Healthcare 2017- Ditch Robots And Bring Back The Doctors

Healthcare 2017- Ditch Robots And Bring Back The Doctors


After yet another fruitful year of practicing what I preach, I thought it’s time to put up a post on my pet peeve, again. The said peeve being, the practice of medicine is slowly being changed into a robotic occupation, where a doctor is given a set of instructions and told to follow them to a “t”. But unfortunately the human body doesn’t not cooperate with this by the book approach as every individual is unique by himself and every disease affects a person differently. Given a set temple and asked to follow the protocols given is the surest way to prolong disease till the patient is deceased. And that’s the reason why I always take evidence based medicine with a pinch of salt.

Evidence based medicine to give its due, works in a fairly efficient way, in a limited spectrum. But given its limitations it is inefficient at best and dangerous at its worst. And why, I will explain now. For those not familiar with evidence based medicine- it’s a set of treatment protocols (usually developed in western countries) which says after checking these protocols this is the best treatment for this disease and hence, everyone worldwide needs to follow these protocols whenever/wherever they see this same disease.

The problems with this approach are manifold. Let me just discuss the top two. Firstly most if not all of these protocols were developed for simple diseases and straightforward diagnostics/treatment procedures. If you have any complicated disease requiring multiple procedures, you just cannot follow any protocol template, you have to diagnose and treat case by case using all your years of experience and intuition and hope for the best. Which in turn defeats the very purpose of evidence based medicine. You need best evidence protocols for the most difficult cases because these are the ones which test you to the limits and are prone to end up with the death of the patient and the doctor being blamed for inadequate/insufficient treatment. Where others who have the luxury of time, weeks and months to study the symptoms will second guess the decisions you make in seconds by the patient’s bedside as the patient lies gasping for air and fighting death minute by minute. What’s the evidence say? Did you follow the treatment protocol? These questions are very easy to ask in hindsight but doesn’t help at the moment when most required.

The second major disadvantage with this protocol based approach for treatment is that the template developed most often uses a particular procedure using a particular piece of equipment which study in turn is sponsored by that particular equipment manufacturer. You can’t blame them – for most of these studies are really expensive and require large scale funding which governments never do and hence the researchers raise money from private players who naturally have a vested interest in promoting their products. So even if there is a better or more simpler or more low cost way available to treat that particular disease it will never be accepted as mainstream – because no one does research on it and no one publishes it and no one by which I mean no respectable medical board or journal accepts it- which results in the low cost or simpler alternative having the status only of quack medicine. While the costlier company sponsored study gets accepted in prestigious journals and then becomes the accepted standard of care worldwide merely because there is no other alternative to it. This grant of legitimacy to costly treatments in the absence of alternatives is the primary reason that doctors from developing countries hate evidence based medicine. It’s all very well to recommend protocols followed in Boston or the Massachusetts general hospital but not everyone is lucky to be practicing in Boston or Massachusetts. What about somebody practicing in Nigeria? Or Nellore? With no access to the level of diagnostic or treatment machinery as given in the protocol as per evidence based medicine? Is it fair to punish that doctor for treating that patient but not following the best established practice protocol? Whose fault is that and how can you apportion the blame?

This craze of getting more and more evidence based protocols also has the side effect of developing and insisting on more and more tests, more than 90% of which are unnecessary- like treadmill test, stress test, angiogram, CT slice- 64/128/216 machines – all of them being developed just to rule out any cardiac disease and your doctor has to prescribe these unnecessary tests every time you go for a simple muscle sprain or gastric distress and indigestion or any other condition which does not involve the heart. But because the best evidence based medicine protocol says you have to rule out heart disease in all cases, everyone gets to do a CT scan at the highest possible resolution beyond 64, beyond 128 beyond 216 slices- even if you are a healthy person with absolutely no evidence of any heart disease. But because the protocol formed in San Francisco or New York or London says so- you have to get that CT scan, every time you over eat samosas and have gas. If this wasn’t a waste of resources and such a tragedy it would be such an inside joke, but I can’t laugh at it now. And neither should the poor unfortunate patients who end up paying for all that waste of time.

So the best thing that you and I can hope for is that the government gets into the act and funds medical research in a big way so that individual researchers do not have to go begging bowl in hand to equipment companies who in turn dictate the treatments to be researched and published. And secondly the realization that data mining and rigid protocol’s don’t work for human beings. There is ample space in medicine for hard won experience and intuition based on it. Or otherwise we will continue to take angiograms for every patient who comes to the hospital with an acidity problem and advocate cardiac by-pass surgeries based on minuscule blockages seen in every minor blood vessel, whether they want to or not get a major heart surgery done. Why? Because the evidence says so, and you want to get the best possible treatment at international level don’t you?

I hope national governments realize the immense damage being caused to local healthcare managements by these artificially imposed from abroad protocols and either help in developing local protocols for local people or at least stop penalizing doctors for using years and years of experience to treat patients instead of following Boston rules. Support doctors not robots.


Waiting For The Doctor

Waiting For The Doctor


A friend on twitter was recently moaning about the time she spent waiting outside doctors rooms as some of the most stressful periods of her life. I agree with that sentiment. Never mind the fact that you are anxious to go in there and find out from your doctor whether you have a life threatening disease or not  the very fact that you are sitting surrounded by other obviously sick people with no hope of a happy ending in sight will give the heebie-jeebies to anyone. Including me. I too like everyone else have spent time waiting outside doctors rooms even though its more out of a sense of delicacy on my part not to announce myself as a colleague and just barge in ignoring others waiting in the line.

Anyway this post is not about the people waiting outside doctors rooms but about why doctors make people wait outside their rooms? A few pointers

  • Ego- Yes the number one reason why you spend hours waiting outside your doctors room is to satisfy your doctors ego- the ego to be wanted, needed and validated as someone worth waiting for. I know this might shock you but its the truth. The reason is, its not easy to get people to wait outside doctors rooms for them to turn up as the competition in medicine is killing and there are umpteen number of doctors out there waiting to see you whenever you want to. To be recognized as a good doctor it takes a minimum of ten years hard work, of hours and hours spent alone in the clinic waiting for that solitary patient to turn up for a consultation, hours spent peeking outside the curtain separating the inner room from the waiting hall every time a mild footstep is heard imagining that at last here comes the patient who will pay for this months rent at least so you can still continue practicing at this same place next month and so on and on. And after all this long struggle when the doctor reaches a place where he becomes recognized- he turns the tables on the very people he waited for and gets a perverse pleasure in making them wait for him. Believe me when i say that there is nothing to equal the joy felt when you walk into a consultation room and see it full of patients waiting for you. It makes you appreciate the sweet success of having arrived. It stokes the ego and gives you a feeling of being invincible and god-like for the only other place people wait so patiently for a glimpse is at the temple. So even though doctors know they can manage their time better and stop wasting others time, still to satisfy their own cravings for popularity they will intentionally make you wait hours to meet them. The bitter truth.
  • The medical representatives- if you see a bunch of medical representatives waiting outside the doctors rooms with you to meet the doctor be assured that your doctor is going to wantonly make you wait outside for hours. The reason is simple- just like politicians need people at their mass meetings to show the media their power and popularity to draw a crowd, similarly doctors need crowds of patients to show medical representatives their drawing power as busy practitioners with loads of people waiting to meet them. Medical representatives are by far the biggest gossips of the medical field- they are the ones who go around spreading stories about which doctor is popular with a dozen people waiting outside and which one is sitting alone in his clinic – despite being a good time manger and being prompt in seeing his patients off rather than making them wait. And guess which doctor gets that all expenses paid trip to egypt to see the pyramids – sponsored by the drug company? Yes, its the same doctor who will make his patients wait for hours showing off his overcrowded waiting hall as a sign of popularity.
  • Other patients- yes this might be a shocker to you but the biggest time waster in any practice is the patient who went in just before you. I have had many patients who have made me want to physically throw them out for wasting my time but have survived because i remembered the Hippocratic oath in time. Some women are the worst offenders in this. They come in with their husbands and children and a whole bunch of people and after consulting for a small problem and paying the fees instead of leaving promptly they stand by the door and then casually start discussing the assorted medical problems of the hubby, the first kid, the second kind, the mother in law, the next door neighbor and everyone else on the street on the mistaken assumption than once having paid a small fee for a single consultation the rest of it should be all free advice on the basis of – well we are just talking, aren’t we, you re not actually seeing the patient, so it doesn’t count- never mind that all this talk consumes the better part of an hour or so just to make sure she doesn’t poison someone with her home remedies. So blame those people who troop into doctors rooms with an army of supporters and sympathizers who have no business being there.
  • The unexpected – yes things like surgeries which can sometimes throw in complications which no one can anticipate- remember every individual is unique with a unique anatomy and blood vessels and nerves can never be found in the same place as shown in textbooks and you can appreciate why surgeons can be late for appointments. And add the occasional friend or relative who drops in to talk only at the busiest time of a doctors  practice and can never be got rid off politely and fast and you can see how the unexpected can impinge on your doctors time.
  • Greed- and now we come to the one reason which can be altered by your doctor if he really wishes to- over selling appointments. If your doctor appreciates that your time is every bit as valuable as his- he will never over book appointments and try to fit in everyone at the same time. It is simply callous time management and can never be tolerated in any other field. To see three patients in one hour is different to seeing three patients in three hours. The difference can be life saving for you and can certainly save you a load of money in hospital bills in future if your doctor can spend enough time concentrating on you and you alone for the fees you pay instead of shunting you out as fast as he can to get the next patient in. Believe me,  no doctor – however  popular he or she is-  is worth your time and money if they act like that because they are going to miss catching your disease at its earliest stages if they are in a hurry and you will be paying the price for it later. Its better to change over to a another doctor who even if he doesn’t have a reputation as the best will at least listen to you patiently. Remember its your health and your life and you are paying the bill for it.

So to conclude i leave you with the thought that all that waiting outside doctors rooms is not accidental but a well thought out strategy by your doctor. Doctors are rarely helpless when it comes to efficient time management – they can stop wating your time or not. And if your doctor chooses not to then its time to stop waiting for him or her and simply move on to someone else who knows the value of others time and respects paying patients enough to give them their attention to. So choose a doctor who is satisfied with seeing three patients a day and buying a maruti suzuki rather than the one who sees thirty patients a day to buy a mercedes benz.  The first one might or might not save you but the second one will definitely kill you. Be wise and move on to a better doctor.

Communist Medicine In A Capitalist World

Communist Medicine In A Capitalist World – The Evidence Based Medicine Conundrum


Any casual reader of history or anyone at all with any general knowledge know that the discredited philosophy of communism and its paramount creation the soviet empire were both destroyed because both economically and even with common sense it beggars belief that decisions can be made in central committees and by fiat be implemented in all places and in all situations without a single thought for local conditions or differences. Crops to be sown, fertilizers to be used and harvesting times were all imposed on farmers from afar by fat-cat bureaucrats sitting in distant Moscow committees who thought they knew better than the local farmers born and bred up on their lands for generations. The result was total collapse of the agriculture sector and widespread famines everywhere in Russia. Production quotas and processes to be implemented in factories led to so many shoddy products that anyone who was just anyone at all in Soviet Russia preferred to use imported products for everything from shavers to ovens.  Rule by distant committee was comprehensively proved to be the stupidest idea to have ever been invented by the human race and believe me we as a species have made many, many more such mistakes.

So if I now told you that the same discredited theory of communism is now being touted as the only way to practice medicine what would you say? I kid you not- search evidence based medicine on the internet and you would find plenty of laudatory articles as the way to go for practicing medicine as per modern protocols. But read past the platitudes and rule by central committee is exactly what you would find.  And just because the committee distributing it is the internet itself it finds its greatest advocates on the net who tout it as the only way to go and not as one more way as it really is. Now enough with all the historical references and let me start explaining what evidence based medicine really is all about.

Sometime in the last decade of the last century (the 1990’s anyone?) there arose a new system of medicine called evidence based medicine. As with everything else when it was first introduced the intentions were noble and its advocates were sincere and it was definitely a step forward to the future. Doctors everywhere welcomed it because it seemed to offer a way forward during those times when doctors most need help- decision time. Evidence based medicine involved putting up the results of large scale clinical trials on the net to help doctors everywhere follow those same guidelines in their treatment for their own patients. It showed what worked or what didn’t work to others who were hard pressed to make difficult clinical decisions in real time. As such it definitely was a step forward. It even helped simplify which drugs to prescribe or which not to. For instance many of the old time doctors used to rely heavily on antibiotics where were popular during their heydays often not realizing that such antibiotics were no longer active due to an effective resistance built up by bacteria continually exposed to the same drugs for so long. Hence evidence based medicine pushed the medical fraternity into discarding old, tried and tested beliefs and adopting newer treatments. And that’s when things started going wrong.

When the popularity of evidence based medicine picked up worldwide big pharma was as usual right there to swing things in their favor. They started sponsoring the large clinical trials needed to get their evidence – often using low cost outsourcing firms in under developed countries where patients signed up for medical trails for a pittance- and used the results of such biased trials to push heavily in favor of their own drugs which had been used in such trials. Other drugs, even tried and tested ones didn’t stand a chance because all the latest evidence (sponsored of course) freely available on the net pointed towards such and such drug – as the only one with enough evidence available to show it worked. If a doctor wished to use any other drug which he felt could be equally effective he stood in grave risk of being taken to court by the patient for not following “internationally accepted standards of care available on the net”. Which led to all the doctors falling in line cowed by threatened medical malpractice suits and patients reading up the results of such biased trials on the internet and demanding of their doctors the same treatment that recommends.

If to take an example you have constipation and I as your doctor want to recommend to you a single plantain (local banana) every night and you go on the net and read that florida oranges grown in glass rooms in chilly Alaska when given to 5000 people led to 4000 people rushing to their toilets every morning and you quote that study to me and demand that I prescribe only Florida oranges to you- imported straight from Alaska- then I have no choice except to write a prescription of the same. Because I or anyone else for that matter have no evidence at all that bananas work, forget the fact that every single individual we know all around us for thousands of years have used bananas to evacuate their bowels. There is no large clinical trial for local bananas- no one paid money to large groups of people to eat a banana and shit in the morning and hence no evidence for banana which makes it a false treatment under the evidence based medicine guidelines and if despite this I want you to eat a banana, god help me, I would end up losing my license for practicing medicine- for not asking you to eat imported Florida oranges which might beggar you with just one months treatment cost. And this is the literal truth and I am not exaggerating. The costliest drugs are the ones which drug companies prefer to send for large clinical trials by recruiting thousands of patients. Hence when the results come out its the same costly drugs which become the default treatment option worldwide and any doctor who differs is branded a witch doctor for not following the evidence. Individuality has been stamped out and creativity rooted out in the name of the evidence based medicine fad.

Just like communists used to prescribe their guidelines from a central committee for everything, evidence based medicine has a central treatment guideline which every doctor has to follow to save their own skins or woe to them. Such evidence gathered in distant populations does not take into account individuals or their idiosyncrasies. Medicine is not an exact science and most prescriptions are based on informed guesses but that doesn’t mean that in the name of standardization a one size fits all variety of medicine becomes the only way to practice. The evidence based medicine fad has been taken to such ridiculous levels that surgeons who often make small incremental advances in surgery by trying out newer and innovative surgical techniques on individual patients cannot publish their results anymore as case reports and case series- which are about smaller groups of patients – are increasingly being not published or downright derided in favor of larger clinical trials. Surgeons are being forced to fall in line with the same efficiency as robots and an individual surgical technique (even surgical flair) is being eliminated in favor of standardization.

The day is not far off when patients can print off their own prescriptions off the internet from a published list of symptoms to treat themselves and a doctor (or a middleman) becomes superfluous to medicine. Is that a step forward? Or will it lead to more chaos? Based on the history of communism I am very skeptical of the future of evidence based medicine as it is now. But I can’t speculate on what the next medical fad will be. Will evidence based medicine escape the stranglehold of big pharma and sponsored clinical trials and evolve into something more inclusive and egalitarian taking into account individual knowledge. Or will it act the monolith and seem impregnable till it suddenly implodes on its own like communism did? Only time will tell.

The Cult Of Mediocrity

The Cult Of Mediocrity


So there I was one day this week, arguing with a colleague about the relative merits and demerits of a bunch of students of whom a few were exceptional, most moderate and fewer were really pain-in-the-necks. We were collating the yearly attendance to forward to the university for exams and as the painy-types had been absent for more than half the working year – making them ineligible to appear for the exams- my colleague was arguing for giving everyone the required percentage of attendance regardless of whether they had actually turned up or not to the clinics. I, on my part, said it was unfair, unfair to equate the kids who had come in at all times, on all days, rains or riots notwithstanding, to attend to patients who required care; if they were in the end to be lumped along with others who had probably taken it easy by sleeping off all day and turning up only when/if they felt like it. Colleague argued that it was not fair to punish the students life like this over such a little thing like lack of attendance to which I replied “but madam if they didn’t attend the clinics, didn’t treat actual patients, didn’t learn anything, I shudder to think of the damage they will do to people, real patients in the real world, once you release them like this on an unsuspecting world”.

Colleague demurred and said that they still have to pass the university exams to which I reminded her of the unspoken but neverthless strictly enforced regulations of giving a 100% pass percentage to every batch of students (by the simple expedient of punishing the teachers if a student fails) on the theory that students are sensitive people and they will not take the rejection of failing so easily and cant be forced to read and appear again for the same subject after six months. If everyone knows that they are all going to pass anyway, I argued, then what the hell are they going to study for? You are removing the incentive to study, to learn, the incentive of humiliation- of being left behind in a class of your juniors while your batchmates go on ahead. Remove that fear and you remove all necessity for knowledge. And I said I really sympathized with those idiots (for want of a more apropriate word) who knowing all this, knowing that they simply have to appear for an exam to pass, knowing all this and still working hard, still studying so much, waking up in the early mornings, reading all night, the kids who are dedicated to learning and to shining in the profession – those kids who don’t know better but are simply moved by an inner urge to succeed.

And it was only when the said colleague sympathised with and continued to espouse the cause of the lazy shits by arguing and pushing strongly for them that I realized that she had a different (hidden) agenda- she was merely demonstrating the “like bats for the like” principle or the “cover your ass by covering your people’s ass” thing. Those who thrive in mediocrity recognize only the mediocre- they are intentionally blind to the bright and the exceptional. Those who benefit and get through for reasons other than pure merit and talent are perforce forced to defend those of their own ilk as they remind them of themselves when younger. The mediocre at all levels and ages hate the bright and the brilliant- even if the brilliance is a product of hidden hard work and uncounted hours spent slaving in preparation while others take it easy and sleep. It’s so sad to see this cult of mediocrity spread even to educational instituitions- where donkeys are encouraged to amble while horses are hobbled. Everywhere I look in our country I see this same indifference to excellence and an encouragement to mediocrity –for the lazy are an abundant lot while the hardworking are we few.

After the above said episode I am reluctant to pass on my knowledge to the next generation as I am more and more convinced that it is going to be unwanted, unappreciated and an exercise in futility. I am even rethinking working here at the teaching hospital, watching the tragedy of bright students getting crushed everyday while the idiots are coddled and feted. All this unnneccessary stress is giving me heartburn and ulcers. So I am planning to shift back to hospital practice and leave the trainign of the next generation surgeons to the wise administrators and their numerous followers who act on the principle “that everyone is equal and no one should get hurt”. This kind of egalitarianism should work out very well for our society when these same batches of student passouts start practicing in the coming years. I am pretty damn sure that my practice will shine all the brighter and my waiting rooms will be fuller once  people realize the kind of doctors they have everywhere because of their encouragement of the mediocre and incompetents. To borrow from Actor Vijay (of Thupakki fame)- I am waiting.

Dodging a Bullet with My Name on It.

Dodging a Bullet with My Name on It.

Disclaimer: This is quite a morbid post and better avoided by those with a queasy stomach. It contains graphic descriptions of diseases and deaths and is not recommended for everyone.

cinefix-matrix-bullet-dodge-600x369I woke up sometime around four this morning with my mind all alert of a sudden. For a few minutes I lay there trying to calm myself of the sudden wave of anxiety that had woke me up and trying to recall what it was that was troubling me so much. And then it crashed on me like a wave. Oh god, how could I miss it? It was so much like an HIV case. And then it all came back. Yesterday, being an unusually busy day with a long line of patients- each one crowding out the other like on an assembly line- I had seen a patient with certain unusual symptoms- a severe disease with no logical added reason like diabetes or some previous fevers or something which could explain the severity of her symptoms. And being such a busy morning with forty plus impatient patients waiting next-in-line I had asked her the mandatory questions, asked her to get the routine blood tests next time she came, did a minor procedure on her then and there and prescribed the usual medicines all the while functioning on my robo- doc mode.

I know that my being tired and distracted with all the noise and clamor of those patients surrounding me doesn’t excuse me from not suspecting something amiss right then and there. But, i suppose my ever present vigilance slipped for a minute and i decided to treat it for then and there and reserve further inquiry for the next visit in three days. But somehow, somewhere in the back of my mind my subconscious was not satisfied with the mystery is what I think now. It must have been plugging away at it all day until in the middle of the night it made the right connections and it woke me up. I was lying there in a cold sweat while thinking how careless i had been in handling an HIV patient. What if, god forbid, I had been exposed too? Was it already too late for me? Am I going to get AIDS and die? Believe me these are morbid thought to think in the middle of the damn night. They don’t make for much pleasant sleep the rest of the night.

When we are students we are taught repeatedly how to protect ourselves. There is a reason that we are taught to take precautions as if every single patient is an HIV patient because you never know who can be one. They might know that they are hiv positive but conceal it and lie to the doctor so they wouldn’t be treated differently- with extra safety measures. Or the poor patients might not themselves have known about it. Any which way if only we, I, had followed the proper procedure of doubting everyone- I wouldn’t be here in the middle of the night shivering with fear. But complacency they say can kill even the best of them and as i had started to think myself as wise as Yoda the Jedi master, I had let down my guard and been as foolish as the newest apprentice.

Of course the blame can also be shared by the authorities- they expect us doctors to do miracles with what we have while they support us only halfheartedly. If you want to give the best health care to the poor patients then you should be prepared to spend more money by hiring more doctors who can spend more time with each patient listening and diagnosing carefully. You can’t expect just a handful of doctors to cope with a hundred patients in five hours and still take a detailed look into everyone’s complaint and not make a single error. We are human too- a fact which the authorities conveniently forget all the time. I had been travelling all night that night, on a rickety government bus, perched on an uncomfortable seat trying to grab a few winks of sleep and as soon as I had landed in the city I had come straight to work after stopping to change at home. I was tired, sleepy and my alert levels were far below normal. Of course I made an error- but the bottom-line is I am in a profession where errors are inexcusable- they can either kill the patient or kill the doctor. No excuses allowed.

And to conclude this post, medicine is as a risky a profession (for doctors, I mean) as you can ever see in life. The chances of our errors killing us is almost as high for airline pilots – remember the Thai flight lost recently due to pilot error? Similarly, one mistake, one moment of carelessness and we doctors are dead- it’s an accepted hazard of the profession though no one talks about it much. If you think I am being paranoid let me explain that on a daily basis we doctors are exposed to far more life threatening diseases than anyone else – including those sick people who have that disease and only “that” disease. For example, I had spent a majority of last week at the fever ward- the place where severely infectious patients are admitted- because there has been a recent explosion of chicken pox cases in the city and everyone’s been pitching in to help out to get over the staff shortages because of the summer hols.

I guess my blood by now is crawling with all sorts of viruses and bacteria after being exposed to the infectious diseases wards all week. I am a walking, talking bio-bomb, most likely. On the other hand the fact that I am still healthy and haven’t caught anything yet only points out the astonishing fact that my immune system is robust and copes with everything that’s thrown at it. Those little buggers, the white blood cells swimming down my arteries must be some helluva strong fellas right? And in the end – what doesn’t kill us only makes us stronger, in the immortal language of that awesomatic rapper 50-Cent. So, let’s see, my options are I can either keep worrying all day long about whether I have caught anything or just get on with life throwing it all to fate and that’s what I am prefer to do. Just get on with my life and hope for the best – like the light brigade- canons to the left of them, canons to the right, rode the six hundred and so will I.

P.S. Just now- this morning the patient has returned with her blood test results. She said she had been cured completely by whatever drugs I had given her earlier- all her symptoms had disappeared. And most importantly her blood test results came out clean- she was not HIV positive which means I was in no real danger whatsoever and had merely been frightened badly. I don’t know who was more relieved at the result – her or me. Somehow I seem to have dodged the bullet this time- but I have learnt my lesson. Eternal vigilance is the price to pay- to sleep well at night. No more excuses- of being tired or anything- nothing will be tolerated. I vow to keep awake, alert, all the time, so help me god. And I sincerely hope that the bullet which has my name on it will take some more time to arrive. I am not dying yet, I have work to do and a life to live and miles to go before I sleep.

Gagging Doctors on Social media.

Gagging Doctors on Social media. gag1

I read somewhere recently that the British government – the British medical association has issued strict rules for doctors on social media- it says something like doctors should not post any opinions or advices on social media as it reflects on the profession adversely. Although I live in India and the Indian government hasn’t had any say on this subject, it’s only a matter of time before they do too- most probably by copying the British government law verbatim- like we did with all of our other laws…Remember the Indian Penal Code, anyone?

 Firstly, I welcome the move to curtail “online medical advice” for too many people write way too many medical advice columns using the easy availability and wide reach of social media and so much so that anyone who gets to read a couple of pubmed articles via google immediately starts doling out medical advice to others. Where I disagree with the British medical association’s new rules is on forbidding the use of the word “opinions”. Now personally speaking, I am an opinionated man and I dole out my frank and outspoken (even contrary) opinion on all subjects under the sun- from relationship issues to current affairs to politics and I almost never confine my opinions to just my chosen profession. But gagging me only because I am a doctor seems to be a bit unfair to me when all other professions are allowed to vent their ideas and feelings online.

Every day as part of life I meet a lot of people (like the bus conductor of my regular bus, the waiter who serves me regularly at the hotel etc) -some of whom on learning that I am a doctor immediately cage for free medical advice or a second opinion on someone else’s previous advice. As any responsible doctor would do- I listen to them, offer my opinion and always, always tell them to consult a good doctor straightaway for a real and valuable consultation. I remind them that I am not their doctor and as such I can only advise them generally based on the limited knowledge I have of them. I don’t consider doling out such free advice as a threat to the medical profession – especially as its only general opinions and nothing specific or in detail. Even when it comes to social media I follow the same set of rules whenever I reply to the half a dozen or so such messages I receive on facebook and twitter daily from friends and strangers. And I make it a point to almost never treat my social media friends as patients in real life because most such online friendships would not stand the test of seeing my real life consultation bill.

 Social media is a medium not supposed to be taken seriously in my view. It is a kind of hobby, a stress-buster to me. So why would I do online again all the same things I do in the real world from morning to night? I use social media to connect socially with people and to offer my views on life and life experiences, not to make money by doling out paid consultations. In fact one of the things I love about facebook or twitter is that I get to meet people with widely different (and unique) life experiences whom I would never get to meet in my real life circles- which revolves mainly around other doctors and hospitals. I am interested in everyone I meet (well except for the trolls)- because each of us has lived a unique life, had unique life experiences and have extraordinary stories to share with the world – social media helps me to hear those stores and apply it to my own life. Now why would the government object to that? Beats me.

 And on the other side of the equation, like a software engineer, or like a teacher or an auditor or anyone else doctor’s too should be allowed to talk about their life including work life and its experiences on social media- just like you would tell your relatives and friends about the exciting day you had at work in any other profession. That doesn’t mean that the doctor is giving out secret professional information on patients which can be used against them. When I first started blogging there were too many trolls (mostly frustrated/incompetent doctors who were envious of my capacity to tell a medical story interestingly) who tried to abuse me and railed against me for violating doctor patient information – as if my blog had a million readers and I was sharing nuclear technology secrets on it. I routinely deleted all the spam mails from such envious people and have continued to write what I want to on my blog and letting my sense of professionalism and conscience to be my guide.

 If you have been regular readers of this blog you would know that sharing my thoughts on social media involves mainly sharing with you about all the heartaches, emotions, confusions and frustrations of medicine. When I write about the struggle of a doctor to understand and diagnose a rare disease I am not stating that I am superior to other doctors- I just offer you a privileged inner view into the thought processes which go behind making a diagnosis- it’s like watching a match live on TV – everything is real- real patients and their real pain. I don’t think I am being unprofessional or betraying any secrets when I share with you the raw stories of how medicine works especially with all the emotions and feelings involved in each decision. And I am sure like people everywhere you too are interested in other people’s stories or my blog won’t be nearing a hundred thousand page views by now.

 So I believe this effort to gag doctors from social media is a dangerous trend and should not succeed- not in Britain and definitely not in India- for I believe that like everyone else a doctor too should be allowed the freedom to express his opinions freely on social media. The story is what matters in the end, not the medium. So is it ok for me to tell your stories on my blog, friends? I await your frank responses. Do tell.

Proving a Damn Point.

Proving a Damn Point. main-qimg-53fdbbb0c15f210bf5925a18bca468d3

A friend was talking to me yesterday when he started complaining about the teasing he was suffering at the workplace from the management and how his entire job experience had turned bitter. When I asked him as to why he was still hanging around that damn job, for after all he was well qualified, experienced and bright and would be snatched up by any other competitor, the answer he gave me was this “because I don’t want them to win, I want to prove my point by sticking on there till they kick me out themselves”. Excuse me, you would rather wait to be kicked out then walk out with dignity? Surprising. Anyway to come back to this “proving a point” thing- I keep hearing this justification very often from plenty of others too and each time I wonder about it, whether it is a wisest course of action.

 The point is, I don’t get the point of proving a point (forgive the bad alliteration, coudnt resist). In my point of view any place, act, or situation which makes you uncomfortable and irritates you is a flashing red sign to get away from that stressful place (or person). If going to work every day means you are at a high state of tension throughout the day and the stress is going to give you High Blood Pressure, Kidney failure, maybe a Stroke or two and an Heart-Attack to boot, then I couldn’t care less about proving a point to some moron if it’s going to hurt me that much ultimately. No anger or grudge is worth destroying our own health and peace of mind. When I stated this belief of mine to another colleague seated nearby, he said that he sympathized with the other guy and if I didn’t agree with the majority view, then I must be a cold blooded type.

 I am not sure what he meant by being hot-blooded but if it means flying into a temper at the drop of a hat, boiling with rage, swearing vengeance, carrying grudges or fighting a vendetta to prove my point- then please count me out. I am not interested in remembering every hurt or betrayal and living just to take revenge for it. That is just not me- I am slow to anger, fast to cool down and I forgive easily. Life, to me, is too short and precious to waste it on grudges. I would rather forget and move on with doing my own thing. And I sure as hell don’t want to prove a point to anyone on anything if it means loss of peace of mind to me. In my often stated view- life should be calm, peaceful and stress-less as we glide over its smoothly polished surface.

 To intentionally create havoc in our own lives just to teach someone else a lesson is utter foolishness in my view. Karma will get them in due course so why waste all our energies and precious moments of the present planning a possible gloating moment of the future? Maybe I will never get it- why people are ready to go so far to get revenge. Maybe I really am a cold fish. Or maybe, just maybe, I am wiser than all those grudge-holders, revenge-seekers and point-provers. Who knows? Have you any idea?