The Doctor is not in Anymore

I recently read an article in Hindustan Times “The Doctor is not in Anymore” by Namita Bhandare and couldn’t resist writing a reply to the same. Following is my reply to Namita:

I read your article in Hindustan Times “The Doctor is not in Anymore” and couldn’t agree more. The way medical profession has changed and doctors treat their patients is not a good sign. It is not just that they are hard pressed for time and want to see as many patients as possible but I feel it is more to do with the greed of the society overall which has affected doctors as well thus making patients mere numbers for them. Who doesn’t want to make more money? Fees of doctors have skyrocketed without realizing that they are treating Indians and not Americans. It is very normal to end up paying (INR 800-900) $20 per visit in a good hospital in Gurgaon – meant only for top of the pyramid. At the same time some doctors stoop to a level wherein they prescribe medicines of companies where they get a cut and patients end up paying 500% more (on Oct 16th NPPA asked companies to slash their medicine prices by 85%) than the normal price of the medicine Or prescribe unnecessary tests. So is the art of diagnosis dying or Doctors want it to die? But is it just the doctors who are at fault and not the patients? Internet has made medical knowledge accessible to everyone to an extent that people start feeling they can do self medication or take advice of that friendly neighborhood chemist who is always more than willing to oblige without consulting a doctor (may be coz of the prohibitive fees). Every other friend or person you talk to can give you his/her advice on medicines that you should take. Leading to abuse of OTC drugs and even Antibiotics (which are available at all medicine shops without prescription) and complicating medical cases. At times this leads patients to a hospital for issues when the normal treatment from a GP at right time would have been able to sort out things. So is all the hope lost ? I feel answers to these problems lie in Technology, which can bridge the gap. Although technology has created issues for us but at the same time the way technology is shaping up daily, I feel that GP is again going to be closer to the patient than one thinks. In fact that GP would be right next to you when you need him / her. Although that day is some good 5-7 yrs away from us but it is going to happen. Web portals like www.RxOcean.com are trying to use technology and bring that doctor and patient closer to each other again. So that neither the doctor nor the patient has to travel miles but at the same time they stay connected to each other forever so that human touch and feeling of trust and assurance remains an integral part of medicine and doesn’t get lost. On the other hand, Medical community also realizes that all is not well. The concept of a GP who used to treat all the normal ailments and used to send patients to a specialist when things really required that is also being re-introduced by Medical Fraternity in the form of Family Medicine. As of today only DNB in family Medicine exists but talks are going on to introduce MD in Family Medicine. So that Family Physicians can take care of normal medical issues till the time need of a specialist arises – and even direct the patients to the right specialist and not let him/her do trial and error.

Thus the time is not far away when we the consumer / patient gets best of both the worlds, assurance of our family GP and at same time convenience of getting treated at home. But we would have to pay some price for that and that price is self-discipline without which all the efforts will go in vain.

Second Opinion in India

Seeking second opinion for a medical problem means evaluating the patient for the same medical problem to give another opinion on the diagnosis or the proposed plan of care.

At times it is required in difficult situations wherein the patient is apprehensive of a surgery or a complex medical problem or when the treatment has been going on since long without showing effective results. Even at times a family physician, also known as a family doctor in India, seeks second opinion of a specialist in a complicated condition. Although there is no data to understand how many people are seeking second opinion as at times patient don’t reveal to their family physician about the second opinion he / she has sought which could be cause of various reasons including but not limited fear of losing trust of the family physician. At the same time they seek second opinion when they patients are not satisfied with the services being availed. Moreover some malpractices by doctors are also leading to increased use of second opinion particularly where costs are prohibitive and involve surgery. Even if treatment doesn’t involve surgery, Second opinion is also valuable in case of chronic diseases.

Need for second opinion will also grow when various insurance companies try to seek second opinion of doctors to understand whether the treatment done was actually required or not. There have been concerns raised in the past that doctors have resorted to expensive treatments when the same ailment could have been treated at a much lower cost. This assumes further significance when dealing with the lives of patients particularly in cases of coronary diseases where expensive stents are used.

Unfortunately in a country like India where there is lack of transparency in medicine and medicines and pathological tests (by few physicians) are prescribed keeping in mind self interests (Gifts and commission from Pharma companies and Pathlabs),Second opinion will become more prevalent with every passing day. Companies like RxOcean have taken the first step in that direction. All sorts of specialists (critical care specialists, pediatricians, orthopedicians, family physicians, diabetes specialists) are available under one umbrella called as RxOcean and they are just a click away from the patients.

Online portals like RxOcean let patients seek second opinion from home

n the month of September 2010, Bhagwan Devi Munjal faced a decision between two types of follow-up treatments for her broken shoulder bone: the standard, six to eight week-long normal therapy which lets the bone join on its own, or surgery to join the bone and get cured within 2 weeks. Although cost wasn’t a concern but her age was. Although the orthopedician consulted had assured that the age is not a concern and surgery would be a better option as the person would be able to recover fast in case of surgery but family physician had her own doubts about the case and she wanted to seek second opinion from other specialist orthopedicians to ensure that surgery would be beneficial.

But Bhagwan Devi, 85, decided not to travel to Delhi or any other place from her current native place. Instead her family discovered that by submitting her medical records through a service available on www.RxOcean.com, she could obtain a second opinion from a top specialist without leaving home.

“It would have been very cost-prohibitive and tiresome for me to travel to couple of hospitals in different cities. I accomplished the same thing without that expense,” she says.

Online second-opinion services offer patients consultations from specialists based on the medical records that they fax, mail or send via the Internet. The average cost, payable upfront via credit card or online transfer to the bank accounts of the organization cost anywhere between INR 150 to INR 500, depending on the number and type of specialists one wants to consult. Patients then receive online access to a second opinion in about a day or two again depending upon the case. In cause of an emergency, RxOcean claims to make these services available within couple of hours thus helping the patients when they need the help most.

Since www.RxOcean.com went online in early 2010, about 100 patients have already taken advantage of the service in last six months, says Dr Kirti Soota, co-founder of the web services company. Some of the patients were not satisfied with the treatment that they were undergoing, some just wanted to ensure that treatment is ok, some people who approached us didnt understand what their doctor wanted to tell them as a result they wanted to have a word with another doctor and a few wanted to discuss issues over the phone related to their sex problems and marital problems for which they didnt want to see a doctor face to face. Many a times these problems just need counseling patients and some OTC drugs are advised. In case we feel the case is serious or diagnosis is wrong then either request the patients to get some more tests done or consult another doctor face 2 face. As was the case with Mrs Bhagwan Devi wherein 2 orthopedists on our panel independently suggested that surgery shouldnt be done coz at this age bones become very fragile.

But such cases are rare may be to the tune of around 5-10%. What we are able to do is give patients more treatment options and hopefully give the patient more peace of mind. Today, Mrs Bhagwan Devi is doing well, and her family speaks highly of their experience with a remote second opinion: “We were lucky to have landed in right hands at the right time but most of the people are not even aware of the services like Second Opinion over the web. We would like more and more people to be aware of this option.”. Dr Soota ends the discussion by saying that we want to popularize this service only by word of mouth as we cant afford to spend a lot on our marketing and advertising and end up increasing our rates which would defeat the whole purpose of formation or RxOcean to reach the masses and be able to provide quality health care services at a very nominal price.

Neck & Shoulder Pain – IT / ITES Workers

My neck has been troubling me for almost a month now. It makes a crackling sound when I rotate it and always gets stiff. At times it gets so lifeless that I feel I am carrying dead weight of my head on my Neck. Along with that my shoulders get swelled and at times eyes and head also pain making me feel what the hell is going on. I somehow knew at the back of my mind that my profession is the problem. Being in IT Industry has its own merits and de-merits.

Merits which generally people from other industry find and also crib about include work schedule flexibility and working from home. We hardly realise that these merits actually become demerits in a very short span of time. You would be wondering how that could be possible. Simple reason being we get glued to our laptops / computers for longer duration in comparison to normal office hours. The usual breaks that one takes in office be it tea break or some chit chat with colleagues also go for a toss at home making us “may be” a bit more productive but at the cost of our health.

I think this is what has been taking its toll on my health – my neck, my eyes and my shoulders have been paining like anything since last month. Anyway, my orthopedician doctor confirmed the same today – he said jokingly it is IT Industry syndrome and if you want to get rid of this issue forever you should leave your job. Not sure if it would be restricted to IT industry in future as all the work in service industry even our books, newspaper, etc are moving to e-paper. Anyway, according to my doctor this continuous working infront of computers leaves one with stressed muscles and hence the swelling and other issues that I have been suffering from.

What I was suggested some simple exercises which need to be done religiously to help improve strength of neck muscles. Also I was advised to take rest breaks and close eyes after every hr and put the head on the backrest of the chair for couple of minutes along with improving the ergnonomics. Ideally Eyes should be at the level of your computer screen so that one doesn’t have to look down or bend his/her neck to work, which rarely happens as when working on desktops only our chairs are adjustable and not our desks. So if you are lucky enough to have normal height then your body would be positioned ergonomically else not. Anyway there are a number of tips for IT workers to sit properly and do some normal things to improve their posture so that they dont face all these issues and it is not that this blog is the first time you are reading about those but certainly we fail to implement those in our normal life and remember those only when we fall sick.

I will keep writing about various issues or health hazards that IT professionals suffer from so that we IT community at large can benefit from it.

Medical Records and Importance of Data / preserving prescriptions

Who is responsible for Data? Are we responsible for maintaining our personal medical records or the hospital or nearby Doctor that we visit us?

More often than not the prescriptions that are given to us by doctors end up in the waste bin after couple days or weeks or years as we think that we have been fully cured and we don’t really require those prescriptions. Do we ever realize how important those prescriptions are even after we get cured. We can do a lot of analysis and unearth answers to some of the questions like

• How many times in a year did I fall ill
• Whether the treatment went as per the plan
• Whether my body reacted badly to certain drugs
• Whether my body responded faster to certain kinds of drugs and slower to certain
• Is there some pattern in illness – monthly, weekly, quarterly
• Is the whole family falling ill in a pattern – be it season change or one particular month.

Apart from the normal questions like above – We should also be able to analyse as to whether some of hereditary diseases that our parents used to suffer from have been passed on to us and whether our children are likely to suffer from those in future. All the above can be answered if prescriptions that we dump in our dustbin are stored properly. Infact every member of the family should maintain his/ her file of records.
Answers to some of the queries can not only help us take preventive action in case we see similar circumstances and patterns emerging but also help us raise the standards of our healthcare sector. Imagine if the same data is collated at the community level a number of problems can be forecasted (outbreak of diseases in certain areas and how it is spreading) and action can be taken in time.

Is it possible to keep all the records in safe custody and do all analysis? Yes, but it would be easier if online medium is used to store personal records. In fact web portals like www.RxOcean.com offer these solutions for free. Users can store their medical records, consult online dietitians and doctors. One can also seek second opinion from various super specialists available on the portal. Also Doctors and Dietitians together analyze your family’s health records and can help you and your family follow healthy and nutritious diet plans. Although benefits are tremendous but what is required is some sort of discipline in filing our records properly as they are too important for us and for the community at large.