Thursday, February 28, 2013

some Information for Users of Mediclaim of Government Insurance companies

Almost 12 to 13 years back Mediclaim in India meant companies like national Insurance,New India Insurance,Oriental insurance etc.
Many of us who had the fore site to get mediclaim done then started with these companies.Over the period of time there has been many changes in their policies.May be I am wrong but I feel them now less user friendly.They were having the maximum number of insurers ,so they almost arm twisted the corporate hospitals to make unreasonable packages.
The deal was in lieu of authorizing their insurance in any particular hospital the hospital had to agree the rates they wanted to be charged.That didn't decrease the premium of the insurer but the payout to the hospital was dropped drastically.So that the hospitals don't loose the business they agreed but it pinches and it pinches to everyone including doctors and hospitals as well.
The ultimate sufferer will be the insured person.Let me give an example.....3 years back from a single room deliver a doctor used to be paid 16000 - 30%
Then suddenly the hospitals  tied up with GIPSA package with these hospitals.So the payout of doctors fell down to 10300 -30 %
Now suddenly from Jan 2013 these government insurance companies thought that there was no inflation for the doctors and now the payout is 8800 -30% which is peanuts.

Now what happens is that after working hard for 24 hours for a delivery you don't expect to take home 5000 RS.Would have done better if I had a good hair cutting saloon.and there were no emergency hours involved as well.

And unfortunately in Gurgaon there are so many VIPS...VPs and CEOs and all of various companies.They expect a VVVIP treatment at hospital but don't realise that hospital can give them that ultra luxury only at a price which has been decreased so much by their companies that they no longer remain the VVVIP they perceive themselves to be.

In very near future I might be saying a no to patients who want me to be present personally at odd hours of night or day at the time of their delivery if their insurance company plans to pay us the GIPSA package or it will be my juniors who will conduct the deliveries or I will be compelled to charge the extra sum from the patient directly.

So the ultimate looser is the insurer.BTW I have changed my insurance from a nationalized company to a Private company ....surely at higher premium but then if I need a medical help it won't be so conditional. 

Wednesday, February 27, 2013

The Reason why I blog post

Today I am elated about my blog.A patients mother complimented me for this blog.She said she enjoyed it and of course that made my day.Then while sitting in my OPD I was net surfing myself in google ......and found a guy called Dilip had posted a comment in one of the popular Gurgaon blog.That gentleman had a very weird suspicion.......was it me who was writing my blogs despite being a busy doctor.He wants someone to give a testimony that it is me who writes it for myself.It irritated me 10% but 90% I was all smiles.Just like when you are a teenager and if boy passes a remark you tend to get irritated but at the same time you smile mouth in cheek if the comment has been a complimentary one.
Now the reasons why I write are
  • To express emotions,achievements,frustrations.It helps me in venting out.In 2009 when I started writing this blog,this was the only idea.
  • As I realised people like my posts I tried to put in real life scenarios about health conditions to make them aware of what I wished to convey without making it a boring article.
  • It also helped me in reaching out to a bigger client base ( though that wasn't the original idea).People who read it and who could relate with me chose to be my patients.So it became a inadvertent marketing tool.
  • In Gurgaon we have a net savvy population where people leave online comments about doc
    tors as per their perception,which is correct sometime and not so correct other times.So if I have a online site where I can tell my side of story if need be  it helps.

Sunday, February 24, 2013

Bilateral X Flap repair for Faecal incontinence

Recently came across a lady in her mid 50s who have four normal deliveries.After her last delivery she realized that she has lost control over her stool particularly when it was little loose.It was commendable on part of this female that at least she had taken the bold step to ask for help.Before visiting us she had visited few other quite big hospital,big names,famous surgeons,famous gynaecologists........a diagnosis of recto vaginal fistula was established.When we examined her it was found that due to traumatic child birth the recto vaginal septum has thinned out,anal sphincter fibers were missing in front and there was no perineal body.She didn't have a Recto vaginal Fistula.

A plan was made to correct her problem.It meant dissecting the vaginal septum from the rectum,identify the two ends of anal sphincter,repairing the old torn anal sphincter,strengthening the rectal mucosa as well as vaginal wall and finally to make skin flap to act as her perineal body.
The surgery involved myself and colorectal surgeon Dr Shalabh Mohan.Either of us could have done it individually but a team effort always gives a better result as you can see from the pictures which follow.Can't finish the post without saying thanks to Dr Deepa Maheshwari for a nice assistance.


It is also important that the Obstetricians are well trained in repairing 3rd and 4th degree perineal tear.If not confident oneself ,one should never shy away in asking any help from some one better trained as it can compromise very badly the quality of life of the lady concerned.

Saturday, February 9, 2013

One of the reason to avoid unindicated Caesarean section - Placenta Accreta

Caesarean is a beautiful surgery and has saved many a maternal as well as foetal lives since the time of probably Julius Caesar.

But like any other operative procedure it has it's downsides as well.Repeated caesarean section has been associated with increased chances of Placenta Praevia (placenta attached in lower segment of the uterus) and Placenta accreta, increta and percreta ( Where placenta encroaches and grows very deep inside the muscle and at times out of the muscle) of the uterus.Both of them are dangerous and potentially life threatening condition.

While placenta praevia can lead to painless bleeding which can need early caesarean to deliver a preterm baby,blood transfusions and if not properly managed conditions like DIC etc.
Placenta Accreta doesn't lead to bleeding usually as the placenta is embed ed deep in the uterus but the problem is when the lady is delivered the placenta won't get separated from the uterus.An attempt to take it out in pieces can lead to a disaster with unimaginable bleeding.The options for treatment are:
If the family is complete - caesareran Hysterectomy
If Family is incomplete -Leave a part of placenta inside,use methotrexate injections.It can lead to vaginal discharge ,infection and quite a mess.In fact it is not a very satisfactory method of treatment but might be option for a lady who hasn't completed her family.

Last month I operated on a Lady in whom the able radiologist Dr Girish Pandit has suspected a placenta accreta quite early in the pregnancy.Her MRI at Max Gurgaon confirmed it.As in her case as her pregnancy was planned decision making was much easy.So immediately after delivering the baby I went ahead for a quick removal of uterus.The whole process was very smooth and the lady recovered as quickly as after a normal caesarean and didn't need a blood transfusion either.Histopathological examination confirmed it to be a percreta.Interestingly this lady had two uterus and two cervix.

.But the condition can be quite uncontollable incase of an undiagnosed Placenta accreta.When I was a registrar in Indraprastha Apollo Hospital,One of the soc lites and wife of a politician got admitted for Caesarean section.Her Ultrasound suggested Placenta praevia but there was no mention of placenta accreta.Two stalwarts of Indian OBGY operated on her.Dr Soonawala flew from Mumbai to operate on her and the primary consultant was very senior Dr Urmil Sharma.On table it was diagnosed as having the condition.A trial was made to take the placenta piecemeal and then there was torrential bleed.The whole OT floor got flooded.It was credit to Dr Makru the Blood bank head who insured a constant supply of blood and blood product.May be more than 90 units of blood/blood product was consumed.Ultimately Vascular surgeon Dr S K Chaku was called for help.With a joint effort of such a experienced team that Lady survived.She was in the ICU for many days.Today when I see her pictures in any page 3 event it makes me feel really thankful to the GOD.

Thus ,not a bad idea to restrict the caesareans to only indicated reasons..........