a man in ancient Babylon. He was the richest man in the city. His friends used to wonder how he became so rich while they stayed poor, having started out at the same place at the same time. They decided to ask him the secret of his riches. The richest man in Babylon then shared his big secrets with his friends. His first secret was a lesson he learnt at a very young age from a wealthy merchant. He said, the merchant asked me how many coins are there in my pocket on pay day. I said ten. Then he asked, what remains at the end of the month. I said none. He told me to keep one coin in my pocket and live on the rest nine. I did so for a year. At the end of the year I realised I could live on nine coins and without any pain. I had managed to make my purse full of twelve coins, when earlier it used to be empty. That was my first lesson and I have not forgotten it as I learnt more lessons about money in my life. The same story can work for you too. It pays to save and invest your money wisely as early as possible. Let us look at some simple numbers and how they can change your life for better. Say you are about in the 25-30 year age group. You are more likely to be at the beginning of your career. Earning cycles are at the lower end. It will be a few years before you will actually see higher income levels. So does that mean you wait till you can actually earn enough to have a so called decent surplus? Like in the story of the wealthiest man of Babylon, if you start saving even 10% of whatever you earn today, it will help you in the long run. To validate my point Refer Table A. It shows how much money you can accumulate over a long period of time even by saving small amounts on a regular basis at a reasonable rate of return. Now let us see what these numbers actually mean to you in life. Refer Table B. In 20 years, your child would be close to pursuing higher education. And for that you would require about a crore of rupees to fund his/her education which costs about Rs.15 lakhs today. If you can start saving Rs.10000 pm today, you can expect to achieve your goal in about 20 years. It might be difficult for some to save that amount per month currently. You can start with whatever amount is possible for you to save. You can later increase the amounts of investments as your income level grows. It will eventually add up. If you start saving Rs.1000 per month today and increase your savings amount by Rs.1000 every year for the next 20 years, you can have handsome corpus of Rs.68 lakhs if you earn a return of 12%p.a. Even at 8% rate of return, this strategy can yield about Rs.47 lakhs. To inculcate the discipline of saving and investing regularly, you should look at automating your investments periodically. Else, things will never happen if every month you have to do paperwork,or...

read more

Dr.Y.Subbarao

Posted by on Oct 15, 2013 in Hi-Five | 0 comments

Dr.Y.Subbarao

Our number one contender probably came as a surprise to many of you, who would have been sitting and trying to figure out which of your favorite Indian docs stole number 1 over the previous four. (Note: Sorry, we don’t consider Deepak Chopra as a proper doctor, not that a wellbeing center would have landed him on this list anyway). Graduating from Madras Medical College and Harvard University,Dr. YellapradaSubbarao is the only one on the list who’s been mentioned in a book written by another on this list, as Siddhartha Mukherjee points out: “Any one of these achievements should have been enough to guarantee him a professorship at Harvard. But Subbarao was a foreigner, a reclusive, nocturnal, heavily accented vegetarian who lived in a one-room apartment downtown, befriended only by other nocturnal recluses.”   These achievements include the discovery of one of the first anti-cancer agents, aminopterin (the precursor of the drug that haunts all pharmacology students – methotrexate) for which he was mentioned in Mukherjee’s novel; along with the discovery of the importance of one of the most critical compounds to living beings – ATP (Yes, an Indian discovered the first super long scientific word you learned). In one of the most cited scientific papers of all time, he was mentioned by his colleague- the legendary Sidney Farber, as a key member in the early fight against cancer. (Do read the chapter in “The Emperor of All Maladies” on Subbarao and Farber. Heck, just read the entire book.)   At a time when it is every Indian’s dream to pursue higher education in America, it’s also been one of the toughest decades since Subbarao’s time for achieving that objective. In the face of stricter immigration and the hounding problem of racial selectivity, we have a lot to learn from Subbarao’s approach (The guy got into Harvard in 1922, while most of us complain about how jobless the USMLE people are for making you write 4 different exams). The two key aspects which we must taking into stride were his determination to persevere in spite of great adversity, and his objective to reach for excellence and not merely success (no, this concept was not invented by Raj Kumar Hirani). We must also mention to aspiring youngsters: PATENT. YOUR.WORK.   Though his associates were awarded the Nobel Prize in Physiology, the man who helped discover folic acid, Vitamin B12, DEC (the filaria one), and the first tetracycline, was hidden behind a shroud of obscurity. The man at the top of our countdown isn’t a global figure or the face of break-through field of medicine, he’s just a simple biochemist who used his genius to contribute more to the benefit of humanity than most deemed universities do in decades. We hope that our younger readers take a great deal of inspiration from him, and realize that there’s still an entire world out there to discover.   “”You’ve probably never heard of Dr. YellapragadaSubbarao. Yet because he lived you may be alive and are well today. Because he lived, you may live longer.”– Doron Antrim in Argosymagazine. With that, we have come to an end of this series of Hi-Five. Do watch this space for the next set of...

read more