Thursday, May 31, 2012

We unethical Indian doctors

For a second let us agree for the sake of argument that  the Indian doctors are a bunch of unethical,money sucking,blood sucking monsters.As per the study Conducted by revered Mr Aamir Khan none of us deserve to be on the list of MCI including Dr Devi Shetty and Dr Puneet Bedi and all who were present in that episode oF Satyamev Jayate.Then 'tera kya hoga kaliya'?Common man for whom Satyavadi harishcandra Aamir Khan jee maharaj is fighting for.......can you afford to go to UK to get your treatment done.Where the health system is so over burdened that there is a huge waiting list for every disease.Aamir khan can go to get his fillers and botox done to UK,USA or where ever he wants to go He can afford it as one thumka of his is worth a crore.He can purchase a womb for his wife.Can the aam adami do that?
My Point is you don't have any option but to deal with us Indian doctors.No system is full proof not even UK system( I know the loop holes of that system as well and can tell it publicly if needed.........How doctors behave in an unethical manner there........when doctors take sick leave when they are not actually sick.....very benign example......have many more to speak about).Indian Medical system is just a reflection of our society which has both good and bad professionals every where.

Don't get scared........Don't feel insecure..............Don't look at your doctor with suspicion...........they are not alike.It is for your own good as it isn't a very pleasant situation to be in when you have handed over your own health to someone whom you can't trust.It isn't as bad as Aamir Khan made it sound.He has to sell his serial..............but a patient doctor relationship is very delicate relationship and if only he had tried to project the correct PICTURE to the public it would have been better for the public, as you realize at the end of the day you have to trust the Indian doctor.If all of us are sacked from where will Indian healthcare import doctors?We are no UK,USA or Australia where doctors from third world countries will come to work with such bad salaries .HAVE FAITH!!

Monday, May 28, 2012

Forgot to bring my purse

Just an incident.......I leave the interpretation on you.Last Monday since morning I got frequent calls from one Mr Tiwari.He wished to see me at my clinic and not at Max Hospital.There are many such patients who prefer the clinic to the hospital.Usually my appointments for Monday and Friday the two evenings when I am at my clinic at Arjung Marg is full by two days in advance.As he showed real urgency I agreed for a 7.00 PM appointment for his 39 weeks + Pregnant wife.He called me at 7.00 Pm to confirm if I was at my clinic.He told me he would be slightly late .I asked him to come on time as I don't have a AC in the waiting area and I don't wish the patients who come on time to keep on waiting in heat because someone else was not on time.He told me.....he can't promise that he would be on time.Then he reached at 8.15 PM.then he told me that his wife was about to deliver with EDC on 25 th may.He was visiting Elchemist Hospital.Gynaecologist there had suggested a caesarean for a cord around the neck of the  baby.As many a ladies working at his office had delivered under me he was there to get a second opinion as he realized that' I was the best gynaecologist around'(His words).Then he told me that he would like to get the delivery done at Artemis hospital but the opinion will be mineAs I was a busy doctor I obviously won't have time to conduct normal delivery of his wife.Crrraapp.......Finally he said after 30 mnts of consultation,so  I have to pay you the fees as well.I don't have the purse.What do I do?I said there is an ATM near by and he said I haven't brought the purse.It sounded cheap to create scene ,so I said ok come tomorrow anytime and make the payment at my home.Some one would be there.
Till date he hasn't turned up with that RS 600 and still Doctors are called money minded :-)).I feel conned and cheated.So how will I treat the next patient?Naturally will ask for the fees first and then proceed with the consultation.Sad part is majority of the patients are not like him.They don't con and thus coz of an occasional  patient not so fair experience don't wish to loose faith in patients,but that is the other side of the story.A doctors perspective!!
When Heard Aamir Khan on Satymaev compelled to write this post.And When you put an allegation on a doctor that the doctor wasn't qualified enough,why don't you check in the first place.It is quite easy to do.Just ask the persons qualification preoperatively,check online the significance of those degrees...........If you can do these researches when things go wrong why not use caution preoperatively? Saw just a part of it........someone did a renal transplant and Pancreatic transplant together.Well there has to be a reason for pancreatic transplant.These two surgeries are not like a delivery or hysterectomy......they are major major surgeries.Really naive on the patients part if they are educated and still don't do their homework properly.And 8 Lakhs for such kind of surgery and the hospital expenses and the blood involved is actually very cheap..........I saw the jaws of the audience drop down on hearing an expense of 8 Lakhs..........When you listen an Aaamir Khan or a Salman khan or a Sharukh khan getting crores for shaking their legs( A frivolous activity in my opinion),even then is your expression the same?????Do you ever realize how much a doctor has slogged to reach where that person is.Do you realize that they were the toppers of their batches who spent years studying and then getting trained to deal with such a critical thing as human life.Have you ever thought why those doctors who behave in slightly 'unethical' manner do so?Do you know how much medical care costs in USA or European Countries?Do you know what are the consultation charges of private practitioners there?
I would certainly not wish my son to be a doctor......A talent should not go waste...........He should be in a industry where he doesn't have to spend more than 10 to 12 years  to study,survive on meagre stipends ,be in such a high strung profession and still all the time run the risk of being called money minded,greedy,unethical.Not fair at all!! We do run the risk of having substandard doctors in future.......if that is how our society behaves........because of Litigations Australia has shortage of local doctors.In UK local doctors prefer to become a GP and leave their main stream as a specialist.

Thursday, May 24, 2012

Recurrent Pregnancy Loss clinic

Miscarriages and Pregnancy losses are painful. Recurrent pregnancy loss means shattered hopes and desperation. At Max Hospital ,Gurgaon  I shall be starting a delegated clinics on all Wednesdays between 4 to 6 PM  for couples who have suffered recurrent Pregnancy losses. With an evidence based approach, sophisticated Lab and a compassionate attitude I hope to fulfil your dreams of a healthy pregnancy.
Who should visit us?
If you have suffered two or more miscarriages
If you had a miscarriage at more than 12 weeks
If there has been a stillbirth i.e death of the baby inside the uterus.
Following a clinic review and appropriate investigation the management of each couple is individualised depending on the cause of their pregnancy losses. The chances  of a successful pregnancy with these measures is ~70%. 

Wednesday, May 23, 2012

When can you tell the sex of the baby?

There are various reasons why one wants to know the sex of an unborn baby.Commonest reason in India has been selection of foetal sex by mid trimester abortion.Doctors,Govt,Media and Aamir Khan are doing their bit.And I hope they succeed in their mission.
Now their are other reasons as well......plain simple curiosity.Majority of my Patients who wish to know if I could comment on the sex of the baby after looking at the scan or who ask when will I tell them the sex of the baby are the curious kinds.Who have read an American book or seen an American Video,which talks of shopping based on the gender of the baby.I don't blame them.But when ever such a question is asked it irritates me to no end.All these people are aware of the existing law,then why do you try to take a chance.........Initially I used to tell them it isn't legally correct to even talk of it.Then When I came out with the Pregnancy Folder for these women,I specified and addressed these questions separately......with the implication of being behind the bar(Both Doctor and Patients).Now when then tell me that .....yes we have read what you have written still we want to know......It Irritates me!!.I try to continue behave my normal self but if I get rude any time on being asked these questions.......I won't blame myself.Not all doctors are involved in female foetocide but still I know  few who were wrongly penalized while having a benign conversation just like the ones I have mentioned above and were stripped of their registration for no fault of theirs.Just they tried to be the polished well behaved doctors to get involved in this kind of talk.They didn't realize that the patients were a part of a STING OPERATION.
My Hand Folded Sincere request : I do understand your urge to know whether to shop blue or pink,but at the same time you irritate me when you ask me this question.I don't know the sex of your baby.Ultrasonologist knows.And if I knew I will never ever comment on it.Till the baby is born Purchase a yellow or a green or any neutral shade of your choice.Once baby is is not even 2 hours job to go to a mall and complete the shopping.
There are people who are so desperate to know the sex of the baby to shop that they visit a foreign country,get a scan done and then proceed for the shopping of desired colour.If you are so desperate.......please do that it isn't illegal.But never ask me this question again.
Hope I won't need to loose my cool over 'the sex of the child'!!

Tuesday, May 15, 2012

Fat to Fab !!

It is not an uncommon scenario where Ladies ask me for a miracle pill to loose weight.Actually there is no such wonder drug yet.There are quick fix surgeries for morbidly obese people......called bariatric surgery.Once upon a time it used to be a very specialized surgery done by just very selected number of Gastrointistinal surgeons.Slowly it is becoming more common done by increasing number of surgeons that it would become common as Laparoscopic removal of gall bladder.Doctors or patients can have a totally different opinion about it..........but in my opinion it is a surgery which one is better off without it provided you can.If you have been so very fond of food to have gained tons of fat.......sorry then this is the only option but it changes your life,both for good and also for bad.
second option is cosmetic surgery.....VASER,Liposuction etc.that works well only for those who are not fat but have abnormal fat deposition in some particular area.Surgeries should best be avoided and the same goes for these cosmetic surgeries.But still if that makes you happy you can opt for a cosmetic procedure as it won't be a life changing experience.
Finally comes the most healthy option and the most difficult one as well.Healthy eating and exercise.I was motivated to write this post as in front of me is a small child who by his sheer dint of determination is turning from fat to fab.He motivates me and I thought of sharing his story with you all........who don't accept that they eat unhealthy,even if they accept they find a way to justify that unhealthy eating and are resilient to come out of bad life style.
My son.......11 years old a academically brilliant child and with so many positives to him had a major issue till few weeks back.He loved junk food and he didn't like to play outdoor sports.Now not being blessed with very active metabolism he started putting weight.He was bullied.....occasionally by his friends ,which left him teary and at times by people at home as well who could not find any other reason to pull him down.His eating would attract even sarcasm at home by people who themselves weren't as healthy.About 6 weeks back I decided to do something about it.We went to a nearby outlet of Ms Shikha Sharma.There was this dietician Ms Medha.........who started guiding my son with his diet.In between Mr Dogra whom I had met on the soccer grounds of my son's school had motivated me to get him enrolled in BIFA.A Brazilian academy for soccer.Mr Dogra's sons also go to the same academy.The diet and exercise regime started together.This kid showed immense determination and in 6 weeks has already knocked off 6 kgs.Most importantly he has developed a habit of eating healthy.When eating out now he asks for a subway salad while his peer groups or even elders go for a Pizza or a burger.He has to loose another 4 kgs......and he stands a Fab young man.I am sure if he can ,you all who wish to loose your fat can also do so.
Last but not the least my special thanks to Mamta,my housekeeper(who incidentally is on leave these days) who cooked all sorts of healthy diet chillas and upmas etc as advised by Ms Medha .
Picture courtsey

Monday, May 14, 2012

Vicky Donor

Feeling very lethargic and sleepy and not yet ready for my OPD which starts in another 30 minutes.Reason being 'Vicky Donor'.Please don't get me wrong......It was just a late night show of the movie that I watched yesterday followed by a early morning delivery which I had to attend.Everyone is talking of this movie as a good a movie even I would agree that it was an entertaining one.But as a woman I am not sure whether I would be so cool with the idea of my partner donating the sperm.My husband found it quite ok........just like blood donation,but then as a female I would not be very comfortable with the whole idea.May be it is just my perception and I agree that I lack that feeling of social serviceMaybe other ladies feel differently.May be you folks are ok to share your partners semen for a social cause.Do share the ideas.Will help me in realizing that I am abnormal after all.......... :-)
And most importantly Ladies who have 'tubal blockage',please don't get upset after watching this movie.You can surely conceive if your partner is as fertile or even less fertile than 'Vicky donor'.It can happen very easily with IVF.Consult a good IVF expert.
After 3 idiots........Vaccum delivery is much easy to explain to my patients and they accept it also very easily.That just proves the power of cinema.Didn't wish the ladies with 'Tubal Blockage' to feel doomed after watching the movie.
Good one though for some fun!!   

Tuesday, May 8, 2012

Urinary Tract Infection in Pregnancy

Urinary tract infection in pregnancy is a commonly encountered condition in pregnancy which needs urgent attention.It is more common in pregnancy due to dilatation of the upper renal ( kidney) tract.About 4 to 7 % of Pregnant women develop asymptomatic bacteuria ( presence of bacteria and pus cells in urine without any obvious symptoms) and of these 40% will develop symptomatic UTI in pregnancy.Cystitis (Infection of bladder ) is present in 1 % of pregnant ladies while acute swelling and infection of kidney (pyelonephritis) complicates 1-2 % of pregnancies.
If you a have any of these following conditions you are more prone to UTI in Pregnancy
Previous History of UTI,diabetes,Treatment with steroids or immunosuppresives,urinary stones and other renal diseases .
as a part of routine ANC check up,Urine ( R and M) is tested to rule out any infection.Those with increased risk of UTI should have more frequent Urine tests.Typical Presenting features of infection are pain in lower abdomen and loin,increased frequency of urination,painful urination,burning while passing urine,blood in the urine,fever,chills,vomiting etc.
UTI whether symptomatic or asymptomatic can lead to preterm labour pains and possibly a growth restricted baby as well,if not promptly treated.
A positive urine ( R and M) should be followed up with a urine ( Culture and sensitivity).A mid stream urine sample should be taken to avoid contamination with bacteria present on skin.
A positive bacteuria needs treatment.For asymptomatic infection the antibiotics are prescribed for 3 days,while acute bladder infection needs the medication for 7 days.
Those having more severe infection ( pyelonephritis) can need antibiotics uptp 14 days along with intravenous fluid to prevent Preterm labour.Kidney function and Ultrasound of Kidney,ureter and bladder is also advised. 15 % of women can have recurrent infection.
General lifestyle changes are to drink 2.5 to 3 lts of water everyday,to clean from front to back ( ie from where to pee towards from where you poo) and one should try to pas ueinr after each act of intercourse.
( Picture courtesy

Saturday, May 5, 2012

Basic communication skills

If I come across a patient in my OPD how will I address that Person?Not by first name.......Ms/Mrs/Dr so and so.If later on a patient comes very frequently to me and becomes friendly ,may be then I am comfortable calling 'them by their first name but still using ' aap' rather than saying 'tum' because I wish to show my warmth but still as a professional I would like to maintain a slight distance,which should be between any doctor and patient.That is basic etiquette.Even in UK it is not acceptable to call your seniors by name unless they themselves ask you to call them by their first name.For me it has always been Mr Plemming,Mr Bickerton,Dr Bolton,Dr Clark ,Mr Banfield and so on.I am sure none of them would have appreciated me calling them by their first name.
I don't know the basic etiquette in USA as never have been there.
What made me write this post?Well,I think in Gurgaon the professionals try to ape the talking style of USA and UK.Start the conversation at first meeting with Dr Kaushiki or mam and by second meeting I find them calling me Kaushiki.....which I find strange and disrespectful,particularly if I haven't asked you to call me by my first name..I find it equally disrespectful when they talk about other Doctors by mentioning their first name like Girish,Anjali,Suman etc etc......If I am being formal to you I don't expect informality from you.
Yesterday I got a call.....Is that Kaushiki? I replied Dr Kaushiki here.Then she said Is that  kaushiki Dwivedee?
I replied back yes Dr Dwivedee here........She continued ok Kaushiki I am sheetal from HDFC .I asked her Do I know you?She said you had visited our branch................I had lost my cool by then........I told her politely and firmly...................I don't like being called kaushiki by strangers and of course as you must have guessed it correctly I never payed attention to what she had to say.    

Little words of appreciation,which matter a lot

Dear Dr. Kaushiki,

Thank you very much for solving my problem. Life has become so much better, with all the inconvenience and the cause of constant embarrassment disappearing totally. I really wish you had done this for me earlier, fully endorsing your prediction of the feeling of 'a change of life'.

I am honestly surprised why people like me keep suffering when there is an easy remedy for it in medical science, and in the deft hands of the saviors like you. I wish somehow more of the sufferers would become aware of it. I will try to do my bit through the face book.

Once again thanks a lot. Do let me know if and when I should come over for a checkup.

Warm Regards
A Gupta

Fibroids and its Management

Fibroids are the commonest tumours of uterus. They are mostly non cancerous in nature .Leiomyosarcoma,  a highly malignant cancer can develop in approximately 0.26 % of the Fibroids.
Fibroids are most common in Africans.It is also common in women who have never been pregnant before.Fibroid is an estrogen ( Female Hormone) dependent tumor.
Symptoms of Fibroids
Painful heavy periods with heaviness in lower abdomen and pressure symptoms.
Types of fibroids
Uterine Fibroids are classified by their location  which effects the symptoms they may cause and how they can be treated.  Fibroids that are inside the cavity of the uterus ( Submucous myomas) will often cause bleeding between periods and often cause severe cramping
Intramural myomas are in the wall of the uterus, and can range in size from microscopic to larger than a grapefruit.  Many intramural fibroids do not cause problems unless they become quite large.  There are a number of alternatives for treating these, but often they do not need any treatment at all.
Subserous myomas are on the outside wall of the uterus, and may even be connected to the uterus by a stalk (pedunculated fibroid.) These do not need treatment unless they grow large, but those on a stalk can twist and cause pain.  This type of fibroid is the easiest to remove by laparoscopy.
Diagnosing Fibroids
They can be diagnosed using Ultrasound, MRI or hysteroscope.
Treatment of Fibroid.
If asymptomatic and less than 12 weeks in size fibroids can be managed conservatively. Medical Management hasn’t been successful in preventing the growth of the fibroids.
If the woman is desirous of having child she should have myomectomy or removal of fibroids which can be removed Laparoscopically.
Total laparoscopic hysterectomy (Removal of uterus using laparoscope) can be performed if the family is complete. It is a myth that only small fibroids can be removed laparoscopically.At Max Hospital Gurgaon I have performed TLH on fibroids upto 28 weeks size weighing 1.8 kgs.
Other methods are Uterine embolization and HIFU are new additions in the treatment modalities of fibroids but not yet as widely used.

Wednesday, May 2, 2012

Bleeding heavily and wish to avoid Hysterectomy??

Hysterectomy or removal of uterus is quite a common procedure for heavy bleeding.If you are one such person who has heavy bleeding ,has completed her family and wish to avoid hysterectomy you do have a few effective less destructive operation.THERMAL BALLOON ABLATION (CAVATERM) is one of them,It is not a new procedure but still little alien for Indian patients.The reason being the cost of the device.The balloon is inserted inside the uterus and under strict control of pressure,temp and time,water is heated inside the balloon which is put in the uterine cavity.This heated up water burns the inner lining of the womb.It is has been found to be quite effective with 40 to 60 % have no periods in future and 90 % are happy with the result.
The balloon is disposable and costs 25k.It doesn't need too much of skill on the part of your surgeon and is quite safe method of controlling heavy periods without performing removal of uterus.
You can't conceive following balloon ablation but at the same time it would be a good idea to use some contraception like a condom.

Tuesday, May 1, 2012

Adenomyosis: How to treat it effectively?

Last week as I was getting ready to leave for the hospital,I heard Mamta talking in quite a hurried tone to some lady.Later she told me that this was a Lady in pain who had come without an appointment.I have given your mobile number and have directed her to the Max Emergency( She is getting smarter by the day.....Max Healthcare should felicitate her).Anyways that Lady called me later and told her painful story of a very painful dysmenorrhoea (painful periods).
I called her two days later.she was a primipara,planning her second child but was waiting for this pain to settle before she planned any further.Her Scan done in dec 2011 was a Normal scan.
After an internal checkup later I was little confused.....It was either an acutely anteflexed uterus or a fibroid.If it was anteflexion than I was in no position to explain her dysmenorrhoea and if fibroid.....well the irregularity didn't feel like a fibroid.Another scan later.....Adenomyosis was the diagnosis in this 29 yrs old Lady.
When the endometrial cells (cells of the inner lining of the womb) invade the muscular layer of uterus it leads to the adenomyosis.It caused heavy and painful periods.If has been associated with fibroids and endometrial hyperplasia as well.An USG finding can be confirmed by a MRI.
It can happen due to weak muscles of the uterus,increased intrauterine pressure or due to some unknown reason.
Medical treatment is bleak.OCpills don't give as good relief as in endometriosis.Mirena ( IUS) has been found to be effective up to certain extent.Zoladex and Danazol have been used as second line treatment but have not been very effective methods.
There have been reports where hysteroscopically or laparoscopically surgeons have tried removing the tissue having 'adenomyosis'I have in fact seen Dr Eric Butrant at Aix an Provance performing such surgeries and these surgeries are quite simple but again there is not enough evidence to talk about it's benefits.
Lastly Hysterectomy always comes like a yamraj and takes away the femninty of a female to provide that final cure and yes it is applicable for adenomyosis too.